Table 1.
Characteristics of people living with HIV formerly incarcerated in an integrated correctional system* (N=1,350) and predictors of time-to-death from any cause after initial release, 2007-2014
| Total n (%) or median (IQR)a |
n (%) who diedb |
Bivariate HR (95% CI) |
p-value | Adjusted HR (95% CI) at t = 0 |
p-value | |
|---|---|---|---|---|---|---|
| Predisposing factors | ||||||
| Age at time of index release | ||||||
| 18-29 | 114 (8.4%) | 5 (4.4%) | referent | referent | ||
| 30-39 | 253 (18.7%) | 25 (9.9%) | 1.95 (0.75-5.10) | 0.17 | 1.98 (0.64-6.15) | 0.24 |
| 40-49 | 617 (45.7%) | 90 (14.6%) | 2.96 (1.21-7.29) | 0.02 | 2.83 (0.95-8.40) | 0.06 |
| ≥50 | 366 (27.1%) | 64 (17.5%) | 4.40 (1.77-10.93) | 0.001 | 3.65 (1.21-11.08) | 0.02 |
| Genderc | ||||||
| Female | 307 (22.7%) | 31 (10.1%) | referent | |||
| Male | 1043 (77.3%) | 153 (14.7%) | 1.59 (1.08-2.34) | 0.02 | ||
| Race/Ethnicity | ||||||
| White | 250 (18.5%) | 41 (16.4%) | referent | referent | ||
| Black | 557 (41.3%) | 60 (10.8%) | 0.62 (0.42-0.92) | 0.02 | 0.52 (0.34-0.80) | 0.003 |
| Hispanic | 495 (36.7%) | 77 (15.6%) | 0.89 (0.61-1.30) | 0.55 | 0.96 (0.65-1.43) | 0.84 |
| Other | 48 (3.6%) | 6 (12.5%) | 0.68 (0.29-1.59) | 0.37 | 0.69 (0.29-1.68) | 0.42 |
| Education level | ||||||
| < High school | 610 (45.2%) | 96 (15.7%) | referent | |||
| ≥ High school | 740 (54.8%) | 88 (11.9%) | 0.76 (0.57-1.02) | 0.06 | ||
| Marital statusd | ||||||
| Not married | 1086 (84.3%) | 151 (13.9%) | referent | |||
| Married | 203 (15.7%) | 32 (15.8%) | 1.12 (0.77-1.64) | 0.55 | ||
| PWID | ||||||
| No | 407 (30.2%) | 31 (7.6%) | referent | referent | ||
| Yes | 943 (69.9%) | 153 (16.2%) | 1.93 (1.31-2.84) | 0.001 | See below | 0.01 |
| PWID × Re-incarceration rate | ||||||
| PWID × 0 re-incarcerations/year | 2.06 (1.23-3.47) | |||||
| PWID × 0-33 re-incarcerations/year | 1.54 (1.00-2.38) | |||||
| PWID × 1 re-incarceration/year | 0.85 (0.48-1.52) | |||||
| PWID × 2 re-incarcerations/year | 0.35 (0.11-1.10) | |||||
| PWID × 3 re-incarcerations/year | 0.14(0.02-0.87) | |||||
| CD4 count at time of diagnosise | ||||||
| ≥ 500 cells/mL | 358 (26.8%) | 21 (5.9%) | referent | referent | ||
| 200-499 cells/mL | 733 (54.8%) | 119 (16.2%) | 2.58 (1.62-4.11) | <0.0001 | 2.54 (1.50-4.31) | 0.005 |
| < 200 cells/mL | 246 (18.4%) | 44 (17.9%) | 3.08 (1.83-5.18) | <0.0001 | 3.44 (1.90-6.20) | <0.0001 |
| Years since HIV diagnosis at time of index release | 11.4 | 12.9 | ||||
| Median (interquartile range) | (5.4-17.1) | (7.4-17.9) | 1.04 (1.02-1.07) | 0.0002 | ||
| HIV diagnosed during last incarceration | ||||||
| No | 1282 (95.0%) | 183 (14.3%) | referent | |||
| Yes | 68 (5.0%) | 1 (1.5%) | 0.12 (0.02-0.88) | 0.04 | ||
| Enabling or disabling factors | ||||||
| Length of index incarceration | ||||||
| ≤ 30 days | 454 (33.6%) | 67 (14.8%) | referent | |||
| 31-364 days | 697 (51.6%) | 102 (14.6%) | 0.94 (0.69-1.29) | 0.72 | ||
| ≥ 365 days | 199 (14.7%) | 15 (7.5%) | 0.58 (0.33-1.02) | 0.06 | ||
| Conditions of index release | ||||||
| Unconditional | 783 (58.0%) | 116 (14.8%) | referent | |||
| Conditional | 351 (26.0%) | 40 (11.4%) | 0.79 (0.55-1.13) | 0.19 | ||
| Bonded | 216 (16 0%) | 28 (13.0%) | 0.92 (0.61-1.38) | 0.67 | ||
