Phillips Victoria L, Pluznik Jacob A, Epting Mallory E, O'Donovan Eleni M, Akiyama Matthew J, Spaulding Anne C
Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
AIDS Behav. 2025 Mar 13. doi: 10.1007/s10461-025-04674-2.
Approximately 1.5% of incarcerated people live with HIV. Limited information on their pre-incarceration healthcare use which could inform discharge planning efforts to link them to treatment is available. We investigate factors associated with pre-incarceration healthcare use and access barriers for a status-neutral HIV cohort. We collected data via self-report from men with HIV (n = 22) or at-risk of contracting HIV (n = 77) who entered the Washington, DC, Department of Corrections jail from November 2020 to June 2021. We analyzed pre-incarceration hospital, emergency department (ED), physician and mental health visits, and access barriers using t-tests, chi-square tests, and logistic regressions informed by the Anderson Behavioral Model of healthcare utilization. During the year prior to incarceration, more than half of men visited the ED, while less than 20% visited a physician. Over half the sample viewed medical care as too expensive, even though 75% were insured. Depressed men were significantly more likely to report access barriers. Homelessness was the only factor found to be significantly associated with a greater likelihood of urgent and acute care use. Neither HIV status, insurance status, educational level nor race affected healthcare use by type of service. Pre-incarceration men with or at-risk of contracting HIV have limited contact with community physicians who are critical to HIV management. Given the effect of unstable housing on the types of healthcare used, programs to promote HIV treatment and pre-exposure prophylaxis (PrEP) should consider embedding condition-specific discharge planning into an approach addressing a wider array of needs.
约1.5%的在押人员感染了艾滋病毒。关于他们入狱前医疗保健使用情况的信息有限，而这些信息本可用于指导出院计划工作，以便将他们与治疗联系起来。我们调查了与入狱前医疗保健使用相关的因素以及一个不考虑艾滋病毒感染状况队列的就医障碍。我们通过自我报告收集了2020年11月至2021年6月进入华盛顿特区惩教部监狱的艾滋病毒感染者（n = 22）或有感染艾滋病毒风险者（n = 77）的数据。我们使用t检验、卡方检验以及基于医疗保健利用的安德森行为模型的逻辑回归分析了入狱前的医院就诊、急诊科就诊、医生就诊和心理健康就诊情况以及就医障碍。在入狱前一年，超过一半的男性去过急诊科，而看过医生的不到20%。超过一半的样本认为医疗费用过高，尽管75%的人有保险。抑郁的男性报告就医障碍的可能性显著更高。无家可归是唯一被发现与更有可能使用紧急和急性护理显著相关的因素。艾滋病毒感染状况、保险状况、教育水平和种族均未影响按服务类型划分的医疗保健使用情况。入狱前感染艾滋病毒或有感染艾滋病毒风险的男性与对艾滋病毒管理至关重要的社区医生接触有限。鉴于不稳定住房对所使用医疗保健类型的影响，促进艾滋病毒治疗和暴露前预防（PrEP）的项目应考虑将针对特定情况的出院计划纳入一种满足更广泛需求的方法中。
