HIV / STI
Understanding Care Gaps in the HIV Care Continuum Post-Incarceration for People with HIV and Criminal Legal Involvement in San Francisco, CA: Insights from Multistate Modeling Paul Wesson* Paul Wesson Wesson Wesson Wesson Wesson Wesson Wesson Wesson Department of Epidemiology and Biostatistics; University of California, San Francisco
Introduction
One in seven people living with HIV (PWH) pass through a carceral setting each year. PWH with criminal legal involvement (CLI) often achieve viral suppression (VS) while incarcerated due to a consistent antiretroviral treatment (ART) regimen, but VS and ART adherence usually lapse upon community re-entry. We modeled the HIV care continuum (linkage to care, retention in care, VS) for PWH-CLI in San Francisco, to understand where, and for whom, gaps occur.
Methods
We constructed a retrospective cohort of PWH-CLI receiving HIV care at jail entry in San Francisco from 1/1/18 to 12/31/22. PWH-CLI were matched to records from an integrated data repository of electronic health records, social services utilization, and mortality from county agencies receiving public health funding. We linked cohort data with HIV viral load data from the Department of Public Health’s HIV Surveillance. We used multistate modeling to model transition probabilities for the HIV care continuum, accounting for re-incarceration, disengagement from HIV care, disengagement from all care, and death as competing events. Multivariate Cox Proportional hazards models examined demographic correlates with state transitions.
Results
Our analytic cohort included 725 PWH-CLI (mean age 42; IQR: 36, 53). Compared to White PWH-CLI, Asian PWH-CLI were less likely to be retained in HIV care (aHR 0.51; 95% CI: 0.27, 0.96). Both Asian (aHR 2.01; 95% CI: 1.25, 3.23) and Hispanic PWH-CLI (aHR 1.35; 95% CI: 1.00, 1,83) were more likely to disengage from all health care services compared to White PWH-CLI. Roughly half of the cohort disengaged from either HIV care or all care services within two years of release from their index incarceration (Figure).
Conclusion
Maintenance of HIV VS and disengagement from care services are persistent challenges for PWH-CLI. As one intervention target, re-engagement strategies should study why PWH-CLI are accessing other care services while disengaging from HIV care services.