| Year of index release | ||||||
| 2007-2008 | 595 (44.1%) | 120 (20.2%) | referent | |||
| 2009-2010 | 388 (28.7%) | 47 (12.1%) | 0.77 (0.54-1.08) | 0.13 | ||
| 2011-2012 | 211 (15.6%) | 15 (7.1%) | 0.79 (0.45-1.38) | 0.41 | ||
| 2013-2014 | 156 (11.6%) | 2 (1.3%) | 0.41 (0.10-1.72) | 0.22 | ||
| Health insurance during follow-up | ||||||
| Consistently uninsured | 365 (27.0%) | 102 (27.9%) | referent | referent | ||
| Consistently insured | 637 (47.2%) | 68 (10.7%) | 0.28 (0.21-0.38) | <0.0001 | 0.09 (0.05-0.17) | <0.0001 |
| Intermittently insured | 348 (25.8%) | 14 (4.0%) | 0.10 (0.06-0.17) | <0.0001 | 001 (0.00-0.04) | <0.0001 |
| Linked to HIV care within 14 days after index releasef | ||||||
| No | 1076 (79.7%) | 144 (13.4%) | referent | |||
| Yes | 274 (20.3%) | 40 (14.6%) | 1.26 (0.89-1.79) | 0.20 | ||
| Transitional case management during index release | ||||||
| No | 1010 (74.8%) | 138 (13.7%) | referent | |||
| Yes | 340 (25.2%) | 46 (13.5%) | 1.14 (0.82-1.59) | 0.45 | ||
| Number of case management (TCM) visits per year of follow-up | ||||||
| 0 | 620 (45.9%) | 108 (17.4%) | referent | referent | ||
| >0-2 | 233 (17.3%) | 20 (8.6%) | 0.39 (0.24-0.62) | <0.0001 | See below | 0.38 |
| 3-4 | 146 (10.8%) | 14 (9.6%) | 0.45 (0.26-0.79) | 0.01 | See below | 0.35 |
| ≥5 | 351 (26.0%) | 42 (12.0%) | 0.68 (0.47-0.97) | 0.03 | See below | <0.0001 |
| Case management (TCM) frequency × Re-incarceration rate | ||||||
| >0-2 TCM visits/year × 0 re-incarcerations/year | 0.77 (0.43-1.37) | |||||
| >0-2 TCM visits/year × 0.33 re-incarcerations/year | 0.64 (0.38-1.07) | |||||
| >0-2 TCM visits/year × 1 re-incarceration/year | 0.43 (0.16-1.16) | |||||
| >0-2 TCM visits/year × 2 re-incarcerations/year | 0.24 (0.03-1.84) | |||||
| >0-2 TCM visits/year × 3 re-incarcerations/year | 0.13 (0.01-3.08) | |||||
| 3-4 TCM visits/year × 0 re-incarcerations/year | 1.60 (0.59-4.31) | |||||
| 3-4 TCM visits/year × 0.33 re-incarcerations/year | 1.23 (0.64-2.36) | |||||
| 3-4 TCM visits/year × 1 re-incarceration/year | 0.73 (0.26-2.07) | |||||
| 3-4 TCM visits/year × 2 re-incarcerations/year | 0.33 (0.03-4.35) | |||||
| 3-4 TCM visits/year × 3 re-incarcerations/year | 0.15 (0.00-10.00) | |||||
| ≥5 TCM visits/year × 0 re-incarcerations/year | 2.83 (1.68-4.78) | |||||
| ≥5 TCM visits/year × 0.33 re-incarcerations/year | 2.01 (1.28-3.15) | |||||
| ≥5 TCM visits/year × 1 re-incarceration/year | 1.00 (0.57-1.75) | |||||
| ≥5 TCM visits/year × 2 re-incarcerations/year | 0.35 (0.12-1.01) | |||||
| ≥5 TCM visits/year × 3 re-incarcerations/year | 0.12 (0.02-0.63) | |||||
| Re-incarceration rate | ||||||
| Median (interquartile range) | 0.19 (0-0.53) | 0.19 (0-0.71) | 1.60 (1.16-2.20) | 0.004 | See below | <0.0001 |
| Re-incarceration rate × PWID × Case management (TCM) frequency | ||||||
| 1-unit increase in re-incarceration rate × non-PWID × 0 TCM visits/year | 21.86 (10.90-43.86) | |||||
| 1-unit increase in re-incarceration rate × non-PWID × >0-2 TCM visits/year | 12.13 (3.63-40.52) | |||||
| 1-unit increase in re-incarceration rate × non-PWID × 3-4 TCM visits/year | 9.97 (1.81-54.83) | |||||
| 1-unit increase in re-incarceration rate × non-PWID x≥5 TCM visits/year | 7.72 (3.63-16.45) | |||||
