Adherence Support May Improve Viral Suppression in Incarcerated Patients With HIV

A low percentage of those who had spent more than 7 days in jail or detention in the previous 12 months had achieved sustained viral suppression (SVS), indicating the need for better support, according to a recent analysis.1 Adherence support and discharge planning could help these individuals maintain viral suppression even after being released.

There are approximately 12,460 individuals in prison living with HIV as of 2023, accounting for a 1.1% prevalence of HIV in correctional facilities compared with a 0.3% prevalence in the general population.2,3 Maintaining SVS is challenging for those who are recently incarcerated due to social conditions such as an inadequate link to their care due to a lack of housing or poor health care access, along with other mental health disorders. HIV viral load has been found to increase in the recently incarcerated population as they reincorporate into the world. This study aimed to identify what factors lead recently incarcerated individuals with HIV to have SVS to understand how to target these individuals.1

Recently incarcerated individuals with HIV were less likely to have sustained viral suppression | Image credit: methaphum - stock.adobe.com

The researchers used the Medical Monitoring Project to collect data on patients with HIV who were recently incarcerated between 2015 and 2022. Data was collected from the US as well as Puerto Rico. Data were collected between June 2015 and May 2023, with eligible individuals needing to be aged 18 years and older, have an HIV diagnosis, and reside in a project area of the Medical Monitoring Project.

A medical documentation of viral load that was less than 200 copies/mL on all viral load tests after a patient’s most recent release was used as the definition of SVS. An individual who answered that they had been in jail, detention, or prison for longer than 24 hours in the previous 12 months at least 1 time and were not currently incarcerated was defined as being recently incarcerated. Sociodemographic data were self-reported.

There were 1012 recently incarcerated individuals with HIV that were included in the study who were separated into SVS and non-SVS groups. Approximately 30.8% of the respondents were 50 years or older, and 83.6% were men. Non-Hispanic Black individuals made up 50.8% of the respondents, and 49.0% identified as heterosexual; only 39.7% had more than a high school education. A total of 70% of the overall respondents did not achieve SVS after they were released.

Individuals with HIV aged 18 to 29 years (prevalence ratio [PR], 1.16; 95% CI, 1.01-1.32) or 30 to 39 years (PR, 1.20; 95% CI, 1.06-1.35) had a higher chance of not having SVS compared with those aged 50 years or older. SVS was also less common in those who had been released within the previous 6 months, as those who had been released in the past 60 days (PR, 1.44; 95% CI, 1.29-1.61) and those released in the previous 61 to 180 days (PR, 1.18; 95% CI, 1.03-1.34) were less likely to have SVS compared with those released more than 6 months prior. Those who were incarcerated 3 or more times were also less likely to have SVS compared with those incarcerated once (PR, 1.25; 95% CI, 1.12-1.39).

Individuals with SVS were more likely to be taking antiretroviral therapy (ART), be adherent to ART, and be retained in care for HIV after they were released compared with those without SVS.

There were some limitations to this study. Causality could not be established due to it being an observational cross-sectional study. There was a small sample size, and the type of correctional facility was not specified. Missing data was possible due to all medical records being abstracted for the most frequent source of data for a participant, which could have left out data from other medical centers. Patients self-reported demographic data. Unmeasured confounders could have affected results.

“Improving continuity of care through approaches such as prerelease discharge planning and postrelease support may help improve SVS in this population,” the authors concluded. “Future research could explore the potential impact of tailored strategies, particularly for younger populations and those with multiple incarcerations on long-term care engagement and treatment adherence.”

References

1. Boothe D, Reyes JV, Myles RL, et al. Characteristics associated with sustained viral suppression status among people with HIV who were incarcerated in the past 12 months, 2015-2022. Public Health Rep. Published online November 3, 2025. doi:10.1177/00333549251378100

2. Maruschak LM. HIV in prisons, 2023 – statistical tables. June 2025. Accessed November 3, 2025. https://bjs.ojp.gov/library/publications/hiv-prisons-2023-statistical-tables/web-report

3. U.S. statistics. HIV.gov. Updated September 18, 2025. Accessed November 3, 2025. https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics