Methods: This retrospective analysis reviewed electronic health records of detainees with confirmed HIV infection detained at any of the 21 IHSC-staffed nationwide facilities between January-December 2015 and January-August 2017. Using SAS software V.9.3, odds ratios, 95% CI, chi-square, univariate and multiple logistic regression analyses were utilized to assess and compare relationships between independent variables and CoC for 2015 and 2017.
Results: 508 HIV infected detainees were identified; they were predominately male (88.4%), born in Mexico (37%), generally had CD4 counts greater than 200 (86.2%) and had an established diagnosis of HIV prior to entering custody (94.1%). Among all primary variables assessed for predictive association to CoC, female gender and infectious disease (ID) consultation were statistically significant (p=0.0.0058, 0.0085) after adjusting for all other variables. Compared to all other detainees, our sample was in custody twice as long (61 days vs 31 days, p<0.001). In 2015 and 2017, 91% of detainees received ART during custody, and CoC prior to release nearly doubled from 29.4% in 2015 to 59.6% in 2017.
Conclusion: Discussing CoC with ICE detainees is imperative given their increased risk for treatment interruption. Our results emphasize that 1) CoC discussion should happen early in custody stay as most detainees have left our care system within two months of entry, 2) providers should be aware of possible bias during counseling and offer the same level of CoC discussion regardless of gender or clinical parameters. Questions prompting and reminding providers to have CoC discussions should be included in HIV-specific templates during the initial health assessment.
M. Yang, None
E. Lederman, None