Danielle F. Haley|Carol E. Golin|Claire E Farel|David A. Wohl|Anna Scheyett|Jenna J. Garrett|David L. Rosen|Sharon Parker
Multilevel challenges to engagement in HIV care after prison release: a theory-informed qualitative study comparing prisoners’ perspectives before and after community reentry
Georgia Department of Public Health|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|University of South Carolina|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|Miriam Hospital|Providence College|Brown University
although prison provides opportunity hiv diagnosis access inprison care following release many hivinfected inmates experience clinical setbacks including nonadherence antiretrovirals elevations viral load hiv disease progression hivinfected former inmates face numerous barriers successful community reentry accessing healthcare however little known outcome expectations hivinfected inmates release postrelease lives align prerelease expectations processes influence engagement hiv care following release prison conducted semistructured interviews 24 pre 13 postrelease hivinfected inmates enrolled randomized controlled trial case management intervention enhance postrelease linkage care two researchers independently coded data using common codebook intercoder reliability strong kappa 086 analyzed data using grounded theory methodology applied thematic analysis collected compared baseline sociodemographic behavioral characteristics cohort participants participate qualitative interviews using fishers exact tests categorical measures wilcoxon ranksum tests continuous measures participants heterosexual middleaged single african american men women histories substance use substudy participants likely anticipate living familyfriends needing income assistance postrelease taking antiretrovirals prior release anticipated needing help securing health benefits medications postrelease release participants felt confident would able manage hiv however upon release many experienced intermittent prolonged periods antiretroviral nonadherence largely due substance use relapse delays care initiation substance use precipitated stressful life experiences including stigma contact drugusing social networks informed social cognitive theory hiv stigma framework findings illustrate reciprocal relationships among substance use experiences stigma pre postrelease environments skills needed engage hiv care findings underscore need comprehensive evidencebased interventions prepare inmates transition incarceration freedom particularly strengthen linkage hiv care focus realities reentry including stigma meeting basic needs preventing substance abuse identifying community resources