Evaluating Viral Suppression Among People with HIV Experiencing Incarceration: Outcomes of a Patient-Centered Care Model in Washington State Prisons,2008–2019

A patient-centered HIV care model (PCHCM) can improve antiretroviral treatment adherence and viral suppression outcomes. No studies have evaluated viral suppression among people with HIV (PWH) in carceral settings under this model. This study compares HIV virologic suppression among PWH in Washington state prisons under a PCHCM to all PWH in Washington between 2008 and 2019. We conducted three analyses of a retrospective cohort of 403 PWH in prison. Prison-wide annual viral suppression proportions among total HIV population and the HIV population tested each year were compared with Washington public health surveillance data. Average changes in viral suppression proportions at intake and release were summarized and tested for statistically significant differences. Prison-wide HIV viral suppression increased from 61.4% in 2008 to 86.0% in 2019, surpassing most annual statewide proportions. Viral suppression proportions among those with at least one yearly viral load test were even higher. Between 2015 and 2019, > 95% of incarcerated PWH achieved viral suppression. Average viral suppression proportions increased during incarceration from 59.1% at intake to 92.4% at release between 2008 and 2019 (p < 0.05). Prison populations can reach near universal viral suppression under a PCHCM, suggesting a higher threshold from which to judge the effectiveness of HIV carceral care.