In 1988, an unlinked seroprevalence study showed that nearly 1 in 5 incoming inmates to New York State (NYS) Department of Corrections and Community Supervision (DOCCS) facilities had HIV infection. Enormous challenges have been addressed in DOCCS facilities with extensive programs for HIV testing, medical care, prison medical staff education, transition planning and stigma reduction. Continuing studies have shown decreasing HIV seroprevalence in incoming inmates with 2.4% of males and 3.7% of females seropositive in 2012. With changing NYS laws on use of surveillance data and NYS’s “Ending the Epidemic” initiative, this project was undertaken to understand the extent and experience of diagnosed HIV infected persons under custody and to further intervention opportunities.
An electronic file of DOCCS inmates under custody inclusive of HIV medical diagnosis codes was matched to the NYS Department of Health (DOH) HIV Registry using probabilistic matching software. CD4 lymphocyte (CD4) and viral load (VL) data routinely reported to the HIV registry were used as a proxy for HIV-related medical care. Evidence of HIV care was defined as >1 CD4 or VL. Prevalence was based on inmates under custody on 12/31/2014, with HIV care assessed for July – December, 2014.
49,224 persons were under custody on 12/31/2014. 1,109 matched to cases in the HIV Registry, for an HIV prevalence of 2.3% (men 2.2%, women 3.7%). HIV care was assessed for 887 who were diagnosed before July 2014 and under custody continuously from July to December, 2014. Medical diagnoses codes documented that 796 (89.7%) of those were known to DOCCS as having HIV. 776 (87.4%) had evidence of HIV care, and 774 (87.2%) had a VL. VL closest to yearend was <200 copies/ml in 721 (81.2%).
This work represents the first direct measure of the prevalence of diagnosed HIV in those under custody in NYS DOCCS. Among those with diagnosed HIV, nearly 9 of 10 had disclosed their diagnosis to DOCCS and were receiving care. Viral suppression of those receiving any HIV care (90.6%) compares favorably to a similar statewide rate of 82% in 2013. The match provides important opportunities for further public health interventions, including interventions with out-of-care persons who have previously disclosed status to DOCCS, intervention with diagnosed HIV-infected incarcerated persons not in care and not known to DOCCS, and NYSDOH follow-up to assess and intervene for linkage to care post-incarceration.