| 1-unit increase in re-incarceration rate × PWID × 0 TCM visits/year | 8.99 (5.14-15.72) | |||||
| 1-unit increase in re-incarceration rate × PWID × >0-2 TCM visits/year | 4.99 (1.62-15.39) | |||||
| 1-unit increase in re-incarceration rate × PWID × 3-4 TCM visits/year | 4.10 (0.80-20.89) | |||||
| 1-unit increase in re-incarceration rate × PWID × >5 TCM visits/year | 3.17 (1.96-5.14) | |||||
| Re-incarcerated for ≥365 days | ||||||
| No | 1092 (80.9%) | 170(15.6%) | referent | referent | ||
| Yes | 258 (19.1%) | 14(5.4%)) | 0.26 (0.15-0.45) | <0.0001 | 0.41 (0.22-0.76) | 0.004 |
|
Percentage of total follow-up time spent re-incarcerated | ||||||
| 0-1% | 605 (44.8%) | 100(16.5%) | referent | |||
| 2-10% | 225 (16.7%) | 21 (9.3%) | 0.44 (0.27-0.70) | 0.001 | ||
| 11-25% | 196 (14.5%) | 31 (15.8%) | 0.75 (0.50-1.12) | 0.16 | ||
| 26-50% | 219 (16.2%) | 23 (10.5%) | 0.48 (0.30-0.75) | 0.001 | ||
| 51-100% | 105 (7.8%) | 9 (8.6%) | 0.44 (0.22-0.87) | 0-02 | ||
| Length of last incarceration | ||||||
| ≤ 30 days | 347 (25.7%) | 63 (18.2%) | referent | |||
| 31-364 days | 769 (57.0%) | 103 (13.4%) | 0.65 (0.48-0.89) | 0.01 | ||
| > 365 days | 234 (17.3%) | 18 (7.7%) | 0.38 (0.22-0.64) | 0.0003 | ||
| Conditions of release from last incarceration | ||||||
| Unconditional | 770 (57.0%) | 122 (15.8%) | referent | |||
| Conditional | 291 (21.6%) | 36 (12.4%) | 0.78 (0.54-1.14) | 0.20 | ||
| Bonded | 129 (9.6%) | 21 (16.3%) | 1.21 (0.76-1.92) | 0.42 | ||
| Currently re-incarcerated | 160 (11.9%) | 5 (3.1%) | 0.19 (0.08-0.46) | 0.0002 | ||
| Need factors | ||||||
| Prescribed ART during index incarceration | ||||||
| No | 590 (43.7%) | 85 (14.4%) | referent | |||
| Yes | 760 (56.3%) | 99 (13.0%) | 1.15 (0.86-1.53) | 0.37 | ||
| Virally suppressed within 90 days prior to index release | ||||||
| No/viral level not reported | 588 (43.6%) | 89 (15.1%) | referent | |||
| Yes | 442 (32.7%) | 52 (11.8%) | 0.97 (0.69-1.37) | 0.85 | ||
| Viral load not drawn prior to release | 320 (23.7%) | 43 (13.4%) | 1.01 (0.70-1.45) | 0.96 | ||
| Number of medical co-morbidities during index incarceration | ||||||
| 0 | 838 (62.1%) | 111 (13.2%) | referent | referent | ||
| 1 | 294 (21.8%) | 37 (12.6%) | 1.16 (0.80-1.69) | 0.43 | 1.44 (0.96-2.15) | 0.08 |
| ≥2 | 218 (16.2%) | 36 (16.5%) | 1.77 (1.21-2.59) | 0.003 | 1.86 (1.23-2.82) | 0.003 |
| Psychiatric need during index incarceration | ||||||
| Low severity score (1-2), untreated | 650 (48.2%) | 89 (13.7%) | referent | |||
| Low severity score (1-2), treated | 58 (4.3%) | 5 (2.0%) | 0.76 (0.31-1.87) | 0.55 | ||
| High severity score (3-5), untreated | 256 (19.0%) | 38 (65.5%) | 0.98 (0.67-1.43) | 0.90 | ||
| High severity score (3-5), treated | 386 (28.6%) | 52 (13.5%) | 1.10 (0.78-1.55) | 0.60 | ||
| Addiction severity score during index incarcerationg | ||||||
| Low severity/no disorder (score 1-2) | 220 (16.7%) | 16 (7.3%) | referent | |||
| Moderate severity disorder (score 3) | 861 (65.2%) | 123 (14.3%) | 2.21 (1.31-3.72) | 0.003 | ||
| Serious disorder (score 4-5) | 239 (18.1%) | 44 (18.4%) | 3.13 (1.77-5.55) | <0.0001 | ||
|
Treated for an opioid use disorder during index incarceration |
||||||
| No | 1341 (99.3%) | 183 (13.6%) | referent | |||
