Former prisoners infected with HIV lapsing on critical prescriptions
By Ruth SoRelle, M.P.H.
A new report points to serious health implications for recently released prisoners with HIV who are not filling prescriptions for anti-retroviral drugs. This trend could also have a negative impact on public health in general, according to researchers from Baylor College of Medicine and The University of Texas Medical Branch in Galveston.
Only 30 percent of released Texas prisoners infected with HIV (the virus that causes AIDS) filled prescriptions for highly active anti-retroviral drugs within 60 days of their release, said a consortium of researchers from BCM and UTMB that appeared recently in the Journal of the American Medical Association.
"This has both public health and individual health implications," said Thomas P. Giordano, M.D., M.P.H., assistant professor of medicine – infectious diseases at BCM and medical director of HIV services at the Thomas Street Health Center, where people with HIV receive care through the Harris County Hospital District.
Health risks
Interruptions in treatment can lead to the development of resistant strains of the virus as well as allowing the levels of virus in the blood to increase, putting the ex-prisoners at risk of acquiring a variety of infections and increasing the risk of transmission of the virus to others.
The study is one of the first to track patients from prison release to care on the outside, said Giordano, who was a collaborator with the UTMB physicians in that school's department of preventive medicine and community health and the correctional managed care division.
By linking data from prison to that in the health care system outside, "we were able to figure out what's going on at a statewide level," said Giordano. "The results are pretty dramatically poor."
Troublesome findings
Of the 2,115 people in the study, they found that only 115, or 5.4 percent, filled their AIDS drug prescription within 10 days of release; only 375, or 15.5 percent, within 30 days; and only 634, or 30 percent, within 60 days. Since the prisoners were given a 10-day supply of medications on release, nearly all the prisoners had an interruption in their HIV therapy.
After adjusting the figures for a variety of demographic and disease factors, they found that Hispanic and African American prisoners were less likely to fill prescriptions within 10, 30 or 60 days. However, paroled inmates were more likely to fill prescriptions within 30 and 60 days and those who were helped in filling out their Texas AIDS Drug Assistance applications were more likely to fill their prescriptions.
"These remarkably high rates of lengthy HIV treatment interruptions are troublesome from a public health perspective," said Jacques Baillargeon, Ph.D., UTMB epidemiologist and an associate professor. "Several studies suggest that many released inmates who discontinue anti-retroviral therapy also resume high-risk behaviors such as injection drug use or unsafe sex, and this combination may result not only in poor clinical outcomes for these individuals but also in the creation of drug-resistant HIV reservoirs in the general community."
Assistance needed
"The patients who received more assistance before release did better," said Giordano. "But everyone was supposed to get some assistance or told where to go to get it. The programs are out there. It's just linking them to patients."
"We are looking at ways to develop an intervention to help them access care," he said.
Others who took part in this study include Josiah D. Rich of Brown University in Rhode Island, Z. Helen Wu and David P. Paar of UTMB, Katherine Wells of the Texas HIV Medication Program with the Texas Department of Health Services in Austin and Brad H. Pollock of UT Health Science Center in San Antonio.
Funding for this work came from the National Institute on Drug Abuse.
View the full report.
