by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer
February 23, 2021
Woznica DM et al. Interventions to improve HIV Care Continuum outcomes among individuals released from prison or jail: systematic literature review. J Acquir Immune Defic Syndr. 2021 March 1; 86(3): 271-285. doi: 10.1097/QAI.0000000000002523. PMID: 33079904.
Incarceration disproportionately affects people with HIV, and outcomes such as ART adherence and virologic suppression have been shown to be worse among people returning from correctional settings. Previous scoping and systematic reviews have examined concepts and findings from studies/interventions developed to improve post-release care outcomes; this analysis aimed to update previous reviews and also to categorize and evaluate existing strategies and effects. Investigators searched peer-reviewed and scholarly databases for published and “grey” literature reports: among 1867 citations screened, 123 full-text reports were assessed for eligibility, with a final 27 reports/publications undergoing complete data abstraction for analyses. An intervention classification scheme grouped into social ecological ‘levels’ was developed: individual, biomedical, interpersonal, organizational, and multi-level. Overall, most interventions were developed for the individual level, and findings on the effectiveness of various interventions were mixed. A few studies found statistically significant effect sizes: three utilizing individual-level interventions involved a combination of patient navigation and/or case management with discharge planning, skill development, motivational enhancement, and peer support (these studies demonstrated higher viral load suppression rates among participants receiving the intervention). At the biomedical level, two studies demonstrating significant effect sizes – specifically, improvements in viral load suppression – used direct delivery of extended-release medication for substance use disorder treatment (e.g., injectable naltrexone for alcohol use disorder). Of note, individual case management generally failed to show benefit: authors assert that “continuing to implement individual-level interventions without attention to [social, political, and economic] contextual factors … will likely yield continuing limited success. Further studies of biomedical, interpersonal, organizational, and multi-level intervention strategies should be prioritized.”
Recent research and program funding focused on incarceration and people with HIV have helped support a more critical examination of the effects of incarceration on HIV care outcomes (pre- and post-release), as well as health-promoting interventions for persons returning from prison, jail, or other detention settings. Nevertheless, large and potentially-avoidable gaps still exist throughout the HIV Care Continuum. With active discussions occurring across multiple dimensions (e.g., decarceration, integrated programming to improve care transitions, novel biomedical interventions and approaches to HIV and substance use), the intersection of incarceration and HIV should be recognized as a priority area for the collective HIV community as we advance current and future “Ending the HIV Epidemic” collaborations and activities.
The author has no conflicts of interest to disclose.
View archived Clinical Research Update entries here.