Senior Epidemiologist Orange County Government, Florida, United States
Background: Linkage to care is a critical step of the HIV care continuum. While the prevalence of incarcerated people with HIV (PWH) is nearly five times that of the general population, this population may experience significant barriers to linkage to care notably upon release. Facilitation of continuity of care from jail to the community through an integrated linkage to care program may provide unique opportunities for improving health outcomes for PWH released from jail.
Methods: A retrospective analysis of HIV-positive adults in Orange County’s Jail Linkage Program who were released between March 2022 and December 2023 was conducted. To assess outcome measures of the program, demographic and clinical data were extracted from Orange County’s HIV care management system and linked with administrative custody data from the Orange County Jail. Linkage to care is defined as having a recorded viral load test, CD4 test, or documented kept medical appointment after release.
Results: Of 254 individuals released from jail, the median age was 39 years (range 20-69 years). Most were male (77.2%), Black/African American (63.4%), and identified as heterosexual (52.8%). Approximately 45.3% of individuals were linked to care, 16.9% of whom were linked within 30 days, 25.2% within 60 days, and 31.5% within 90 days post-release. The median time from the individual’s release to their first case management appointment was 14 days, while the median time from release to their first kept medical appointment was 42 days. Among those linked to care, 45.2% were documented to be virally suppressed (median=29 copies/mL).
Conclusion: The findings from this analysis are limited yet promising. Nevertheless, significant barriers to successful linkage to care persist among PWH released from jail. Continued implementation of the current jail-based linkage to care program is warranted and may offer new opportunities for improved health outcomes.
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