Second, we identified patients who had been newly diagnosed while incarcerated in and who presented to the AIDS Center post-release. This second set of patients was defined as having received clinical care post-release. Data from both sets of patients—those diagnosed pre and those diagnosed in —were used to examine utilization of care post-release.
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The members of the research team from the AIDS Center completed the chart review and data abstraction, stripping the dataset of all personal identifiers. Analyses were limited to descriptive statistics due to the small sample size. By Russian research ethics standards, this research using de-identified data was considered exempt from review. Of these individuals tested in , Available demographic characteristics are presented in table 1. The who were not registered may represent individuals who were still incarcerated or had been released from prison and, for whatever reasons, chose not to seek care at the AIDS Center.
Per the residence information noted in the medical records, Three individuals indicated that they were homeless, six lived in the adjacent Leningrad Oblast, and two lived outside of the St. Petersburg region. The remaining Nineteen individuals 6. Forty-five Care utilization characteristics are presented in table 2. Of these, The remaining 63 Table 2 Care utilization among HIV-positive patients with histories of incarceration. Thus, a total of However, treatment information from medical charts indicated that that only TB diagnostic tests were performed for of the patients post-release.
Of these , 40 Of individual charts, only Five individuals indicated ephedrine or other stimulant use. Although almost all opioids and stimulants are administered intravenously, only 18 individuals had records indicating intravenous injection. Nine individuals reported combined alcohol and opiate abuse, while six reported simultaneous consumption of several drugs. Petersburg, Russia, with histories of incarceration. There are several data limitations that must be addressed that are indicative of the problems faced in attempting to understand and improve the systems for transitioning patients from prison to HIV care upon release and the overall system of patient record keeping.
Additionally, because HIV testing is mandated upon entry into the penal system and medical records of incarcerated individuals are not transferred from non-penal medical services, all newly incarcerated individuals are HIV tested upon arrival. Future efforts examining this issue will require closer collaboration with the correctional system so that medical records for incarcerated persons can be made available, even in de-identified form to ensure confidentiality.
The second limitation was the lack of access to other forms of data relevant to our inmate sample. Our findings represent estimates of those who successfully linked to care following release from incarceration.
In order to address this, we employed the capture-recapture method described earlier. It is very likely that the actual number of AIDS Center patients with incarceration histories is far greater than what we found.
On this last point, we have no denominator for the prisoners in our set of individuals who were released in the 3-year follow-up period, making it impossible to determine the proportion of patients who successfully linked to care. Another limitation pertains to the availability and quality of medical chart data regarding substance use and comorbidities.
It is probable that the majority of the individuals identified in this study had histories of substance use, as the number of charts indicating substance use experience is surprisingly low compared with other data about substance use histories particularly injection in prison populations. Similarly, there was a surprising lack of information in the medical charts about disease comorbidities. The lack of consistent information about TB testing could reflect poor data collection by health care providers e.
This information is relevant to the provision of comprehensive clinical care but was not noted in the charts. This absence of data may reflect the siloed medical care delivery systems that are common in post-Soviet Russia and demonstrates the need for integrated clinical care across medical specialties and disciplines. This would facilitate future efforts to examine incidence and prevalence of HIV-associated comorbidities among larger cohorts of individuals receiving care.
With substance use as a core driver of HIV and incarceration in Russia, it is disconcerting that so little is known about the HIV care trajectories of people with incarceration histories. Our finding that only a third of the patients were receiving HAART is troubling and may be attributable to a number of factors, including not meeting treatment eligibility requirements for that time or regulations discouraging HAART initiation among active PWID who had not previously completed a 6-month abstinence from substance use.
Regardless of whether or not these restrictions were justified, they did affect who had HAART access. Our findings reflect what is happening more broadly in the Russian context. A second strength of this study is that it illuminates the urgent need for more effective systems to link formerly incarcerated individuals to community-based health care and services. This is critical given that many individuals have multiple incarcerations over a life time, risking repeated disruptions in clinical care. Programmes providing community-based support and care are needed, as well as programmes to ensure linkage to and retention in such services for incarcerated persons transitioning back to communities post-release.
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Further research and intervention efforts are warranted, as untreated or undertreated HIV infection is deleterious both for infected individuals and for achieving and maintaining low community viral load. The authors would like to thank the medical records personnel at the St. Petersburg AIDS Center for their assistance in locating and abstracting the data from the medical records included in this study.
This study is one of the first to examine the clinical histories of HIV-infected persons in St. Petersburg, Russia, who have histories of incarceration. Of these individuals tested for HIV in prison in , Of the individuals examined for tuberculosis infection post-release, Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
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Sign In. Advanced Search. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents. HIV-care access among people with incarceration experience in St. Petersburg, Russia Monica S Ruiz.
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Correspondence: Monica S. Oxford Academic. Google Scholar. Robert Heimer. Olga S Levina. NGOStellit, St. Petersburg, Russsian Federation. N V Badosova. Vadim V Rassokhin. If any of these are available and willing, their signature on a release form with a death certificate could see you in possession of any records you need.
If so, how? Thank you so much for your time. With regrets for you and I. He was bipolar I have no mental illness diagnoses and my son who could be irrational, at times denied me access during his life, even though he lived with me and I helped him in many ways. I believe I could have saved his life if I could have been involved. He had no estate or family besides myself and his sister.
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Do I have to go through an expensive court proceeding in order to get to become his personal representative? Can I present his birth certificate and death certificate only? This service company told me I need to go to probate. How does a long time partner become a personal representative in order to access medical records after death of their partner?
Medical and General Power of Attorney cease once person dies. Should a will have been made? How long does a hospital have to keep medical records? I am trying to get information concerning my fathers cancer surgery for Aug.