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.

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

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.

Results of this study have been published and can be found at:

https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(17)30209-6/abstract

https://idsa.confex.com/idsa/2017/webprogram/Paper62773.html