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Jacques Baillargeon, PhD; Thomas P. Giordano, MD, MPH; Josiah D. Rich, MD, MPH; Z. Helen Wu, PhD; Katherine Wells, MPH; Brad H. Pollock, PhD, MPH; David P. Paar, MD

JAMA. 2009;301(8):848-857.

Context  Interruption of antiretroviral therapy (ART) during the first weeks after release from prison may increase risk for adverse clinical outcomes, transmission of human immunodeficiency virus (HIV), and drug-resistant HIV reservoirs in the community. The extent to which HIV-infected inmates experience ART interruption following release from prison is unknown.

Objectives  To determine the proportion of inmates who filled an ART prescription within 60 days after release from prison and to examine predictors of this outcome.

Design, Setting, and Participants  Retrospective cohort study of all 2115 HIV-infected inmates released from the Texas Department of Criminal Justice prison system between January 2004 and December 2007 and who were receiving ART before release.

Main Outcome Measure  Proportion of inmates who filled an ART prescription within 10, 30, and 60 days of release from prison.

Results  Among the entire study cohort (N = 2115), an initial prescription for ART was filled by 115 (5.4%) inmates within 10 days of release (95% confidence interval [CI], 4.5%-6.5%), by 375 (17.7%) within 30 days (95% CI, 16.2%-19.4%), and by 634 (30.0%) within 60 days (95% CI, 28.1%-32.0%). In a multivariate analysis of predictors (including sex, age, race/ethnicity, viral load, duration of ART, year of discharge, duration of incarceration, parole, and AIDS Drug Assistance Program application assistance), Hispanic and African American inmates were less likely to fill a prescription within 10 days (adjusted estimated risk ratio [RR], 0.4 [95% CI, 0.2-0.8] and 0.4 [95% CI, 0.3-0.7], respectively) and 30 days (adjusted estimated RR, 0.7 [95% CI, 0.5-0.9] and 0.7 [95% CI, 0.5-0.9]). Inmates with an undetectable viral load were more likely to fill a prescription within 10 days (adjusted estimated RR, 1.8 [95% CI, 1.2-2.7]), 30 days (1.5 [95% CI, 1.2-1.8]), and 60 days (1.3 [95% CI, 1.1-1.5]). Inmates released on parole were more likely to fill a prescription within 30 days (adjusted estimated RR, 1.3 [95% CI, 1.1-1.6]) and 60 days (1.5 [95% CI, 1.4-1.7]). Inmates who received assistance completing a Texas AIDS Drug Assistance Program application were more likely to fill a prescription within 10 days (adjusted estimated RR, 3.1 [95% CI, 2.0-4.9]), 30 days (1.8 [95% CI, 1.4-2.2]), and 60 days (1.3 [95% CI, 1.1-1.4]).

Conclusion  Only a small percentage of Texas prison inmates receiving ART while incarcerated filled an initial ART prescription within 60 days of their release.

Author Affiliations: Department of Preventive Medicine and Community Health (Dr Baillargeon), Correctional Managed Care Division (Drs Baillargeon and Paar), Department of Obstetrics and Gynecology (Dr Wu), and Department of Internal Medicine (Dr Paar), University of Texas Medical Branch, Galveston; Department of Medicine, Baylor College of Medicine, and the Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center, Houston, Texas (Dr Giordano); Department of Medicine, Brown Medical School, Providence, Rhode Island (Dr Rich); Texas HIV Medication Program, Department of State Health Services, Austin (Ms Wells); and Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio (Dr Pollock).

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