Linkage to HIV care following release from prison in Rhode Island

Approximately 17% of people living with HIV (PLWH) pass through the US correctional system every year, yet there is limited research on disruptions to care during incarceration among PLWH. The objective of this study was to characterize linkage to first HIV care service following release from prison between 2010 and 2011 in Rhode Island, a state with dedicated efforts to improve health and social services following incarceration. Methods We examined first incarceration among 55 PLWH with at least one clinical visit following release as part of the Linkage to Care Study (LINCS). Kaplan-Meier estimates and log rank tests were used to compare average times to linkage across demographic, HIV risk and clinical characteristics. Adjusted time-to-event analysis was conducted using Cox regression. Results The sample was85% male, mean age of 46 years, 52% African American/Black, and 85% in care prior to incarceration. Median time to linkage was 28.5 days with 80% linking within 90 days. 64% had CD4<200 and 33% had detectable HIV-RNA (>50 copies/ml) at their first visit post-release. Compared to CD4>200, those with CD4<200 linked to care sooner, although this relationship was not statistically significant (Hazard Ratio: 2.1 95% CI 0.8, 5.7). Conclusion Despite timely linkage to care among those with lower CD4s, a substantial proportion of individuals have detectable HIV-RNA or CD4<200 at their first visit post-release. These findings suggest additional efforts are needed to promote continuity in care for PLWH who are incarcerated. Further analyses will examine linkage to HIV care through 2012 and across additional states.