RESUMO
BACKGROUND: Hepatitis C virus (HCV) infection disproportionately impacts people experiencing homelessness. Hepatitis C virus can lead to negative health outcomes, including mortality. We evaluated the impact of a permanent supportive housing (PSH) program (ie, "treatment") on liver-related morbidity and mortality among persons with chronic homelessness and HCV infection. METHODS: We matched records for persons eligible for a New York City PSH program (2007-2014) with Heath Department HCV and Vital Statistics registries and Medicaid claims. Among persons diagnosed with HCV before or 2 years posteligibility, we added stabilized inverse probability of treatment weights to negative binomial regression models to compare rates for liver disease-related emergency department visits and hospitalizations, and hazard ratios for mortality, by program placement 2 and 5 years posteligibility. RESULTS: We identified 1158 of 8783 placed and 1952 of 19 019 unplaced persons with laboratory-confirmed HCV infection. Permanent supportive housing placement was associated with significantly reduced liver-related emergency department visits (adjusted rate ratio [aRR] = 0.76, 95% confidence interval [CI] = .61-.95), hospitalizations (aRR = 0.62, 95% CI = .54-.71), and all-cause (adjusted hazard ratio [aHR] = 0.65, 95% CI = .46-.92) and liver-related mortality (aHR = 0.72, 95% CI = .09-.83) within 2 years. The reduction remained significant for hospitalizations after 5 years. CONCLUSIONS: Placement into PSH was associated with reduced liver-related morbidity and mortality among persons with HCV infection and chronic homelessness.
Assuntos
Hepatite C , Pessoas Mal Alojadas , Hepacivirus , Hepatite C/complicações , Hepatite C/epidemiologia , Humanos , Habitação PopularRESUMO
Objectives. To evaluate the impact of duration and service category on HIV health outcomes among low-income adults living with HIV and enrolled in a housing program in 2014 to 2017.Methods. We estimated relative risk of engagement in care, viral suppression, and CD4 improvement for 561 consumers at first and second year after enrollment to matched controls through the New York City HIV surveillance registry, by enrollment length (enrolled for more than 1 year or not) and service category (housing placement assistance [HPA], supportive permanent housing [SPH], and rental assistance [REN]).Results. The SPH and REN consumers were enrolled longer and received more services, compared with HPA consumers. Long-term SPH and REN consumers had better engagement in care, viral suppression, and CD4 count than controls at both first and second year after enrollment, but the effect did not grow bigger from year 1 to 2. HPA consumers did not have better outcomes than controls regardless of enrollment length.Conclusions. Longer enrollment with timely housing placement and a higher number and more types of services are associated with better HIV health outcomes for low-income persons living with HIV with unmet housing needs.
Assuntos
Infecções por HIV , Habitação , Participação do Paciente/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Adulto , Idoso , Contagem de Linfócito CD4/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Pobreza/estatística & dados numéricos , Carga ViralRESUMO
Among 958 applicants to a supportive housing program for low-income persons living with HIV (PLWH) and mental illness or a substance use disorder, we assessed impacts of housing placement on housing stability, HIV care engagement, and viral suppression. Surveillance and administrative datasets provided medical and residence information, including stable (e.g., rental assistance, supportive housing) and unstable (e.g., emergency shelter) government-subsidized housing. Sequence analysis identified a "quick stable housing" pattern for 67% of persons placed by this program within 2 years, vs. 28% of unplaced. Compared with unplaced persons not achieving stable housing quickly, persons quickly achieving stable housing were more likely to engage in care, whether placed (per Poisson regression, ARR: 1.14;95% CI 1.09-1.20) or unplaced (1.19;1.13-1.25) by this program, and to be virally suppressed, whether placed (1.22;1.03-1.44) or unplaced (1.26, 1.03-1.56) by this program. Housing programs can help homeless PLWH secure stable housing quickly, manage their infection, and prevent transmission.
