ABSTRACT
Directly observed therapy (DOT) of antiretroviral (ARV) medications has beneficial effects on HIV treatment for incarcerated inmates but has been associated with limited continuation after release and inadvertent disclosure of HIV status. Guided self-administered therapy (g-SAT) may be a preferred method of ARV delivery and may encourage medication-taking behavior. We surveyed the preference of 102 HIV-positive jailed inmates at the San Francisco City and County Jails regarding receiving ARVs via DOT versus g-SAT while incarcerated. Participants overwhelmingly preferred g-SAT over DOT.
Subject(s)
Anti-HIV Agents/therapeutic use , Directly Observed Therapy/psychology , HIV Infections/drug therapy , Prisoners/psychology , Self Administration/psychology , Adult , Confidentiality/standards , Cross-Sectional Studies , Directly Observed Therapy/statistics & numerical data , Female , Humans , Male , Medication Adherence/psychology , Medication Adherence/statistics & numerical data , Patient Preference/psychology , Patient Preference/statistics & numerical data , Prisoners/statistics & numerical data , Randomized Controlled Trials as Topic , San Francisco , Self Administration/statistics & numerical data , Social Stigma , Viral LoadABSTRACT
Continuity of health care among the formerly incarcerated is an emerging public health challenge. We used data from the San Francisco County Jail to determine whether discharge planning improves access to care on release. Inmates who were HIV positive and received discharge planning were 6 times more likely to have a regular source of care in the community compared with inmates with other chronic medical conditions, and they were as likely to have a regular source of care compared with the general San Francisco population.
Subject(s)
Aftercare/organization & administration , Continuity of Patient Care/organization & administration , HIV Infections/therapy , Health Services Accessibility/organization & administration , Patient Discharge , Prisoners/statistics & numerical data , Analysis of Variance , Chronic Disease/therapy , Cross-Sectional Studies , Female , HIV Infections/epidemiology , Health Care Surveys , Health Services Needs and Demand , Humans , Male , Medically Uninsured/statistics & numerical data , Middle Aged , Morbidity , Patient Discharge/standards , Patient Discharge/statistics & numerical data , Public Health , San Francisco/epidemiology , Socioeconomic Factors , Surveys and Questionnaires , Total Quality Management/organization & administrationABSTRACT
Incarcerated HIV-infected persons in San Francisco have benefited from intensive case management in jail and postrelease, which includes but is not focused on interventions to prevent transmission. In this population of predominately injection drug users (IDUs), we had the opportunity to examine interview data from 1999 and 2005 that included health characteristics and risk factors. Those in 2005 were less likely to be satisfied with social support and less likely to be partnered; more likely to have some form of health insurance. On average, health was perceived in both periods to be better the longer the person had been in jail. Injection drug use was reported lower in 2005, but a subset of nearly a quarter in each survey time period reported sharing needles. Persons in 2005 were less likely to report they always used condoms as compared to those in 1999 (odds ratio 0.26, 95% confidence interval 0.12-0.59, p = 0.001). While there were differences in study design and methodology, this comparison demonstrated overall similarities in characteristics of HIV-infected inmates. Findings echo those of others, in other populations of HIV-infected persons. Reasons could include HIV prevention fatigue or decay in effectiveness of prevention messages. Despite an established program for case management and links to services, renewed efforts are needed to maintain effectiveness of prevention strategies to this high-risk population.
