HIV prevention and care efforts in the United States increasingly focus on supporting HIV care engagement and antiretroviral treatment (ART) utilization [1,2,3]. Studies show that continual adherence to an appropriate ART regimen in persons living with HIV (PLWH) is highly effective at suppressing HIV to an undetectable level, preventing progression to AIDS and HIV-related mortality, as well as substantially lowering the risk of HIV transmission to seronegative persons [2, 4,5,6,7]. Routine HIV care engagement is a key predictor of ART adherence and is also important for detecting ART resistance [3, 8, 9]. National health improvement strategies such as the National HIV/AIDS Strategy and Healthy People 2020 include objectives to reduce and eventually eliminate gaps in continual HIV care engagement and ART adherence [1, 10].

Since the 1990s, the federal government has provided funding to cover an array of financial, social, and medical services through the Ryan White HIV/AIDS Program (RWHAP) to ensure all PLWH have access to HIV care and treatment regardless of socioeconomic status [9, 11]. Nonetheless, racial and socioeconomic disparities in HIV care engagement and viral suppression rates have long persisted and contribute to significant disparities in AIDS incidence, AIDS-related mortality, and HIV infection among persons of color [12, 13]. A growing body of research shows that disparities in HIV care engagement and treatment utilization are associated with the intersection of multiple oppressive inequities and stigmas related to race, sexual orientation, and gender identity [14,15,16,17,18,19,20,21].

These same social conditions also render PLWH particularly vulnerable to incarceration in the US criminal justice system [22,23,24]. One in six PLWH in the US cycle through correctional facilities annually and the HIV prevalence among persons incarcerated in prisons is 3.5 times that of the general population [25, 26]. The state of Louisiana currently has the highest incarceration rate and the second highest HIV infection rate in the country. Louisiana’s prison system also has the second highest HIV prevalence among incarcerated persons at 3.5% [25]. As such, prisons have been recognized as important settings for HIV care initiatives. With the assistance of government funding, more and more state and federal prisons have implemented opt-out or opt-in HIV testing efforts to identify PLWH [22,23,24, 27,28,29,30]. Prisons are required to provide ART to known PLWH while they are incarcerated. Compared to PLWH in the community, PLWH in correctional facilities have been shown to have relatively high rates of HIV care engagement, ART adherence, and HIV viral suppression [27, 30,31,32]. However, these trends are not sustained upon release. It is estimated that three-fourths of PLWH who were treated during incarceration will discontinue HIV care or become sub-optimally adherent to ART within 90 days after release [30, 32, 33]. Recently released PLWH have also been shown to experience substantial increases in HIV viral load, reversal of viral suppression status, and shorter duration before progressing to an AIDS diagnosis [22, 30,31,32, 34]. This downturn in HIV health maintenance comes at a notably precarious time as recently released persons are vulnerable to behaviors that carry a high risk of HIV transmission, such as unprotected sex with previous and new partners and relapses in substance abuse, including injection drug use [35,36,37,38,39,40].

PLWH that have recently been released from a correctional facility may face an onslaught of financial and social barriers that have been shown to hinder access to HIV care and ART. Due to incarceration-related stigma, many newly released PLWH face ostracism and disapproval from their support system (family, friends, etc.), as well as extensive discrimination in employment opportunities, housing, education, and safety net programs such as food and housing assistance [34, 39,40,41,42,43,44]. Under these conditions, PLWH may prioritize fulfilling basic needs for survival and avoiding stigma over maintaining their HIV and overall health. Other barriers to engagement in HIV care and support services include encountering or anticipating stigmatized treatment from provider staff and physicians, difficulties navigating bureaucratic benefits systems, and transportation needs [34, 39,40,41,42,43,44]. Recently released PLWH are also at a high risk of struggling with untreated substance use disorders and mental health issues that are known to interfere with HIV care engagement and ART adherence goals [34, 36, 45,46,47,48,49].

Some prison systems offer pre-release reentry services aimed at helping PLWH link to HIV medical and other critical support services upon release and prepare for challenges that may arise while transitioning to life in the community. Clients enrolled in these services may receive referrals to medical and HIV-related case management providers in the community, information on social support services in the community, and assistance developing a transition strategy. In some states, staff may be able to assist with making initial medical and case management appointments and filling out applications for safety net programs (such as Medicaid, food stamps, and drug assistance programs) before the person’s release date. If available, reentry case managers can also conduct needs and goals assessments, help clients develop HIV care and transmission risk reduction plans, and provide psychosocial support. Receiving pre-release reentry services is highly associated with timely linkage to HIV care and continual ART adherence after release [28, 33, 39, 47, 48, 50,51,52]. Nonetheless, few prisons that house and treat incarcerated PLWH have the resources needed to offer pre-release reentry services that are comprehensive enough to be optimally effective [28, 32, 48, 53].

In Louisiana state prisons, adult PLWH are offered an array of pre-release reentry services provided by Louisiana’s Department of Health – Office of Public Health’s STD/HIV Program (SHP) and typically receive up to 2 weeks’ worth of ART from the prison infirmary at time of release to prevent an interruption in ART adherence prior to linking to an HIV care provider in the community. For over two decades, SHP has struggled to maintain the capacity of the reentry services offered due to fluctuating levels of federal and state funding and support from care providers in the community. By 2008, SHP had one RWHAP-funded corrections specialist who was responsible for providing discharge planning and limited reentry case management to all incarcerated PLWH before release. Between 2009 and 2011, 59% of those who received reentry services had linked to HIV care within 90 days after release. This result was within the range of linkage rates demonstrated by other pre-release reentry programs around this time, however, caseloads increasingly became unmanageable for one staff person and programs with more extensive reentry case management services produced better results [23, 50,51,52, 54, 55].

In 2013, SHP secured funding from the Health Resources and Services Administration (HRSA) through the Special Projects of National Significance (SPNS) grant to hire an additional corrections specialist and pilot the use of video conferencing to connect incarcerated PLWH to RWHAP-funded case managers from community-based organizations (CBOs) in their communities before release. Case managers would provide reentry case management via video conference to create a plan for addressing challenges and barriers to HIV care and ART use and potentially establish a relationship with the client that included mutual trust and respect. Upon release, clients would have an opportunity to link to the same case manager who they interacted with during the video conference. Studies show that recently released PLWH are more likely to experience and anticipate less stigmatizing treatment and continually engage with providers in the community who maintain these types of relationships, especially if these relationships are active during incarceration [40, 42, 47, 56]. Video conferencing was chosen as the mode of service delivery in order to foster a more personal connection and save limited resources that would have otherwise been spent having the case managers travel to various prison facilities across the state and undergo the varying security procedures required for entering the facilities. SHP envisioned that this initial interaction with the case manager would promote prompt linkage to case management upon release. Once enrolled in case management in the community, clients would receive further assistance with linking to HIV care and other services that may support continual retention in HIV care and adherence to ART, such as mental health and substance abuse services, other non-HIV medical services, housing, food, transportation, and employment.

This paper describes the impact of adding the case management video conference supplement to the standard array of pre-release reentry services offered. The primary outcome was the likelihood of linking to HIV care within 90 days following release among recently released PLWH.