HIV among persons incarcerated in the USA: a review of evolving concepts in testing, treatment, and linkage to community care.
HIV among persons incarcerated in the USA: a review of evolving concepts in testing, treatment, and linkage to community care.
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DOI：
10.1097/qco.0b013e32835c1dd0
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发表时间：
2013-02
影响因子：
3.9
通讯作者：
Flanigan TP
中科院分区：
文献类型：
--
作者：
Westergaard RP;Spaulding AC;Flanigan TP
被监禁者感染艾滋病毒的风险高得不成比例。他们还往往具有与抗逆转录病毒治疗利用不足相关的风险因素，如药物滥用、精神疾病和难以获得护理。在这篇综述中，我们描述了监禁如何成为艾滋病毒护理不理想的脆弱性标志，以及刑事司法环境如何作为促进高风险边缘化人群艾滋病毒护理检测、联系和保留的平台。在监狱和拘留所，常规的、可选择退出的艾滋病毒检测策略比传统的、基于风险的策略更适合于对矫正人群进行筛查。在繁忙的城市监狱环境中，快速艾滋病毒检测是可行和可接受的。虽然在许多监狱环境中成功实施了抗逆转录病毒治疗，但释放到社区与无法获得药物治疗和其他结构性因素密切相关，导致病毒抑制丧失。艾滋病毒临床医生、刑事司法人员和公共卫生从业人员之间的合作是扭转艾滋病毒流行趋势的一项重要战略。成功将取决于加大努力，寻找未确诊感染的个体，并使那些失去护理的人接受长期治疗。
People who are incarcerated have a disproportionately high risk of HIV infection. They also tend to have risk factors associated with under-utilization of antiretroviral therapy such as substance abuse, mental illness, and poor access to care. In this review, we describe how incarceration is a marker of vulnerability for suboptimal HIV care, but also how criminal justice settings may be leveraged as a platform for promoting testing, linkage and retention in HIV care for a high-risk, marginalized population. In both prisons and jails, routine, opt-out HIV testing strategies are more appropriate for screening correctional populations than traditional, risk-based strategies. Rapid HIV testing is feasible and acceptable in busy, urban jail settings. While antiretroviral therapy is successfully administered in many prison settings, release to the community is strongly associated with inconsistent access to medications and other structural factors leading to loss of viral suppression. Collaborations among HIV clinicians, criminal justice personnel and public health practitioners represent an important strategy for turning the tide on the HIV epidemic. Success will depend upon scaled-up efforts to seek individuals with undiagnosed infection and bring those who are out-of-care into long-term treatment.