Accessing Antiretroviral Therapy Following Release From Prison
Accessing Antiretroviral Therapy Following Release From Prison
复制标题
DOI：
10.1001/jama.2009.202
复制
发表时间：
2009-02-25
影响因子：
120.7
通讯作者：
Paar, David P.
中科院分区：
文献类型：
--
作者：
Baillargeon, Jacques;Giordano, Thomas P.;Paar, David P.
从监狱释放的人可能会增加不良临床结果、人类免疫缺陷病毒（HIV）传播和社区耐药HIV宿主的风险。HIV感染的囚犯在从监狱释放后经历ART中断的程度尚不清楚.Objectives为了确定在从监狱释放后60天内填写ART处方的囚犯的比例，并检查这一结果的预测因素.设计，设置，回顾性队列研究的所有2115艾滋病毒-2004年1月至2007年12月期间从德克萨斯州刑事司法部监狱系统释放的感染囚犯，以及在释放前接受抗逆转录病毒治疗的囚犯。结果在整个研究队列中，（N= 2115），115人填写了ART的初始处方（5.4%）获释后10天内的囚犯（95%置信区间[ CI]，4.5%- 6.5%），375（17.7%）在30天内（95% CI，16.2%- 19.4%），634（30.0%）在60天内（95% CI，28.1%- 32.0%）。在预测因子的多变量分析中，（包括性别、年龄、种族/民族、病毒载量、ART持续时间、出院年份、监禁持续时间、假释和艾滋病药物援助计划申请援助），西班牙裔和非洲裔美国囚犯在10天内填写处方的可能性较小。（校正的估计风险比[ RR]，分别为0.4 [ 95% CI，0.2- 0.8]和0.4 [ 95% CI，0.3- 0.7]）和30天（调整后的估计RR，0.7 [ 95% CI，0.5- 0.9]和0.7 [ 95% CI，0.5- 0.9]）。病毒载量检测不到的囚犯更有可能在10天（调整后的估计RR，1.8 [ 95% CI，1.2- 2.7]），30天（1.5 [ 95% CI，1.2- 1.8]）和60天（1.3 [ 95% CI，1.1- 1.5]）内填写处方。假释犯更有可能在30天内（调整后的估计RR，1.3 [95%CI，1.1- 1.6]）和60天内（1.5 [95%CI，1.4- 1.7]）完成处方。接受援助完成德克萨斯州艾滋病药物援助计划申请的囚犯更有可能在10天内完成处方（调整后的RR估计值，3.1 [ 95% CI，2.0- 4.9]），30天（1.8 [95%CI，1.4- 2.2]）和60天（1.3 [95%CI，1.1- 1.4]）。结论只有一小部分德克萨斯州监狱囚犯在监禁期间接受ART，并在释放后60天内填写了最初的ART处方。
from prison may increase risk for adverse clinical outcomes, transmission of human immunodeficiency virus ( HIV), and drug- resistant HIV reservoirs in the community. The extent to which HIV- infected inmates experience ART interruption following release from prison is unknown.Objectives To determine the proportion of inmates who filled an ART prescription within 60 days after release from prison and to examine predictors of this outcome.Design, Setting, and Participants Retrospective cohort study of all 2115 HIV-infected inmates released from the Texas Department of Criminal Justice prison system between January 2004 and December 2007 and who were receiving ART before release.Main Outcome Measure Proportion of inmates who filled an ART prescription within 10, 30, and 60 days of release from prison.Results Among the entire study cohort ( N= 2115), an initial prescription for ART was filled by 115 ( 5.4%) inmates within 10 days of release ( 95% confidence interval [ CI], 4.5%- 6.5%), by 375 ( 17.7%) within 30 days ( 95% CI, 16.2%- 19.4%), and by 634 ( 30.0%) within 60 days ( 95% CI, 28.1%- 32.0%). In a multivariate analysis of predictors ( including sex, age, race/ ethnicity, viral load, duration of ART, year of discharge, duration of incarceration, parole, and AIDS Drug Assistance Program application assistance), Hispanic and African American inmates were less likely to fill a prescription within 10 days ( adjusted estimated risk ratio [ RR], 0.4 [ 95% CI, 0.2- 0.8] and 0.4 [ 95% CI, 0.3- 0.7], respectively) and 30 days ( adjusted estimated RR, 0.7 [ 95% CI, 0.5- 0.9] and 0.7 [ 95% CI, 0.5- 0.9]). Inmates with an undetectable viral load were more likely to fill a prescription within 10 days ( adjusted estimated RR, 1.8 [ 95% CI, 1.2- 2.7]), 30 days ( 1.5 [ 95% CI, 1.2- 1.8]), and 60 days ( 1.3 [ 95% CI, 1.1- 1.5]). Inmates released on parole were more likely to fill a prescription within 30 days ( adjusted estimated RR, 1.3 [ 95% CI, 1.1- 1.6]) and 60 days ( 1.5 [ 95% CI, 1.4- 1.7]). Inmates who received assistance completing a Texas AIDS Drug Assistance Program application were more likely to fill a prescription within 10 days ( adjusted estimated RR, 3.1 [ 95% CI, 2.0- 4.9]), 30 days ( 1.8 [ 95% CI, 1.4- 2.2]), and 60 days ( 1.3 [ 95% CI, 1.1- 1.4]).Conclusion Only a small percentage of Texas prison inmates receiving ART while incarcerated filled an initial ART prescription within 60 days of their release.