Examining Pre-Release Interventions on HIV Outcomes 12 Months After Release from Louisiana State Corrections.

Louisiana has the highest proportion of people living with HIV (PLWH) in state prison custody. Linkage to care programs minimize odds of HIV care drop-off after release. Louisiana has two pre-release linkage to HIV care programs, one implemented through Louisiana Medicaid and another through the Office of Public Health. We conducted a retrospective cohort study of PLWH released from Louisiana corrections from January 1, 2017 to December 31, 2019. We compared HIV care continuum outcomes within 12 months after release between intervention groups (received any vs. no intervention) using two proportion z-tests and multivariable logistic regression. Of 681 people, 389 (57.1%) were not released from a state prison facility and thus not eligible to receive interventions, 252 (37%) received any intervention, and 228 (33.5%) achieved viral suppression. Linkage to care within 30 days was significantly higher in people who received any intervention (v. no intervention, p = .0142). Receiving any intervention was associated with higher odds of attaining all continuum steps, though only significantly for linkage to care (AOR = 1.592, p = .0083). We also found differences in outcomes by sex, race, age, urbanicity of the return parish (county), and Medicaid enrollment between intervention groups. Receiving any intervention increased the odds of achieving HIV care outcomes, and was significantly impactful at improving care linkage. Interventions must be improved to enhance long-term post-release HIV care continuity and eliminate disparities in care outcomes.

Estimation of unmet need for HIV primary medical care: a framework and three case studies.

Reauthorization of the Ryan White Comprehensive AIDS Resources Emergency Act requires that each jurisdiction estimate the number of people living with HIV/AIDS who have unmet need for care. Past assessments of unmet need have used various definitions of care, relied on qualitative evaluations, or examined nonrepresentative subpopulations. This article outlines a single, flexible framework designed to quantitatively estimate unmet need in varied settings. The framework adopts a definition of unmet need which focuses on HIV primary medical care (CD4 test, viral load test, or antiretroviral therapy in a 12-month period), employs a standard analytic structure to integrate population and care data, and allows use of locally available data. We report on three field tests (Louisiana, Atlanta, and San Francisco). The field tests suggest that the unmet need framework provides an approach which can be used by states and metropolitan areas to estimate the number of individuals with unmet need for HIV primary medical care.

Street outreach for HIV prevention: effectiveness of a state-wide programme.

Street outreach is considered a key HIV prevention strategy in the United States. To determine whether street outreach to prevent HIV infection as practised by state-funded community-based organizations (CBOs) is effective in promoting condom use, we conducted an evaluation using a quasi-experimental design. Twenty-one CBOs involved in street outreach conducted cross-sectional surveys assessing risk behaviour and exposure to outreach activities in 66 intervention and 13 comparison areas in Louisiana over a 2-year period. Surveys were collected from 4950 persons at intervention sites and 1597 persons at comparison sites. After controlling for demographic characteristics and sexual risk factors, persons in intervention sites were more likely to use condoms than persons in comparison sites [odds ratio 1.37 (95% confidence interval 1.20, 1.56; P<0.001)]. Contact with an outreach worker mediated condom use. The mechanism of effect may be related to direct contact with an outreach worker and condom distribution rather than to broader community mobilization.