Incarceration and health outcomes in HIV‐infected patients: The impact of substance use, primary care engagement, and antiretroviral adherence. (6th February 2015)

• Record Type: Journal Article
• Authors: Wang, Emily A.; McGinnis, Kathleen A.; Long, Jessica B.; Akgün, Kathleen M.; Edelman, E. Jennifer; Rimland, David; Wang, Karen H.; Justice, Amy C.; Fiellin, David A.
• Is Part Of: American journal on addictions. Volume 24:Number 2(2015)
• Page Start: 178
• Page End: 184
• Publication Date: 2015-02-06
• Subjects: Substance abuse -- Periodicals; Substance abuse -- Treatment -- Periodicals; 616.86005
• DOI: 10.1111/ajad.12177
• Languages: English
• ISSNs: 1055-0496

Abstract

<abstract abstract-type="main" xml:lang="en"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ajad12177-sec-0001" sec-type="section"> <title>Background and Objectives</title> <p>One in seven HIV‐infected individuals is incarcerated each year. We used data from the Veterans Aging Cohort Study (VACS) to explore the relationship between incarceration and HIV disease outcomes and evaluate potential mediators of this relationship.</p> </sec> <sec id="ajad12177-sec-0002" sec-type="section"> <title>Methods</title> <p>HIV disease outcomes included: low CD4 counts (<200 cells/mL), detectable viral RNA loads (>500 copies/mL), and the VACS Index score. We performed a mediation analysis among 1, 591 HIV‐infected patients to examine whether unhealthy alcohol use, drug use, primary care engagement, or antiretroviral adherence mediated observed associations.</p> </sec> <sec id="ajad12177-sec-0003" sec-type="section"> <title>Results</title> <p>Among 1, 591 HIV‐infected patients, 47% reported having a history of incarceration. In multivariate analyses, a history of incarceration was associated with a higher VACS Index score (β 2.47, 95% CI 0.52–4.43). Mediation analysis revealed that recent drug use attenuated the association by 22% (β 1.93, 95% CI −0.06, 3.91) while other proposed mediators did not.</p> </sec> <sec id="ajad12177-sec-0004" sec-type="section"> <title>Conclusions and Scientific Significance</title> <p>Improving access to drug treatment when incarcerated and upon release may be an important target to improving the health of HIV‐infected individuals with a history of incarceration. (Am J Addict 2015;24:178–184)</p> </sec> </abstract>