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Study Shows Few Texas Prisoners Transition Well to Community HIV Treatment

by Matt Clarke

On February 25, 2009, the Journal of the American Medical Association (JAMA) published an article which reported what percentage of Texas prisoners who were receiving Anti-Retroviral Therapy (ART) for HIV while in prison accessed ART drugs after release. The article showed that only half the prisoners applied for ART drugs within 90 days of being released from prison and only one-fifth of them did it in time to avoid treatment interruption.

Texas prisoners who are receiving ART are given a ten-day supply of ART drugs, a copy of their HIV lab report, a list of clinicians treating HIV in their home community, a Texas AIDS Drug Assistance Program (ADAP) application form and an ADAP medication certification form signed by a physician when released from prison. They are told to contact ADAP to receive at least another 30 days of ART drugs for free. To apply for drugs through ADAP requires filling out a 4-page ADAP application. The application and a 1-page form filled out by a clinician detailing current laboratory values must be submitted to the central ADAP office. Then the applicant contacts an ADAP caseworker via a toll-free phone number. The caseworker assigns the applicant to an ADAP-approved pharmacy that receives the ART drugs from ADAP. The whole process takes from five to ten days. Subsequent 30-day supplies of ART drugs are available from ADAP to applicants who meet the financial criteria for assistance. Almost all newly-released prisoners would qualify.

The article studied all 2,115 prisoners receiving ART released from the Texas Department of Criminal Justice (TDCJ) from 2004 through 2007. The authors checked ADAP records to see which of them had applied for ART drugs through ADAP and when they did so.
Because the releasees are given only a 10-day supply of ART drugs and the ADAP process takes five to ten days, it is especially important for ADAP applications to be submitted quickly. However, only 5% of the releasees filled an ADAP prescription within 10 days of release. TDCJ has an ADAP application assistance program and prisoners who had that service were much more likely to apply for ADAP and to do so in a timely fashion. However, the service was new, underfunded and not available to all the releasees. Overall, only 53.1% of the releasees filled an ADAP prescription within 90 days of release. Only 80% of the 53.1% filled a second ADAP prescription.

Releasees who were under 30 or over 50, belonged to a minority group, had detectable viral loads under 200 or were incarcerated less than a year were less likely to timely fill an ADAP prescription. Those receiving ADAP application assistance, with undetectable viral loads and released on parole or mandatory supervision were more likely to timely fill an ADAP prescription. Notably, receiving ADAP application assistance resulted in a threefold improvement in timely filling an ADAP prescription and erased the twofold difference between racial/ethnic groups.

Source: Accessing Antiretroviral Therapy Following Release From Prison, JAMA, February 25, 2009--Vol. 301, no. 8, pp. 848-857, available at

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