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Predictors of mortality within prison and after release among persons living with HIV in Indonesia

OBJECTIVES: HIV-related mortality is increasing in Indonesia, where prisons house many people living with HIV and addiction. We examined all-cause mortality in HIV-infected Indonesian prisoners within prison and up to 24 months postrelease. MATERIALS AND METHODS: Randomly selected HIV-infected male...

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Autores principales: Culbert, Gabriel J, Crawford, Forrest W, Murni, Astia, Waluyo, Agung, Bazazi, Alexander R, Sahar, Junaiti, Altice, Frederick L
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724785/
https://www.ncbi.nlm.nih.gov/pubmed/29238241
http://dx.doi.org/10.2147/RRTM.S126131
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author Culbert, Gabriel J
Crawford, Forrest W
Murni, Astia
Waluyo, Agung
Bazazi, Alexander R
Sahar, Junaiti
Altice, Frederick L
author_facet Culbert, Gabriel J
Crawford, Forrest W
Murni, Astia
Waluyo, Agung
Bazazi, Alexander R
Sahar, Junaiti
Altice, Frederick L
author_sort Culbert, Gabriel J
collection PubMed
description OBJECTIVES: HIV-related mortality is increasing in Indonesia, where prisons house many people living with HIV and addiction. We examined all-cause mortality in HIV-infected Indonesian prisoners within prison and up to 24 months postrelease. MATERIALS AND METHODS: Randomly selected HIV-infected male prisoners (n=102) from two prisons in Jakarta, Indonesia, completed surveys in prison and were followed up for 2 years (until study completion) or until they died or were lost to follow-up. Death dates were determined from medical records and interviews with immediate family members. Kaplan–Meier and Cox proportional hazards regression models were analyzed to identify mortality predictors. RESULTS: During 103 person-years (PYs) of follow-up, 15 deaths occurred, including ten in prison. The crude mortality rate within prison (125.2 deaths per 1,000 PYs) was surpassed by the crude mortality rate (215.7 deaths per 1,000 PYs) in released prisoners. HIV-associated opportunistic infections were the most common probable cause of death. Predictors of within-prison and overall mortality were similar. Shorter survival overall was associated with being incarcerated within a specialized “narcotic” prison for drug offenders (hazard ratio [HR] 9.2, 95% confidence interval [CI] 1.1–76.5; P=0.03), longer incarceration (HR 1.06, 95% CI 1.01–1.1; P=0.01), and advanced HIV infection (CD4(+) T-cell count <200/µL, HR 4.8, 95% CI 1.2–18.2; P=0.02). Addiction treatment was associated with longer survival (HR 0.1, 95% CI 0.01–0.9; P=0.03), although treatment with antiretroviral therapy (ART) or methadone was not. CONCLUSION: Mortality in HIV-infected prisoners is extremely high in Indonesia, despite limited provision of ART in prisons. Interventions to restore immune function with ART and provide prophylaxis for opportunistic infections during incarceration and after release would likely reduce mortality. Narcotic prisons may be especially high-risk environments for mortality, emphasizing the need for universal access to evidence-based HIV treatments.
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spelling pubmed-57247852017-12-11 Predictors of mortality within prison and after release among persons living with HIV in Indonesia Culbert, Gabriel J Crawford, Forrest W Murni, Astia Waluyo, Agung Bazazi, Alexander R Sahar, Junaiti Altice, Frederick L Res Rep Trop Med Original Research OBJECTIVES: HIV-related mortality is increasing in Indonesia, where prisons house many people living with HIV and addiction. We examined all-cause mortality in HIV-infected Indonesian prisoners within prison and up to 24 months postrelease. MATERIALS AND METHODS: Randomly selected HIV-infected male prisoners (n=102) from two prisons in Jakarta, Indonesia, completed surveys in prison and were followed up for 2 years (until study completion) or until they died or were lost to follow-up. Death dates were determined from medical records and interviews with immediate family members. Kaplan–Meier and Cox proportional hazards regression models were analyzed to identify mortality predictors. RESULTS: During 103 person-years (PYs) of follow-up, 15 deaths occurred, including ten in prison. The crude mortality rate within prison (125.2 deaths per 1,000 PYs) was surpassed by the crude mortality rate (215.7 deaths per 1,000 PYs) in released prisoners. HIV-associated opportunistic infections were the most common probable cause of death. Predictors of within-prison and overall mortality were similar. Shorter survival overall was associated with being incarcerated within a specialized “narcotic” prison for drug offenders (hazard ratio [HR] 9.2, 95% confidence interval [CI] 1.1–76.5; P=0.03), longer incarceration (HR 1.06, 95% CI 1.01–1.1; P=0.01), and advanced HIV infection (CD4(+) T-cell count <200/µL, HR 4.8, 95% CI 1.2–18.2; P=0.02). Addiction treatment was associated with longer survival (HR 0.1, 95% CI 0.01–0.9; P=0.03), although treatment with antiretroviral therapy (ART) or methadone was not. CONCLUSION: Mortality in HIV-infected prisoners is extremely high in Indonesia, despite limited provision of ART in prisons. Interventions to restore immune function with ART and provide prophylaxis for opportunistic infections during incarceration and after release would likely reduce mortality. Narcotic prisons may be especially high-risk environments for mortality, emphasizing the need for universal access to evidence-based HIV treatments. Dove Medical Press 2017-03-08 /pmc/articles/PMC5724785/ /pubmed/29238241 http://dx.doi.org/10.2147/RRTM.S126131 Text en © 2017 Culbert et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution–Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Culbert, Gabriel J
Crawford, Forrest W
Murni, Astia
Waluyo, Agung
Bazazi, Alexander R
Sahar, Junaiti
Altice, Frederick L
Predictors of mortality within prison and after release among persons living with HIV in Indonesia
title Predictors of mortality within prison and after release among persons living with HIV in Indonesia
title_full Predictors of mortality within prison and after release among persons living with HIV in Indonesia
title_fullStr Predictors of mortality within prison and after release among persons living with HIV in Indonesia
title_full_unstemmed Predictors of mortality within prison and after release among persons living with HIV in Indonesia
title_short Predictors of mortality within prison and after release among persons living with HIV in Indonesia
title_sort predictors of mortality within prison and after release among persons living with hiv in indonesia
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724785/
https://www.ncbi.nlm.nih.gov/pubmed/29238241
http://dx.doi.org/10.2147/RRTM.S126131
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