Linkage to care and HIV positive individuals who were diagnosed in a correctional facility: The Florida Cohort Study Dilser V. Ayala, Gladys E. Ibañez, Ph.D, Robert Cook, Ph.D., Christa Cook, Ph.D., Jordan See, Jaime Morano, M.D., M.P.H., and Zhi Zhou, Ph.D. 1 out of 6 persons living with HIV/AIDS in the U.S. will go through the correctional system in any given year 1. The current HIV prevalence rate in correctional facilities is 6 times higher than in the U.S. population 1. The correctional system can provide much needed healthcare services including HIV testing and linkage to care in the community upon release. It is unclear whether testing positive in a correctional versus a non-correctional setting leads to better linkages to care. Therefore, this study examines linkage to care for those diagnosed in a correctional settings compared to those diagnosed elsewhere. Of the 651 participants currently enrolled, 69% (n=436) reported being incarcerated at least once. Those who reported being incarcerated versus never incarcerated were more likely to be non-Hispanic Black (68.6% vs 46.7%; p <.0001); more likely to have less than a high school education; more likely to be unable to work or disabled; more likely to live further than 1 hour away from their HIV care provider; and more likely to have an HIV case manager. Fourteen percent (n=88) of the participants enrolled were diagnosed with HIV in a correctional facility. Those diagnosed in a correctional facility were more likely to have less than a high school education; more likely to live further than one hour away from their HIV care provider; more likely to take longer than 6 months from testing to treatment; and more likely to be homeless than those diagnosed elsewhere. Those diagnosed in a correctional facility had 179% (OR=2.79; 95% CI [1.70, 4.57]) greater odds of taking more than six months from testing to care compared to those diagnosed elsewhere (see Table 1). After removing those with no incarceration history, participants diagnosed in a correctional facility were less likely to be alcohol consumers; still more likely to live further than an hour away from their HIV care provider; and still more likely to take longer than 6 months from testing to treatment. Participants. The study utilizes data from The Florida Cohort Study, from which 651 participants with HIV have been enrolled across the state of Florida. Recruitment took place at multiple sites across the state where participants took a self-administered survey. Measures. Demographics, alcohol use, incarceration history (Yes/No); HIV Care (e.g., time from diagnosis to care, distance to provider); linkage to care (e.g. do you have a case manager) Qualitative data on reasons for delaying HIV care upon diagnosis was obtained through the following question: What was the main reason you didn’t go to a doctor, nurse, or health care worker for HIV medical care within 6 months of testing positive for HIV? Data Analysis. Descriptive statistics (frequencies) and cross tabulations were conducted. There seems to be a lag in linkage to care for those who were diagnosed in correctional settings. Reasons for this lag is still unclear. The major reasons for delayed care between those diagnosed in correctional facilities and elsewhere overlap, although those who were incarcerated mentioned incarceration as a main reason for this delay. Persons diagnosed inside and outside of correctional facilities need help dealing with fear, denial, and drug use to improve linkage to care. Future studies, including qualitative studies, are needed to understand the linkage to care process for those who are incarcerated and diagnosed inside correctional settings. 1. AIDS InfoNet. (2014, February 24). Fact sheet number 615: HIV in prisons and jails. Retrieved from Southern HIV & Alcohol Research Consortium (SHARC) Conference HIV and Alcohol Symposium (Florida International University, Miami, Florida, ; May 17-18, 2016 SHARC is a collaboration effort funded by NIH and involves faculty from:  Florida International University  University of Florida  RUSH University SHARC is a collaboration effort funded by NIH and involves faculty from:  Florida International University  University of Florida  RUSH University Introduction Methods Figure 1. Reasons of delayed care depending on location of diagnosis Diagnosis in correctional facility Diagnosed elsewhere Results Incarceration history ( n = 651) Location of diagnosis ( n = 651) Location of Diagnosis only among those with incarceration history (n= 451 ) Incarcerated Never incarcerated Diagnosed in a correctional facility Diagnosed Elsewhere Diagnosed in a correctional facility Diagnosed Elsewhere Less than a high school education 37.4*** 20.8*** 44.1** 31.9** Current alcohol consumers * 75.8* Live further than 1 hour away from HIV care provider 19.1** 11.5** 26.9** 15.1** 27.3* 16.6* Took longer than 6 months from testing to treatment *** 15.0*** 33.7** 16.7** Homeless 21.8*** 10.6*** 27.2* 16.5* Unable to work or disabled 53.5*** 39.8*** HIV case manager 86.3** 75.7** *p<.05**p<.01 ***p<.001 Table 1. Demographics and Linkage to Care by Incarceration History and Site of Diagnosis Literature Cited Conclusion/Discussion Reasons for delayed HIV care after diagnosis was provided by 92 participants. The qualitative results show that fear, denial, and drug use are the main reasons for delaying HIV care after diagnosis regardless of whether they were diagnosed in a correctional facility or elsewhere. Although, for those who were diagnosed in a correctional facility, being incarcerated was also mentioned as a common reason for delaying.