Clinical Scorecard: Strategies to Enhance HIV Care Continuum Outcomes for Individuals with HIV and a History of Incarceration: A Narrative Review
At a Glance
Category
Detail
Condition
HIV infection among individuals with incarceration experience
Key Mechanisms
Barriers to HIV care engagement post-incarceration including unstable housing, unemployment, mental health and substance use disorders, lack of insurance, and poor care coordination
Target Population
People with HIV and recent incarceration experience in the United States
Care Setting
Correctional facilities (prisons and jails) and community-based HIV care settings
Key Highlights
People with HIV and incarceration experience have higher HIV prevalence and face multiple barriers to care post-release.
Structured HIV care and ART access in prisons improve outcomes compared to community settings; jails often disrupt care continuity.
Recent interventions (2020–2023) show limited evidence of effectiveness; more innovation and rigorous evaluation are needed.
Guideline-Based Recommendations
Diagnosis
Routine opt-out HIV testing for all people entering correctional facilities unless undiagnosed HIV prevalence is <0.1%.
Management
Immediate access to antiretroviral therapy (ART) for incarcerated individuals diagnosed with HIV.
Provision of discharge plans that expedite linkage to community-based HIV care and supply temporary ART (eg, 30 days) upon release.
Monitoring & Follow-up
Monitor viral suppression and HIV care continuum outcomes post-release to identify declines and intervene accordingly.
Risks
Disruptions in care during reentry increase risk of viral rebound and poor health outcomes.
Barriers such as unstable housing, unemployment, untreated mental health and substance use disorders, and reincarceration complicate HIV management.
Patient & Prescribing Data
People with HIV and recent incarceration experience
When linked and retained in care post-release, viral suppression rates are comparable to the general HIV population; however, linkage and retention are often inadequate.
Clinical Best Practices
Implement reentry services that support engagement in HIV care and social services after release.
Coordinate care transitions between correctional facilities and community providers to maintain ART adherence.
Address social determinants such as housing, employment, and mental health/substance use treatment to improve HIV care outcomes.
Develop and rigorously evaluate multilevel and systems-level interventions tailored to this population.
by Hilary Goldhammer, Milo Dorfman, Katie Kramer, Nicole S Chavis, Demetrios Psihopaidas, Melanie P Moore, Joseph Stango, Janet Myers, Sean Cahill, Kenneth H Mayer, Alex S Keuroghlian