RESUMEN: Unas 958 personas de bajos recursos y quienes viven con VIH y enfermedades mentales o bien presentan problemas de abuso de sustancias solicitaron a un programa de vivienda complementada con servicios de apoyo. Entre ellas, se evaluó los impactos de la colocación en viviendas sobre la estabilidad en la misma, así como la participación en los cuidados médicos para el VIH, y la supresión de la carga viral. Las bases de datos administrativas y del registro de vigilancia brindaron información médica y domiciliar, incluyendo información sobre vivienda estable (por ejemplo, asistencia de pago de renta a largo plazo, o vivienda complementada con servicios de apoyo) y vivienda inestable (por ejemplo, alojamiento de emergencia temporal) subsidiada por el gobierno. El método "análisis de secuencia" permitió identificar una pauta caracterizada por estabilidad domiciliar conseguida de modo ligero (es decir, de forma oportuna) en el 67% de las personas quienes fueron colocadas por este programa dentro de un lapso de dos años, comparado con 28% de las personas quienes no fueron colocadas. En comparación con las personas quienes no fueron colocadas y no lograron estabilidad de vivienda de modo ligero, las personas quienes lograron estabilidad de vivienda de modo ligero tuvieron una mayor probabilidad de participar en cuidados médicos, ya sea que fueran colocadas (según regresión de Poisson, cociente de riesgo ajustado: 1.14; intervalo de confianza de 95%: 1.09-1.20) o no fueran colocadas (1.19, 1.13-1.25) por este programa, así como de lograr la supresión de la carga viral, ya sea que fueran colocadas (1.22, 1.03-1.44) o no fueran colocadas (1.26, 1.03-1.56) por este programa. Los programas que facilitan la colocación en o el pago de vivienda y apoyo en el mismo pueden ayudar a las personas con VIH y sin hogar obtener vivienda estable de modo ligero, controlar su infección, y prevenir la transmisión.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Pessoas Mal Alojadas/psicologia , Transtornos Mentais/complicações , Assistência Pública/estatística & dados numéricos , Habitação Popular/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Avaliação de Resultados em Cuidados de Saúde , Pobreza , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologiaRESUMO
Objectives. To compare trends in HIV outcomes for cisgender and transgender persons living with HIV (PLWH) in New York City.Methods. We used HIV surveillance data for the analysis. We based CD4 count on the last measurement in a calendar year and defined viral suppression as the last viral load being less than or equal to 200 copies per milliliter in the calendar year.Results. The estimated number of PLWH increased from 73 415 in 2007 to 83 299 in 2016, including 606 transgender persons (0.8%) in 2007 and 1054 transgender persons (1.3%) in 2016. The proportion with CD4 count of 500 cells per cubic millimeter or more increased from 38% in 2007 to 61% in 2016 among cisgender persons versus 32% to 60% among transgender persons. The proportion with a suppressed viral load increased from 52% in 2007 to 80% in 2016 among cisgender persons versus 42% to 73% among transgender persons.Conclusions. Among PLWH in New York City, CD4 count and viral suppression improved during 2007 to 2016, with larger improvements among transgender persons, leading to narrower gaps. However, continuing efforts to improve HIV outcomes among transgender PLWH are needed to further eliminate disparities, particularly in viral suppression.
Assuntos
Contagem de Linfócito CD4 , Infecções por HIV/imunologia , Infecções por HIV/virologia , Transexualidade/imunologia , Transexualidade/virologia , Carga Viral , Adolescente , Adulto , Idoso , Fármacos Anti-HIV/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Vigilância da População , Transexualidade/epidemiologia , Adulto JovemRESUMO
We conducted a randomized controlled trial to determine whether, for homeless persons living with HIV/AIDS (PLWHA), rapid re-housing can improve housing and HIV viral suppression more than standard housing assistance. We recruited 236 PLWHA from HIV emergency housing in New York City (NYC) and randomized them to: (1) Enhanced Housing Placement Assistance (EHPA), i.e., immediate assignment to a case manager to rapidly re-house the client and provide 12 months of case management or (2) usual services, i.e., referral to an NYC housing placement program for which all HIV emergency housing residents were eligible. We compared time to stable housing placement and percentage virally suppressed from baseline to 12 months. EHPA clients were placed faster than usual services clients (p = 0.02; 25% placed by 150 days vs. 243 days, respectively), more likely to be placed [adjusted hazards ratio = 1.8; 95% confidence interval(CI) 1.1-2.8], and twice as likely to achieve or maintain suppression (adjusted odds ratio 2.1; 95% CI 1.1-4.0).
Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Pessoas Mal Alojadas/estatística & dados numéricos , Assistência Pública/estatística & dados numéricos , Habitação Popular , Adulto , Administração de Caso , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Humanos , Masculino , Cidade de Nova Iorque , Avaliação de Resultados em Cuidados de Saúde , Resultado do TratamentoRESUMO
Persons with HIV who are receiving housing services often have high rates of engagement in care, yet many are not virally suppressed. We linked data from the New York City Housing Opportunities for Persons with AIDS (HOPWA) program to electronically reported laboratory tests from the HIV surveillance registry to examine factors associated with a lack of viral suppression. Of 1491 HOPWA consumers, 523 (35.1%) were not durably suppressed, and 253 (17.0%) were unsuppressed at their last viral load test. Substance use, age < 27 years, and emergency housing all independently predicted lack of durable viral suppression and lack of viral suppression at last viral load test.
Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , HIV/efeitos dos fármacos , Vigilância em Saúde Pública/métodos , Transtornos Relacionados ao Uso de Substâncias/complicações , Carga Viral/efeitos dos fármacos , Síndrome da Imunodeficiência Adquirida , Adulto , Feminino , Infecções por HIV/epidemiologia , Habitação , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Sistema de Registros , Transtornos Relacionados ao Uso de Substâncias/psicologia , Resposta Viral Sustentada , Adulto JovemRESUMO
Health care facility characteristics have been shown to influence intermediary health outcomes among persons with HIV, but few longitudinal studies of suppression have included these characteristics. We studied the association of these characteristics with the achievement and maintenance of HIV viral suppression among New York City (NYC) residents aged 13 years and older newly diagnosed with HIV between 2006 and 2012. The NYC HIV surveillance registry provided individual and facility data (N = 12,547 persons). Multivariable proportional hazards models estimated the likelihood of individual achievement and maintenance of suppression by type of facility, patient volume, and distance from residence, accounting for facility clustering and for individual-level confounders. Viral suppression was achieved within 12 months by 44% and at a later point by another 29%. Viral suppression occurred at a lower rate in facilities with low HIV patient volume (e.g., 10-24 diagnoses per year vs. ≥75, adjusted hazard ratio [AHR] = 0.87, 95% confidence interval [CI] 0.79-0.95) and in screening/diagnosis sites (vs. hospitals, AHR = 0.86, 95% CI 0.80-0.92). Among persons achieving viral suppression, 18% experienced virologic failure within 12 months and 24% later. Those receiving care at large outpatient facilities or large private practices had a lower rate of virologic failure (e.g., large outpatient facilities vs. large hospitals, AHR = 0.63, 95% CI 0.53-0.75). Achievement and maintenance of viral suppression were associated with facilities with higher HIV-positive caseloads. Some facilities with small caseloads and screening/diagnosis sites may need stronger care or referral systems to help persons with HIV achieve and maintain viral suppression.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , HIV/fisiologia , Instalações de Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde , Carga Viral/efeitos dos fármacos , Adolescente , Adulto , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Vigilância da População , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Resultado do Tratamento , Carga Viral/estatística & dados numéricosRESUMO
It is unknown whether providing housing to persons experiencing homelessness decreases HIV risk. Housing, including access to preventive services and counseling, might provide a period of transition for persons with HIV risk factors. We assessed whether the new HIV diagnosis rate was associated with duration of supportive housing. We linked data from a cohort of 21,689 persons without a previous HIV diagnosis who applied to a supportive housing program in New York City (NYC) during 2007-2013 to the NYC HIV surveillance registry. We used time-dependent Cox modeling to compare new HIV diagnoses among recipients of supportive housing (defined a priori, for program evaluation purposes, as persons who spent > 7 days in supportive housing; n = 6447) and unplaced applicants (remainder of cohort), after balancing the groups on baseline characteristics with propensity score weights. Compared with unplaced applicants, persons who received ≥ 3 continuous years of supportive housing had decreased risk for new HIV diagnosis (HR 0.10; CI 0.01-0.99). Risk of new HIV diagnosis decreased with longer duration placement in supportive housing. Supportive housing might aid in primary HIV prevention.