| Yes | 9 (0.7%) | 1 (11.1%) | 2.47 (0.34-17.7) | 0.37 | ||
| Percentage of all re-incarcerations during which ART was prescribed | ||||||
| Never re-incarcerated | 535 (39.6%) | 89 (16.6%) | referent | referent | ||
| 0-10% | 128 (9.5%) | 25 (19.7%) | 0.87 (0.56-1.36) | 0.54 | 0.34 (0.18-0.65) | 0.001 |
| 11-50% | 97 (7.2%) | 15 (15.3%) | 0.62 (0.36-1.07) | 0.09 | 0.12 (0.06-0.27) | <0.0001 |
| 51-90% | 101 (7.5%) | 9 (8.7%) | 0.33 (0.17-0.66) | 0.002 | 0.04 (0.01-0.11) | <0.0001 |
| 91-100% | 489 (36.2%) | 46 (9.4%) | 0.45 (0.31-0.64) | <0.0001 | 0.08 (0.03-0.21) | <0.0001 |
| Percentage of all re-incarcerations that ended in viral suppression | ||||||
| Never re-incarcerated | 535 (39.6%) | 89 (16.6%) | referent | |||
| 0-24% | 297 (22.0%) | 46 (15.5%) | 0.71 (0.50-1.01) | 0.06 | ||
| 25-49% | 83 (6.2%) | 10 (12.0%) | 0.47 (0.24-0.90) | 0.02 | ||
| 50-74% | 172 (12.7%) | 17 (9.9%) | 0.40 (0.24-0.67) | 0.001 | ||
| 75-100% | 263 (19.5%) | 22 (8.4%) | 0.40 (0.25-0.64) | 0.0001 | ||
| Percentage of all re-incarcerations with a documented change from virologic failure to suppression | ||||||
| Never re-incarcerated | 535 (39.6%) | 89 (16.6%) | referent | |||
| 0-24% | 591 (43.8%) | 76 (12.9%) | 0.60 (0.44-0.81) | 0.001 | ||
| 25-49% | 79 (5.9%) | 7 (8.9%) | 0.33 (0.15-0.70) | 0.004 | ||
| 50-74% | 86 (6.4%) | 7 (8.1%) | 0.32 (0.15-0.69) | 0.004 | ||
| 75-100% | 59 (4.4%) | 5 (8.5%) | 0.38 (0.16-0.94) | 0.04 | ||
| Prescribed ART during last incarceration | ||||||
| No | 357 (26.4%) | 69 (19.3%) | referent | |||
| Yes | 993 (73.6%) | 115 (11.6%) | 0.62 (0.46-0.84) | 0.002 | ||
| Virally suppressed within 90 days prior to release from last incarceration | ||||||
| No/viral level not reported | 411 (30.4%) | 79 (19.2%) | referent | |||
| Yes | 653 (48.4%) | 67 (10.3%) | 0.56 (0.40-0.77) | 0-0004 | ||
| Viral load not drawn prior to release | 286 (21 .2%) | 38 (13.3%) | 0.72 (0.49-1.06) | 0.10 | ||
| Viral suppression status during last incarceration | ||||||
| Never virally suppressed | 398 (29.5%) | 77 (19.3%) | referent | |||
| Failure, then suppression | 260 (19.3%) | 31 (11.9%) | 0.60 (0.39-0.91) | 0.02 | ||
| Suppression, then failure | 38 (2.8%) | 6 (15.8%) | 0.80 (0.35-1.84) | 0.60 | ||
| Consistent suppression | 485 (35.9%) | 40 (8.2%) | 47 (0.32-0.68) | <0.0001 | ||
| Viral load never drawn | 169 (12.5%) | 30 (17.8%) | 1.07 (0.70-1.63) | 0.76 | ||
| Number of medical comorbidities during last incarceration | ||||||
| 0 | 653 (48.4%) | 92 (14.1%) | referent | |||
| 1 | 340 (25.2%) | 39 (11.5%) | 0.85 (0.59-1.24) | 0.41 | ||
| ≥2 | 357 (26.4%) | 53 (14.8%) | 1.16 (0.82-1.62) | 0.40 | ||
| Psychiatric need during last incarceration | ||||||
| Low severity score (1-2), untreated | 589 (43.6%) | 81 (13.8%) | referent | |||
| Low severity score (1-2), treated | 99 (7.3%) | 35 (35.4%) | 1.21 (0.81-1.80) | 0.35 | ||
| High severity score (3-5), untreated | 199 (14.7%) | 16 (8.0%) | 1.14 (0.66-1.94) | 0.64 | ||
| High severity score (3-5), treated | 463 (34.3%) | 52 (11.2%) | 0.82 (0.58-1.17) | 0.28 | ||
| Addiction severity score during last incarcerationh | ||||||
| Low severity/no disorder (score 1-2) | 122 (9.2%) | 19 (15.6%) | referent | referent | ||
