Health care utilization by people with HIV on release from provincial prison in Ontario, Canada in 2010: a retrospective cohort study

ABSTRACT

Limited evidence suggests that at the time of release from prison, people with HIV face barriers to health care, which may contribute to worsening HIV clinical outcomes. We aimed to describe health care utilization for people with HIV released from provincial prison in Ontario in 2010, and to compare rates of use with prisoner and general population controls.

We used Ontario’s administrative health records and data from the Ontario Ministry of Community Safety and Correctional Services on all persons released from provincial prison in 2010. We matched each person with HIV released from provincial prison by age and sex with three controls in each of three groups: people with no HIV released from provincial prison, people with HIV in the general population, and people with no HIV in the general population. We compared rates of use of primary care, non-primary ambulatory care, emergency departments, and hospitalization in the year after the first release from provincial prison in 2010 and in the corresponding period for matched controls.

We identified 330 persons with HIV released from provincial prison in 2010. Their median time to first HIV-ambulatory care visit after prison release was 177 days (SD 136–239). Compared to all control groups, people with HIV released from provincial prison had higher rates of primary care use, unscheduled emergency department visits and hospital admissions at 30, 90 and 365 days after release.

People with HIV released from provincial prison have a long time to first contact with HIV ambulatory care, and higher rates of health care utilization across health care settings. Interventions are required to facilitate post-release linkage to care for this population.

KEYWORDS:

• HIV
• healthcare
• prison
• incarceration
• primary care

Acknowledgments

We acknowledge the contributions of the Ontario Ministry of Community Safety and Correctional Services, which supported the study.

Parts of this material are based on data and/or information compiled and provided by CIHI. However, the analyses, conclusions, opinions and statements expressed in the material are those of the authors, and not necessarily those of CIHI.

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources and the Ministry of Community Safety and Correctional Services (MCSCS). No endorsement by ICES, or the Ontario MOHLTC or MCSCS is intended or should be inferred.

Tony Antoniou is supported by a New Investigator Award from the Canadian Institutes for Health Research.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement: We are not able to share data because of restrictions specified in our Research Agreement with the Ministry of Community Safety and Correctional Services (MCSCS) and in the data sharing agreements of the Institute for Clinical Evaluative Sciences. Persons who would like to request access to data from the MCSCS would need permission from the MCSCS, and should direct requests to Michael Kirk at [email protected]. Access to data at ICES can be granted to those who to meet pre-specified criteria for confidential access, available at www.ices.on.ca/. Requests to access ICES data for research purposes may be submitted to ICES’ Data and Analytic Services, with information at http://www.ices.on.ca/DAS and contact: [email protected].

Data deposition: Not applicable.

Additional information

Funding

This work was supported by the Foundation for Advancing Family Medicine of the College of Family Physicians of Canada and Physicians’ Services Incorporated Foundation.