Assuntos
Infecções por HIV/prevenção & controle , Pessoas Mal Alojadas , Assistência de Longa Duração , Habitação Popular , População Urbana , Adolescente , Adulto , Estudos de Coortes , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Acessibilidade aos Serviços de Saúde , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Vigilância da População , Serviços Preventivos de Saúde , Prevenção Primária/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Pontuação de Propensão , Modelos de Riscos Proporcionais , Sistema de Registros/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto JovemRESUMO
Publications on diagnosed HIV infection among transgender people have been limited to state- or local-level data. We analyzed data from the National HIV Surveillance System and present results from the first national-level analysis of transgender people with diagnosed HIV infection. From 2009 to 2014, HIV surveillance jurisdictions from 45 states plus the District of Columbia identified and reported at least one case of newly diagnosed HIV infection for transgender people; jurisdictions from 5 states reported no cases for transgender people. Of 2351 transgender people with newly diagnosed HIV infection during 2009-2014, 84.0% were transgender women (male-to-female), 15.4% were transgender men (female-to-male), and 0.7% were additional gender identity (e.g., gender queer, bi-gender). Over half of both transgender women (50.8%; 1002/1974) and men (58.4%; 211/361) with newly diagnosed HIV infection were non-Hispanic black/African American. Improvements in data collection methods and quality are needed to gain a better understanding of HIV burden among transgender people.
Assuntos
Etnicidade/estatística & dados numéricos , Infecções por HIV/diagnóstico , Infecções por HIV/etnologia , Pessoas Transgênero , Adolescente , Adulto , Etnicidade/psicologia , Feminino , Identidade de Gênero , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Características de Residência , Transexualidade , Estados Unidos/epidemiologia , Adulto JovemRESUMO
We investigated the effect of neighborhood characteristics on achievement and maintenance of HIV viral suppression among New York City (NYC) residents aged 13 years and older diagnosed between 2006 and 2012. Individual records from the NYC HIV surveillance registry (n = 12,547) were linked to U.S. Census and American Community Survey data by census tract of residence. Multivariable proportional hazards regression models indicated the likelihood of achievement and maintenance of suppression by neighborhood characteristics including poverty, accounting for neighborhood clustering and for individual characteristics. In adjusted analyses, no neighborhood factors were associated with achievement of suppression. However, residents of high- or very-high-poverty neighborhoods were less likely than residents of low-poverty neighborhoods to maintain suppression. In conclusion, higher neighborhood poverty was associated with lesser maintenance of suppression. Assistance with post-diagnosis retention in care, antiretroviral therapy prescribing, or adherence targeted to residents of higher-poverty neighborhoods may improve maintenance of viral suppression in NYC.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adesão à Medicação , Determinantes Sociais da Saúde , Carga Viral , Adulto , Idoso , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Vigilância da População , Pobreza/estatística & dados numéricos , Áreas de Pobreza , RNA Viral , Características de Residência/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento , Carga Viral/efeitos dos fármacosRESUMO
OBJECTIVES: We measured HIV care outcomes of transgender persons, who have high HIV infection rates but are rarely distinguished from men who have sex with men (MSM) in HIV surveillance systems. METHODS: New York City's surveillance registry includes HIV diagnoses since 2000 and HIV laboratory test results for transgender persons since 2005. We determined immunological status at diagnosis, delayed linkage to care, and nonachievement of viral suppression 1 year after diagnosis for transgender persons diagnosed with HIV in 2006 to 2011 and compared transgender women with MSM. RESULTS: In 2006 to 2011, 264 of 23 805 persons diagnosed with HIV were transgender (1%): 98% transgender women and 2% transgender men. Compared with MSM, transgender women had similar CD4 counts at diagnosis and rates of concurrent HIV/AIDS and delayed linkage to care but increased odds of not achieving suppression (adjusted odds ratio = 1.56; 95% confidence interval = 1.13, 2.16). CONCLUSIONS: Compared with MSM, transgender women in New York City had similar immunological status at diagnosis but lagged in achieving viral suppression. To provide appropriate assistance along the HIV care continuum, HIV care providers should accurately identify transgender persons.
Assuntos
Infecções por HIV/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pessoas Transgênero/estatística & dados numéricos , Síndrome da Imunodeficiência Adquirida/epidemiologia , Adolescente , Adulto , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Grupos Raciais , Fatores Socioeconômicos , Adulto JovemRESUMO
We sought to calculate rates of HIV diagnoses by area of birth among foreign-born persons in a high-incidence US city with many immigrants, and determine probable place of HIV acquisition. Data from the New York City HIV surveillance registry and American Community Survey were used to calculate HIV diagnosis rates by area of birth and determine probable place of HIV acquisition among foreign-born diagnosed in 2006-2012. HIV diagnosis rates varied by area of birth and were highest among African-born persons; absolute numbers were highest among Caribbean-born persons. Probable place of acquisition was a foreign country for 23 % (from 9 % among Middle Easterners to 43 % among Africans), US for 61 % (from 34 % among Africans to 76 % among South Americans), and not possible to estimate for 16 %. HIV prevention and testing initiatives should take into account variability by foreign area of birth in HIV diagnosis rates and place of acquisition.
Assuntos
População Negra/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Infecções por HIV/diagnóstico , Infecções por HIV/etnologia , Hispânico ou Latino/estatística & dados numéricos , Vigilância da População/métodos , Adolescente , Adulto , África/etnologia , Idoso , Região do Caribe/etnologia , América Central/etnologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Fatores de Risco , Distribuição por Sexo , Adulto JovemRESUMO
A static model of undiagnosed and diagnosed HIV infections by year of infection and year of diagnosis was constructed to examine the impact of changes in HIV case-finding and HIV incidence on the proportion of late diagnoses. With no changes in HIV case-finding or incidence, the proportion of late diagnoses in the USA would remain stable at the 2010 level, 32.0%; with a 10% increase in HIV case-finding and no changes in HIV incidence, the estimated proportion of late diagnoses would steadily decrease to 28.1% in 2019; with a 5% annual increase in HIV incidence and no changes in case-finding, the proportion would decrease to 25.2% in 2019; with a 5% annual decrease in HIV incidence and no change in case-finding, the proportion would steadily increase to 33.2% in 2019; with a 10% increase in HIV case-finding, accompanied by a 5% annual decrease in HIV incidence, the proportion would decrease from 32.0% to 30.3% in 2011, and then steadily increase to 35.2% in 2019. In all five scenarios, the proportion of late diagnoses would remain stable after 2019. The stability of the proportion is explained by the definition of the measure itself, as both the numerator and denominator are affected by HIV case-finding making the measure less sensitive. For this reason, we should cautiously interpret the proportion of late diagnoses as a marker of the success or failure of expanding HIV testing programs.
Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Modelos Teóricos , Infecções por HIV/mortalidade , Soropositividade para HIV/epidemiologia , Humanos , Incidência , Vigilância da População , Prevalência , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: We estimated the proportions of persons living with HIV/AIDS (PLWHA) in New York City (NYC) retained in care and virally suppressed. METHODS: We used routinely reported laboratory surveillance data to measure trends in retention in care and viral suppression in PLWHA in NYC from 2006 through 2010. Our denominator excluded persons lacking any HIV-related laboratory tests during the 5 years prior to the year of analysis. RESULTS: The proportion of patients retained in care (≥ 1 care visit in a calendar year) was stable, at 82.5% in 2006 and 81.8% in 2010. However, the proportion of persons with evidence of viral suppression increased significantly, from 44.3% to 59.1%. Blacks were least likely to have viral suppression (adjusted prevalence ratio [APR] = 0.89; 95% confidence interval [CI] = 0.87, 0.90). A U-shaped relationship between age and viral suppression was observed, with the 20- to 29-year age group least likely to have a suppressed viral load. CONCLUSIONS: Higher and more plausible proportions retained in care and virally suppressed than national estimates may reflect the difference in methodology and our comprehensive HIV-related laboratory reporting system.
Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Vigilância em Saúde Pública/métodos , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/imunologia , Síndrome da Imunodeficiência Adquirida/terapia , Adolescente , Adulto , Distribuição por Idade , Contagem de Linfócito CD4 , Criança , Pré-Escolar , Etnicidade , Feminino , Infecções por HIV/etnologia , Infecções por HIV/imunologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Cooperação do Paciente , Prevalência , Grupos Raciais , Distribuição por Sexo , Carga Viral , Adulto JovemRESUMO
BACKGROUND: Treatment with methadone and buprenorphine medications for opioid use disorder (MOUD) during incarceration may lead to better community re-entry, but evidence on these relationships have been mixed. We aimed to identify community re-entry patterns and examine the association between in-jail MOUD and a pattern of successful reentry defined by rare occurrence of reincarceration and preventable healthcare utilization. METHODS: Data came from a retrospective, observational cohort study of 6066 adults with opioid use disorder who were incarcerated in New York City jails and released to the community during 2011-14. An outcome was community re-entry patterns identified by sequence analysis of 3-year post-release reincarceration, emergency department visits, and hospitalizations. An exposure was receipt of in-jail MOUD versus out-of-treatment (42 % vs. 58 %) for the last 3 days before discharge. The study accounted for differences in baseline demographic, clinical, behavioral, housing, and criminal legal characteristics between in-jail MOUD and out-of-treatment groups via propensity score matching. RESULTS: This study identified five re-entry patterns: stability (64 %), hospitalization (23 %), delayed reincarceration (7 %), immediate reincarceration (4 %), and continuous incarceration (2 %). After addressing confounding, 64 % and 57 % followed the stability pattern among MOUD and out-of-treatment groups who were released from jail in 2011, respectively. In 2012-14, the prevalence of following the stability pattern increased year-by-year while a consistently higher prevalence was observed among those with in-jail MOUD. CONCLUSIONS: Sequence analysis helped define post-release stability based on health and criminal legal system involvement. Receipt of in-jail MOUD was associated with a marker of successful community re-entry.
Assuntos
Prisões Locais , Transtornos Relacionados ao Uso de Opioides , Adulto , Humanos , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Metadona/uso terapêutico , Análise de SequênciaRESUMO
BACKGROUND: Non-fatal overdose is a leading predictor of subsequent fatal overdose. For individuals who are incarcerated, the risk of experiencing an overdose is highest when transitioning from a correctional setting to the community. We assessed if enrollment in jail-based medications for opioid use disorder (MOUD) is associated with lower risk of non-fatal opioid overdoses after jail release among individuals with opioid use disorder (OUD). METHODS: This was a retrospective, observational cohort study of adults with OUD who were incarcerated in New York City jails and received MOUD or did not receive any MOUD (out-of-treatment) within the last three days before release to the community in 2011-2017. The outcome was the first non-fatal opioid overdose emergency department (ED) visit within 1 year of jail release during 2011-2017. Covariates included demographic, clinical, incarceration-related, and other characteristics. We performed multivariable cause-specific Cox proportional hazards regression analysis to compare the risk of non-fatal opioid overdose ED visits within 1 year after jail release between groups. RESULTS: MOUD group included 8660 individuals with 17,119 incarcerations; out-of-treatment group included 10,163 individuals with 14,263 incarcerations. Controlling for covariates and accounting for competing risks, in-jail MOUD was associated with lower non-fatal opioid overdose risk within 14 days after jail release (adjusted HR=0.49, 95% confidence interval=0.33-0.74). We found no significant differences 15-28, 29-56, or 57-365 days post-release. CONCLUSION: MOUD group had lower risk of non-fatal opioid overdose immediately after jail release. Wider implementation of MOUD in US jails could potentially reduce post-release overdoses, ED utilization, and associated healthcare costs.
Assuntos
Buprenorfina , Metadona , Overdose de Opiáceos , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Buprenorfina/uso terapêutico , Estudos de Coortes , Serviço Hospitalar de Emergência , Encarceramento , Metadona/uso terapêutico , Cidade de Nova Iorque/epidemiologia , Overdose de Opiáceos/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Prisioneiros , Estudos RetrospectivosRESUMO
BACKGROUND: Offering medications for opioid use disorder (MOUD) in carceral settings significantly reduces overdose. However, it is unknown to what extent individuals in jails continue MOUD once they leave incarceration. We aimed to assess the relationship between in-jail MOUD and MOUD continuity in the month following release. METHODS: We conducted a retrospective cohort study of linked NYC jail-based electronic health records and community Medicaid OUD treatment claims for individuals with OUD discharged from jail between 2011 and 2017. We compared receipt of MOUD within 30 days of release, among those with and without MOUD at release from jail. We tested for effect modification based on MOUD receipt prior to incarceration and assessed factors associated with treatment discontinuation. RESULTS: Of 28,298 eligible incarcerations, 52.8 % received MOUD at release. 30 % of incarcerations with MOUD at release received community-based MOUD within 30 days, compared to 7 % of incarcerations without MOUD (Risk Ratio: 2.62 (2.44-2.82)). Most (69 %) with MOUD claims prior to incarceration who received in-jail MOUD continued treatment in the community, compared to 9 % of those without prior MOUD. Those who received methadone (vs. buprenorphine), were younger, Non-Hispanic Black and with no history of MOUD were less likely to continue MOUD following release. CONCLUSIONS: MOUD maintenance in jail is strongly associated with MOUD continuity upon release. Still, findings highlight a gap in treatment continuity upon-reentry, especially among those who initiate MOUD in jail. In the wake of worsening overdose deaths and troubling disparities, improving MOUD continuity among this population remains an urgent priority.
