P-2070. Evaluation of Human Immunodeficiency Virus (HIV) Virologic Suppression among Reincarcerated Individuals within in the Illinois Department of Corrections

TL;DR

This study examines how well HIV patients in Illinois prisons maintain virus suppression after being released and reincarcerated, finding that wrap-around services improved outcomes but housing and access to care remain challenges.

Contribution

The study evaluates the impact of expanded wrap-around services on virologic suppression among reincarcerated HIV patients in Illinois prisons.

Findings

62 out of 75 patients who achieved virologic suppression at release maintained it upon reincarceration.

Loss of virologic suppression was significantly associated with housing instability, lack of care access, and rural jail transfers.

The proportion of individuals maintaining virologic suppression increased from 49.7% in 2014 to 82.7% in 2024 with expanded services.

Abstract

The University of Illinois Hospital and Health Sciences Center (UIH) multidisciplinary telemedicine clinic provides HIV care to justice-involved individuals in the Illinois Department of Corrections (IDOC). Post-release HIV care remains challenging, with virologic suppression (VS) dropping from 73% at release to 49.7% at reincarceration into IDOC in a prior study. To improve continuity of care, wrap-around services were expanded from follow-up care at UIH to medical insurance assistance, case management, employment/housing support, and statewide follow-up care.

This IRB-approved, retrospective cohort study taking place from 1/1/21- 8/31/24 analyzed demographic, clinical, and social determinants of health in people with HIV aged ≥18 years, in custody in IDOC, released and reincarcerated during the study period. The primary outcome was a change in the number of patients with complete VS at time of release as compared to reincarceration. Secondary outcomes included change in immunologic function and identification of factors influencing loss of VS upon reincarceration.

Of 393 patients released during the study period, 95 were reincarcerated, 82 were included, and 75 had VS at time of release. [Figure 1] Of the 75 who achieved VS at release, 62 maintained VS (group 1) at reincarceration, while 13 experienced loss of VS (group 2) (p = 0.0001). Median CD4 count of those who met inclusion criteria declined significantly from release to reincarceration (p = 0.0032) but the change in CD4% was not significant (p = 0.0973).

No difference was found between group 1 and 2 in scheduling a statewide follow-up visit (p = 0.0813), following up at UIH clinic at least once (p = 1.00), or having ADAP coverage (p = 0.7552). Loss of VS was significantly associated with patient-reported housing instability (p = 0.0046), lack of access to care (p = 0.0056), living outside of Chicago (p = 0.0318) and transferring from a jail in a rural setting (p = 0.0054).

As the role of IDOC telemedicine team expanded, the proportion of individuals who maintained VS upon reincarceration increased from 49.7% in 2014 to 82.7% in 2024. While interventions show progress, more targeted efforts are needed to address housing, care access, and non-Chicago residency.

Scott Borgetti, MD, GlaxoSmithKline: Grant/Research Support

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