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The Impact of Incarceration on the Continuity of HIV Care in Connecticut

In order to better understand the complex relationship between incarceration and longitudinal HIV treatment outcomes after release, an innovation database integration project was undertaken. Multiple custody and pharmacy databases from the Connecticut Department of Correction were combined with community-based case management, HIV monitoring, and mortality data for all PLH, available through mandatory reporting to the Connecticut Department of Public Health. This interdisciplinary collaboration has produced one of the largest, most comprehensive, retrospective cohorts of criminal justice-involved people living with HIV of any statewide system in the United States. This new integrated database provides access to eight years of uninterrupted, longitudinal HIV monitoring and mortality data, allowing three independent analyses of HIV treatment outcomes and survival in PLH released from prison or jail.

These analyses broadly focus on:

1.) Linkage to HIV care after release

2.) Retention in HIV during the first three years after release

3.) Timing and causes of death after release

This project included 1,350 subjects, enrolled and followed during January 1, 2007 - December 31, 2014.

Project PI: Kelsey B. Loeliger, PhD (MD/PhD Candidate)

Kelsey Loeliger received her B.S. from the University of Maryland-Baltimore County where she began her research career in an HHMI-affiliated retrovirus laboratory, followed by a post-baccalaureate translational research fellowship at the National Heart, Lung, and Blood Institute. She is currently in her final year of a combined M.D./Ph.D. program at the Yale School of Medicine and Yale School of Public Health. After graduating, she plans to complete residency training in either Internal Medicine or Obstetrics/Gynecology, followed by a fellowship in Infectious Diseases or Maternal-Fetal Medicine. This will allow her to focus her clinical practice on vulnerable and underserved patient populations. In addition to her clinical work, she aims to generate research findings that can directly inform health policy and clinical practice to address health disparities and promote social justice. Her previous international work assessed how the interplay between substance use, incarceration, HIV, psychiatric disease, violence, and other social circumstances impacts the health of women in Malaysia. She also worked in rural South Africa to identify barriers preventing HIV antiretroviral therapy initiation and adherence. She received her PhD in May 2018 for her dissertation research, which was a collaboration with the Connecticut Department of Correction and Connecticut Department of Public Health that used big data to track and ultimately improve HIV treatment outcomes and survival after release from incarceration. Through the “Seek Test Treat Retain” Harmonization Consortium funded by the National Institute on Drug Abuse, she is also exploring gender-based differences in HIV risk behaviors and treatment outcomes in criminal justice-involved persons.

Funding Provided by: 
National Institute on Drug Abuse (NIDA)

Yale University Medical Scientist Training Program under National Institute of General Medical Sciences (NIGMS)

Yale Center for Interdisciplinary Research in AIDS (CIRA) under National Institute of Mental Health (NIMH)

Project Period: 
January 1, 2007 to December 31, 2014

  • Professor of Medicine (Infectious Diseases) and of Epidemiology (Microbial Diseases); Affiliated Faculty, Yale Institute for Global Health; Director, Yale Center for Clinical and Community Research, Department of Medicine; Director, HIV in Prisons Program; Director, Community Health Care Van; Academic Icon Professor of Medicine, University of Malaya-Centre of Excellence for Research in AIDS (CERiA)

    Frederick (Rick) L. Altice is a professor of Medicine, Epidemiology and Public Health and is a clinician, clinical epidemiologist, intervention and implementation science researcher at Yale University School of Medicine and School of Public Health. Dr. Altice’s primary research focuses on interventions and implementation science at the interface between infectious diseases and addiction and he has conducted research in several global health settings. He also has a number of projects working in the criminal justice system, including transitional programs addressing infectious diseases, medications for opioid use disorder (methadone, buprenorphine, extended release naltrexone), mental illness, homelessness and social instability. Specific topics include alcohol, opioid, stimulant and nicotine use disorders on HIV treatment outcomes, HIV and addiction treatment, interface with the criminal justice system, and pharmacokinetic drug interactions between treatment for substance use disorders and antiretroviral and tuberculosis therapy. At a basic level, his research focuses on clinical epidemiology, especially in key populations at risk for HIV (e.g., MSM, TGW, PWID, prisoners, sex workers) and development, adaptation and evaluation of of biomedical and behavioral interventions to improve treatment outcomes. His research, however, has evolved and included development and testing of mobile technologies (mHealth) to intervene with key populations to promote health outcomes.  His research is especially concentrated in health services research techniques with a focus on implementation science, seeking to introduce and scale-up evidence-based interventions in numerous contexts. A number of implementation science strategies are underway to examine scale-up of medication-assisted therapies to treat opioid use disorder in community, criminal justice and in primary care settings. Most recently, his work has been augmented through use of decision science techniques to understand and promote patient preferences, including the development of informed and shared decision-making aids. His work has emerged primarily with a global health focus with funded research projects internationally in Malaysia, Ukraine, Moldova, Armenia, Kyrgyzstan, Peru, and Indonesia. He has participated in projects through the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Agency, Special Projects of National Significance with HRSA, and the Center for Substance Abuse Treatment. He is currently also collaborating on projects with the WHO, UNAIDS, USAID, PEPFAR and UNODC. Current internationally funded projects in dedicated research sites that are being conducted in Malaysia, Ukraine, Moldova, Azerbaijan, Armenia, Kyrgyzstan and Peru. His research and training sites in Malaysia (2005), Peru (2010) and Ukraine (2005) are dedicated training and research sites for the Global Health Equity Scholars Fogarty Training Program and the Doris Duke International Fellowship program. He is currently the director for two International Implementation Science Research and Training Centers with collaborations between Yale University and the University of Malaya and Sichuan University.
  • Associate Professor of Medicine (Infectious Diseases, AIDS) and Epidemiology in the Department of Chronic Disease Epidemiology; Associate Program Director of Research, Infectious Diseases

    Dr. Meyer is an Associate Professor of Medicine and Public Health at Yale. She is a physician with board certification in Internal Medicine, Addiction Medicine and Infectious Diseases. Her clinical work has included a weekly HIV clinic at York Correctional Institution for Women, the only carceral facility for women in the state of Connecticut, which informs her investigative work. She has received formal training in clinical research methods through two post-doctoral fellowships, one in Investigative Infectious Diseases and one in Interdisciplinary HIV Prevention Training at the Center for Interdisciplinary Research on AIDS, and a Master of Science in Biostatistics and Epidemiology at Yale School of Public Health. Her research focuses on HIV prevention and treatment in women, addressing justice system involvement, substance use disorders, and intimate partner violence. She has published in a broad array of peer-reviewed journals, collaborating with interdisciplinary teams of scientists, and has been continuously funded by the NIH and other federal, industry, and foundational sources for over a decade.