Assuntos
Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides , Humanos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Masculino , Estudos Retrospectivos , Feminino , Adulto , Tratamento de Substituição de Opiáceos/métodos , Pessoa de Meia-Idade , Prisões Locais , Buprenorfina/uso terapêutico , Estudos de Coortes , Prisioneiros , Metadona/uso terapêutico , Adulto Jovem , Estados Unidos/epidemiologia , Continuidade da Assistência ao Paciente , PrisõesRESUMO
OBJECTIVES: To measure trends in HIV diagnoses among foreign-born (FB) New Yorkers and compare the epidemic in FB with that in non-FB (NFB). METHODS: New York City (NYC) HIV/AIDS surveillance registry data were used to measure trends in HIV diagnoses in 2001-2009, calculate HIV diagnosis rates by area of birth, and compare demographic and care characteristics of FB and NFB diagnosed in 2006-2009. The registry contains data on all New Yorkers diagnosed with HIV infection, HIV disease and AIDS, and receives laboratory results on all New Yorkers living with HIV/AIDS. RESULTS: From 2001 to 2009, new HIV diagnoses among FB increased modestly in number but significantly as a percent of all cases (17% in 2001 to 28% in 2009; p<0.01). In 2006-2009, the annual rate of diagnosis was lower among FB than NFB (37 vs 56 per 100 000). Compared with NFB, FB persons were significantly more likely to be diagnosed concurrently with AIDS; FB had a lower median CD4 count at initiation of care. FB persons were less likely to have insurance, and 13% needed language interpretation services. CONCLUSIONS: The percentage of HIV diagnoses in NYC attributed to FB persons has increased. HIV infection may remain undiagnosed longer in FB than NFB. FB may benefit from targeted prevention outreach and other services.
Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Emigrantes e Imigrantes/estatística & dados numéricos , Soropositividade para HIV/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Síndrome da Imunodeficiência Adquirida/diagnóstico , Adolescente , Adulto , Fármacos Anti-HIV , Contagem de Linfócito CD4 , Criança , Pré-Escolar , Diagnóstico Tardio , Feminino , Soropositividade para HIV/diagnóstico , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Vigilância da PopulaçãoAssuntos
Soropositividade para HIV , Pessoas Transgênero , Transexualidade , HIV , Homossexualidade Masculina , Humanos , Masculino , Estados UnidosRESUMO
OBJECTIVES: To measure housing assistance and homelessness among persons living with HIV (PLWH) and their association with health. METHODS: Exposure categories were: experiencing homelessness (per emergency shelter use or self-report), receiving housing assistance (per housing subsidy) without homelessness, or neither homelessness nor receiving housing assistance. Outcomes were: engagement (≥1 visit) and retention (≥2 visits ≥90 days apart) in HIV-related medical care and one-time (latest viral load) and durable (≥1 viral load test, all suppressed) HIV viral suppression (<200 copies/mL). Among PLWH in New York City (NYC), we calculated and conducted modified Poisson regressions of the four outcomes according to exposure category. RESULTS: During 2018, 45% of NYC's 84,053 PLWH received housing assistance, and 8% experienced homelessness. Relative to homelessness, receipt of assistance without homelessness was associated with 3-7% higher adjusted relative risk (ARR) of engagement and retention in care and 31-64% higher ARR of one-time and durable viral suppression. Relative to not receiving assistance, receipt of assistance without homelessness was associated with 6-18% higher ARR of care and 2-5% lower ARR of viral suppression. CONCLUSIONS: Programs promoting housing stability may support HIV care and viral suppression, particularly if preventing homelessness. These may help improve HIV care and suppression rates.