Wohl David A, Golin Carol E, Knight Kevin, Gould Michele, Carda-Auten Jessica, Groves Jennifer S, Napravnik Sonia, Cole Stephen R, White Becky L, Fogel Cathie, Rosen David L, Mugavaro Michael J, Pence Brian W, Flynn Patrick M
*The Institute for Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC; †The Institute of Behavioral Research, Texas Christian University, Fort Worth, TX; and ‡Division of Infectious Diseases, The University of Alabama School of Medicine, Birmingham, AL.
J Acquir Immune Defic Syndr. 2017 May 1;75(1):81-90. doi: 10.1097/QAI.0000000000001337.
HIV-infected individuals transitioning from incarceration to the community are at risk for loss of viral suppression. We compared the effects of imPACT, a multidimensional intervention to promote care engagement after release, to standard care on sustaining viral suppression after community re-entry.
This trial randomized 405 HIV-infected inmates being released from prisons in Texas and North Carolina with HIV-1 RNA levels <400 copies/mL to imPACT versus standard care. The imPACT arm received motivational interviewing prerelease and postrelease, referral to care within 5 days of release, and a cellphone for medication text reminders. The standard care arm received routine discharge planning and a cellphone for study staff contact. The primary outcome was the difference between arms in week 24 postrelease viral suppression (HIV-1 RNA <50 copies/mL) using intention-to-treat analysis with multiple imputation of missing data.
The proportion with 24-week HIV-1 RNA <50 copies/mL was 60% and 61% in the imPACT and standard care arms, respectively [odds ratio for suppression 0.95 (95% confidence interval: 0.59 to 1.53)]. By week 6 postrelease, 86% in the imPACT arm versus 75% in the standard care arm attended at least 1 nonemergency clinic visit (P = 0.02). At week 24, 62% in both arms reported not missing any antiretroviral doses in the past 30 days (P > 0.99).
Higher rates of HIV suppression and medical care engagement than expected based on previous literature were observed among HIV-infected patients with suppressed viremia released from prison. Randomization to a comprehensive intervention to motivate and facilitate HIV care access after prison release did not prevent loss of viral suppression. A better understanding of the factors influencing prison releasees' linkage to community care, medication adherence, and maintenance of viral suppression is needed to inform policy and other strategic approaches to HIV prevention and treatment.
从监禁环境过渡到社区的艾滋病毒感染者面临病毒抑制丧失的风险。我们比较了imPACT（一种促进释放后护理参与的多维干预措施）与标准护理对社区重新进入后维持病毒抑制的效果。
本试验将405名从德克萨斯州和北卡罗来纳州监狱释放的HIV-1 RNA水平<400拷贝/mL的艾滋病毒感染囚犯随机分为imPACT组和标准护理组。imPACT组在释放前和释放后接受动机性访谈，在释放后5天内转诊至护理机构，并提供一部手机用于药物短信提醒。标准护理组接受常规出院计划和一部手机用于研究人员联系。主要结局是使用意向性分析和对缺失数据进行多重插补，比较两组在释放后第24周病毒抑制（HIV-1 RNA<50拷贝/mL）的差异。
imPACT组和标准护理组中24周HIV-1 RNA<50拷贝/mL的比例分别为60%和61%[抑制的优势比为0.95（95%置信区间：0.59至1.53）]。到释放后第6周，imPACT组中86%的人至少进行了1次非紧急门诊就诊，而标准护理组中这一比例为75%（P=0.02）。在第24周，两组中62%的人报告在过去30天内没有漏服任何抗逆转录病毒药物剂量（P>0.99）。
在从监狱释放的病毒血症得到抑制的艾滋病毒感染患者中，观察到的艾滋病毒抑制率和医疗护理参与率高于基于先前文献预期的水平。随机分配接受全面干预以促进监狱释放后艾滋病毒护理的获取并不能防止病毒抑制的丧失。需要更好地了解影响监狱释放人员与社区护理联系、药物依从性和维持病毒抑制的因素，以为艾滋病毒预防和治疗的政策及其他战略方法提供信息。
