The availability of antiretroviral therapy (ART) has markedly reduced HIV-related mortality and morbidity in Africa. Yet HIV remains the leading cause of death among adult men and women in South Africa due fails to initiated ART or remain in care. Between 2 and 3% of HIV-infected men in South Africa pass through the corrections system annually. While incarcerated uptake of ART is excellent, unfortunately after release most are lost from care. Qualitative and quantitative research conducted by the research team with 492 ex-inmates in South Africa indicates that upon release from correctional settings, this population encounters confusion regarding where and when to receive care, long queueing times, family abandonment and limited social capital, enacted stigma, economic insecurity, and substance use (injection drug use reported by 11% of our participants). This project seeks to further characterize loss from care following release and to develop and pilot test a group support and HIV care model to retain ex-inmates in HIV care. This support group approach is based on adapting the South African community adherence clubs for a special vulnerable population. Such a care and support group for ex-inmates transitioning in care (a transition community adherence club or TCAC) has the potential to simultaneously address the multiple barriers to medical care through addressing social and care delivery barriers. We hypothesize that intervening on these levels will impact retention in care, virologic suppression, morbidity, and HIV transmission. The current proposal will allow for the development and piloting of this TCAC strategy to improve HIV care for ex-inmates to increase knowledge regarding care engagement for ex-inmates and to prepare for a randomized clinical trial of the TCAC powered for an effectiveness outcome of in-care with an undetectable viral load at 6 months after release.

Public Health Relevance

HIV remains the leading cause of death in South Africa as a result of a failure of people living with HIV to seek HIV treatment and be retained in care. After initiating antiretroviral therapy while incarcerated, most ex-inmates fail to remain engaged in care. The goal of this research is to reduce mortality, morbidity, and HIV transmission by developing an actionable approach to retaining these individuals in HIV care.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Planning Grant (R34)
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Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
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Gordon, Christopher M
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Johns Hopkins University
Internal Medicine/Medicine
Schools of Medicine
United States
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Ndlovu, Derrick T; Hoffmann, Christopher J (2018) Including the criminal justice-involved at the HIV policy, research and service delivery table. J Int AIDS Soc 21:e25145