Mabuto Tonderai, Woznica Daniel M, Lekubu Gloria, Seatlholo Nieser, Mshweshwe-Pakela Nolundi, Charalambous Salome, Hoffmann Christopher J
Aurum Institute, Johannesburg, South Africa.
The University of the Witwatersrand School of Public Health, Johannesburg, South Africa.
BMC Public Health. 2020 Mar 12;20(1):324. doi: 10.1186/s12889-020-8417-2.
We sought to describe linkage to care, ART continuity, and factors associated with linkage to care among people with HIV following release from incarceration in South Africa.
We conducted a study of South African correctional service community reentrants who were receiving ART at the time of release. The study was implemented in three of 46 correctional service management areas. Participants were enrolled prior to corrections release and followed up to 90 days post-release to obtain self-reported linkage to care status and number of days of ART provided at corrections release. Clinic electronic and paper charts were sought and abstracted to verify self-reported linkage to care. Log-binomial regression, adjusted for facility, was used to identify associations with post-release linkage to care (self-reported and verified). We sought to specifically assess for associations with HIV diagnosis during index incarceration, ART initiation during index incarceration, and duration of incarceration.
From May 2014 to December 2016, 554 inmates met eligibility and 516 (93%) consented to participate; 391 were released on ART, 40 of whom were excluded from analysis post-release. Of the remaining 351, 301 (86%) were men and the median age was 35 years (interquartile range 30, 40). Linkage to care was self-reported by 227 (64%) and linkage to care could be verified for 121 (34%). At most, 47% of participants had no lapse in ART supply. Initiating ART during the index incarceration showed a trend toward increased self-reported post-release linkage to care. Age > 35 years was associated with increased verified linkage to care while HIV diagnosis outside of a correctional setting and ART initiation during the index incarceration showed trends toward association with increased verified linkage to care.
The results of our study are the first description of retention in care following correctional facility release from an African setting and indicate high levels of attrition during the transition from correctional facility to community care. Initiating ART within a correctional facility did not impair post-release linkage to care.
我们试图描述南非囚犯出狱后与医疗服务的联系、抗逆转录病毒治疗（ART）的连续性，以及与获得医疗服务联系相关的因素。
我们对出狱时正在接受抗逆转录病毒治疗的南非惩教服务社区重新进入者进行了一项研究。该研究在46个惩教服务管理区域中的3个区域实施。参与者在出狱前登记，并在出狱后随访90天，以获取自我报告的与医疗服务的联系状况以及出狱时提供的抗逆转录病毒治疗天数。查找并提取诊所电子和纸质病历，以核实自我报告的与医疗服务的联系。使用经设施调整的对数二项回归来确定与出狱后与医疗服务联系（自我报告和核实）的关联。我们试图特别评估与索引监禁期间的艾滋病毒诊断、索引监禁期间的抗逆转录病毒治疗启动以及监禁持续时间的关联。
2014年5月至2016年12月，554名囚犯符合资格，516名（93%）同意参与；391人在接受抗逆转录病毒治疗时获释，其中40人在出狱后被排除在分析之外。在其余351人中，301人（86%）为男性，中位年龄为35岁（四分位间距30，40）。227人（64%）自我报告与医疗服务有联系，121人（34%）的与医疗服务的联系可以得到核实。最多47%的参与者抗逆转录病毒治疗供应没有中断。在索引监禁期间开始抗逆转录病毒治疗显示出自我报告的出狱后与医疗服务联系增加的趋势。年龄>35岁与核实的与医疗服务联系增加有关，而在惩教机构外的艾滋病毒诊断和索引监禁期间的抗逆转录病毒治疗启动显示出与核实的与医疗服务联系增加有关的趋势。
我们研究的结果是对非洲背景下惩教机构释放后医疗服务留存情况的首次描述，表明从惩教机构向社区护理过渡期间流失率很高。在惩教机构内开始抗逆转录病毒治疗不会损害出狱后与医疗服务的联系。