| Moderate severity disorder (score 3) | 945 (70.9%) | 107 (11.3%) | 0.70 (0.43-1.13) | 0.15 | 0.65 (0.38-1.12) | 0.12 |
| Serious disorder (score 4-5) | 265 (19.9%) | 56 (21.1%) | 1.37 (0.81-2.30) | 0.24 | 1.17 (0.65-2.09) | 0.61 |
| Treated for an opioid use disorder during last incarceration | ||||||
| No | 1322 (97.9%) | 183 (13.8%) | referent | |||
| Yes | 28 (2.1%) | 1 (3.6%) | 0.28 (0.04-1.97) | 0.20 | ||
| Viral suppression and timing of last viral load drawn prior to death/censoring | ||||||
| Viral suppression, within 6 months | 840 (62.2%) | 79 (9.4%) | referent | referent | ||
| Virologic failure, within 6 months | 208 (15.4%) | 65 (31.3%) | 3.63 (2.62-5.05) | <0.0001 | 2.76 (1.94-3.92) | <0.0001 |
| Viral suppression, >6 months | 160 (11.9%) | 17 (10.6%) | 1.10 (0.65-1.85) | 0.73 | 0.83 (0.48-1.42) | 0.49 |
| Virologic failure, >6 months | 87 (6.4%) | 11 (12.6%) | 1.19 (0.64-2.24) | 0.58 | 0.72 (0.37-1.42) | 0.35 |
| Viral load never drawni | 55 (4.1%) | 12 (21.8%) | 3.90 (2.13-7.16) | <0.0001 | 2.13 (1.09-4.18) | 0.03 |
*
Includes combined information for both prisoners and jail detainees
PWID= people who acquired HIV through injection drug use (people who inject drugs;); non-PWID=people without an injection drug use history
a
Bivariate analyses include all 1,350 individuals released during the observation period· During a median follow-up time of 5·2 (IQR 3·0-6·7) years (6,418 person-years), there were 184 deaths during follow-up. Due to missing data for the CD4 count and addiction severity score variables as specified below, the final parsimonious model includes 1,319 individuals followed for 6,276 person-years, during which there were 182 deaths. Numbers listed are n (%) out of the total number of individuals in the sample (n=1350). Percentages may not sum to 100% due to rounding or missing data as specified below.
b
Numbers listed are the row n (%) of individuals with the specified characteristic who experienced the outcome of interest (death)
c
Transgender males (n=1) have been included the male category and transgender females (n=3) have been included in the female category
d
Individuals with missing/unreported marital status (n=61) were excluded from the bivariate analysis such that the total n=1289
e
Individuals with missing/unreported CD4 count at time of diagnosis (n=13) were excluded from the bivariate analysis such that the total n=1337. For 33 individuals missing a CD4 count at time of diagnosis but with CD4 counts available within 3 months of their diagnosis date, their first CD4 counts were used as an approximation of their CD4 counts at time of diagnosis.
f
The “No” category includes 25 individuals who were either re-incarcerated or died within 14 days without having a VL drawn in the community.
g
Index incarceration periods where the addiction severity score was never assessed (n=30) were excluded from the bivariate analysis such that the total n=1320.
h
Last incarceration periods where the addiction severity score was never assessed (n=18) were excluded from the bivariate analysis such that the total n=1332.
i
The “viral load never drawn” category includes 18 individuals who were followed in the community for <6 months prior to death or censoring.