Use of an mHealth Intervention to Improve Engagement in HIV Community-Based Care Among Persons Recently Released from a Correctional Facility in Washington, DC: A Pilot Study

AIDS Behav. 2019 Apr;23(4):1016-1031. doi: 10.1007/s10461-018-02389-1.

Abstract

We examined the preliminary effectiveness of a computerized counseling session plus post-incarceration text messaging intervention (CARE + Corrections) to support ART adherence and linkage/engagement in community care among recently incarcerated persons with HIV in Washington, D.C. Recently incarcerated persons with HIV ≥ 18 years old were recruited from the D.C. jail or community outreach and randomized to CARE + Corrections or control arm. Participants completed assessments at baseline, 3-months and 6-months. Multivariable random effects modeling identified predictors of suppressed viral load (≤ 200 copies/mL) and engagement in HIV care at 6 months. Participants (N = 110) were aged 42 (IQR 30-49); 58% male, 24% female, 18% transgender, 85% Black, and lifetime incarceration was a median of 7 years (IQR 2-15). More controls had a regular healthcare provider at baseline. Although not statistically significant, intervention participants had increased odds of viral suppression versus controls at 6 months (AOR 2.04; 95% CI 0.62, 6.70). Those reporting high ART adherence at baseline had higher odds of viral suppression at follow-up (AOR 10.77; 95% CI 1.83, 63.31). HIV care engagement was similar between the two groups, although both groups reported increased engagement at 6 months versus baseline. We observed a positive but non-significant association of viral suppression in the CARE + Corrections group, and care engagement increased in both groups after 6 months. Further attention to increasing viral suppression among CJ-involved persons with HIV upon community reentry is warranted.

Keywords: Engagement in care; HIV; Incarcerated persons; mHealth.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Anti-Retroviral Agents / therapeutic use*
  • Counseling
  • Criminals*
  • Delivery of Health Care*
  • District of Columbia
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / psychology
  • HIV Infections / virology*
  • Humans
  • Male
  • Medication Adherence*
  • Middle Aged
  • Pilot Projects
  • Prisons*
  • Retention in Care
  • Telemedicine*
  • Text Messaging
  • Viral Load

Substances

  • Anti-Retroviral Agents