Two interventions in particular—patient navigation services featuring peer support and substance use treatment—appear especially successful at improving HIV care engagement and viral suppression among PLWH who return to the community from jail or prison, a systematic literature review reported in Journal of Acquired Immune Deficiency Syndromes showed.
Researchers examined 27 studies, 23 of which were peer-reviewed. Seventeen studies evaluated individual-level interventions, but these generally were no more successful than typical discharge planning, although the study authors suggested this could be in part due to insufficient local resources. (Case management only works if there are easily accessible services to which clients can be linked, after all.)
Functional support was key to the success of interventions, the authors found; they cited impactful examples such as accompanying individuals to appointments at which they had to complete paperwork, and ensuring that people feel valued as they reenter the community.
Re-entry programs should be informed by post-release, peer-supported patient navigation, as well as medication treatment for substance use, study authors recommended.
While these types of support are helpful, they are not enough on their own to ensure a successful transition to HIV care after incarceration, a trio of authors noted in an accompanying commentary. Jacob A. Pluznik, BSc, Ank E. Nijhawan, M.D., M.P.H., and Anne C. Spaulding, M.D., M.P.H., focused on the potential for long-acting injectable antiretrovirals to be helpful in this scenario: Assuming that ongoing research on the efficacy of long-acting therapy in people with adherence challenges is successful, people in jail or prison could be given the injection before returning to the community, providing them time to deal with subsistence needs without compromising viral suppression, they suggested.