The vast majority of HIV-infected Texas prison inmates who receive antiretroviral therapy while incarcerated experience significant interruptions in HIV treatment after their release into the community. This disturbing finding is the result of a 4-year study of more than 2,000 inmates with HIV infection released from Texas Department of Criminal Justice prisons between January 2004 and December 2007.
The study was led by University of Texas Medical Branch at Galveston epidemiologist and associate professor Jacques Baillargeon.
Using databases maintained by the Texas Department of State Health Services and TDCJ, Baillargeon and his co-investigators found that only 18 percent of inmates filled a prescription for antiretroviral medications within 30 days after release. Moreover, only 30 percent did so within 60 days. "These remarkably high rates of lengthy HIV treatment interruptions are troublesome from a public health perspective," said Baillargeon. "Several studies suggest that many released inmates who discontinue antiretroviral therapy also resume high-risk behaviors such as injection drug use or unsafe sex, and this combination may result not only in poor clinical outcomes for these individuals but also in the creation of drug-resistant HIV reservoirs in the general community."
"The U.S. prison system has become an important front in the effort to treat and control the spread of human immunodeficiency virus (HIV) infection, serving as the principal screening and treatment venue for thousands of individuals with or at high risk for HIV infection who have limited access to community-based health care. Many inmates are offered HIV testing for the first time while incarcerated, and three-quarters of inmates with HIV infection initiate treatment during incarceration," the authors write.
Because the majority of former inmates are without private or public health insurance for the first several months after release, accessing antiretroviral therapy (ART) in a timely manner represents a challenge. "Those who discontinue ART at this time are at increased risk of developing a higher viral burden, resulting in greater infectiousness and higher levels of drug resistance, potentially creating reservoirs of drug-resistant HIV in the general community," they add. The extent to which HIV-infected inmates experience ART interruption following release from prison is unknown.
Dr. David Paar, a co-author and director of the clinical virology division of UTMB Correctional Managed Care, said that this high rate of treatment interruption appears related in large part to multiple barriers faced by newly released inmates in accessing community-based health care. "A solution to this problem will require carefully coordinated efforts between the criminal justice system, public health agencies, and community healthcare systems," Paar noted.
- Jacques Baillargeon; Thomas P. Giordano; Josiah D. Rich; Z. Helen Wu; Katherine Wells; Brad H. Pollock; David P. Paar. Accessing Antiretroviral Therapy Following Release From Prison. JAMA, 2009;301(8):848-857 [link]
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