Interventions to improve HIV care continuum outcomes among individuals released from prison or jail: Systematic literature review.

Woznica, Daniel M; Fernando, Nimasha B; Bonomo, Elizabeth J; Owczarzak, Jill; Zack, Barry; Hoffmann, Christopher J

BACKGROUND HIV care continuum outcomes deteriorate among people returning from incarceration. Interventions to improve care outcomes post-incarceration have been characterized by substantial heterogeneity in approach, outcome metrics, and results. A large number of recently published interventions have not been systematically reviewed. METHODS We searched peer reviewed and scholarly databases for published and grey literature describing interventions to improve HIV care continuum outcomes among individuals released from prison or jail. We systematically screened quantitative and qualitative intervention reports published through 2018, then extracted and analyzed study data using a classification scheme that we developed for categorizing intervention levels and strategies. RESULTS We included 23 reports from peer-reviewed literature, two from grey literature, and two from conference abstracts (27 total). Seventeen studies were classified as individual-level, three as biomedical-level, two as organizational-level, and five as multilevel. Nine studies were randomized controlled trials, four of which reported power calculations. Fifteen studies were quasi-experimental; one was a case study. Eleven studies were conducted in prisons, seven in jails, and nine in both prisons and jails. Of 11 studies reporting hypothesis tests, five found statistically significant effect sizes on primary outcomes. CONCLUSION Interventions that demonstrate post-release improvements in clinic attendance and viral suppression include patient navigation strategies, especially involving peer support, and substance use treatment strategies. FUNDING NIH #5R34MH115777.