Gabriel J Culbert, Forrest W Crawford, Astia Murni, Agung Waluyo, Alexander R Bazazi, Junaiti Sahar, Frederick L Altice
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Kaplan-Meier and Cox proportional hazards regression models were analyzed to identify mortality predictors.</p><p><strong>Results: </strong>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 in released prisoners (215.7 deaths per 1,000 PYs). 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; <i>P</i>=0.03), longer incarceration (HR 1.06, 95% CI 1.01-1.1; <i>P</i>=0.01), and advanced HIV infection (CD4<sup>+</sup> T-cell count<200cells/μL; HR 4.8, 95% CI 1.2-18.2; <i>P</i>=0.02). Addiction treatment was associated with longer survival (HR 0.1, 95% CI 0.01-0.9; <i>P</i>=0.03), although treatment with antiretroviral therapy (ART) or methadone was not.</p><p><strong>Conclusions: </strong>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. Narcotics prisons may be especially high-risk environments for mortality, emphasizing the need for universal access to evidence-based HIV treatments.</p>","PeriodicalId":21138,"journal":{"name":"Research and Reports in Tropical Medicine","volume":"8 ","pages":"25-35"},"PeriodicalIF":3.1000,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/RRTM.S126131","citationCount":"15","resultStr":"{\"title\":\"Predictors of Mortality within Prison and after Release among Persons Living with HIV in Indonesia.\",\"authors\":\"Gabriel J Culbert, Forrest W Crawford, Astia Murni, Agung Waluyo, Alexander R Bazazi, Junaiti Sahar, Frederick L Altice\",\"doi\":\"10.2147/RRTM.S126131\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>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 post-release.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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 in released prisoners (215.7 deaths per 1,000 PYs). 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; <i>P</i>=0.03), longer incarceration (HR 1.06, 95% CI 1.01-1.1; <i>P</i>=0.01), and advanced HIV infection (CD4<sup>+</sup> T-cell count<200cells/μL; HR 4.8, 95% CI 1.2-18.2; <i>P</i>=0.02). Addiction treatment was associated with longer survival (HR 0.1, 95% CI 0.01-0.9; <i>P</i>=0.03), although treatment with antiretroviral therapy (ART) or methadone was not.</p><p><strong>Conclusions: </strong>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. 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引用次数: 15
摘要
目标:印度尼西亚与艾滋病毒有关的死亡率正在上升，那里的监狱关押着许多艾滋病毒感染者和成瘾者。我们调查了感染艾滋病毒的印度尼西亚囚犯在监狱内和释放后长达24个月的全因死亡率。材料和方法:从印度尼西亚雅加达的两所监狱中随机选择感染艾滋病毒的男性囚犯(n=102)，在监狱中完成调查并随访2年(直到研究完成)，或直到他们死亡或失去随访。死亡日期是根据医疗记录和对直系亲属的采访确定的。分析Kaplan-Meier和Cox比例风险回归模型以确定死亡率预测因子。结果:在103人年的随访中，有15人死亡，其中10人死于监狱。监狱内的粗死亡率(每1 000年死亡125.2人)超过释放囚犯的粗死亡率(每1 000年死亡215.7人)。与艾滋病毒相关的机会性感染是最常见的可能死亡原因。监狱内死亡率和总体死亡率的预测指标相似。总体而言，较短的生存期与被关押在专门关押毒品罪犯的“麻醉”监狱有关(风险比[HR] 9.2, 95%可信区间[CI] 1.1-76.5;P=0.03)，监禁时间较长(HR 1.06, 95% CI 1.01-1.1;P=0.01)，晚期HIV感染(CD4+ t细胞计数P=0.02)。成瘾治疗与更长的生存期相关(HR 0.1, 95% CI 0.01-0.9;P=0.03)，而抗逆转录病毒疗法(ART)或美沙酮治疗则没有。结论:尽管印度尼西亚监狱提供的抗逆转录病毒治疗有限，但感染艾滋病毒的囚犯死亡率极高。通过抗逆转录病毒治疗恢复免疫功能并在监禁期间和释放后预防机会性感染的干预措施可能会降低死亡率。麻醉品监狱可能是死亡率特别高的环境，强调需要普遍获得基于证据的艾滋病毒治疗。
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 post-release.
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 in released prisoners (215.7 deaths per 1,000 PYs). 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<200cells/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.
Conclusions: 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. Narcotics prisons may be especially high-risk environments for mortality, emphasizing the need for universal access to evidence-based HIV treatments.
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