CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

health issues. Incarceration may play a role in perpetuating these cycles, while also serving as a key opportunity for healthcare access. The purpose of this analysis is to estimate the baseline incidence of HIV, syphilis, and fatal overdose among individuals experiencing incarceration in jails, describe the acute impact of jail on the incidence of these conditions, and identify key demographic determinants that may be relevant to prevent disease in this population. Methods: We linked 2023 Washington state HIV, STI, and fatal overdose surveillance data to a 2023 corrections registry built from public jail rosters. We calculated the baseline incidence of each condition (pre-incarceration for syphilis and HIV, and >90 days post-incarceration for fatal overdose) and compared this to published statewide statistics. We then calculated incidence post-incarceration (180 days following release for HIV and syphilis, and 90 days for fatal overdose). We estimated rate differences using a Poisson model and calculated the number of cases attributable to incarceration. Finally, we described the inferred route of transmission, gender, race, and census-tract level socioeconomic characteristics among those experiencing one or more conditions. Results: Among the 129,661 individuals incarcerated in 2023, there were19 HIV diagnoses, 608 syphilis diagnoses, and 349 fatal overdoses. Baseline incidence rates for these conditions were 2.6 to 10.0 times higher than Washington state as a whole (14.1 vs 5.4 for HIV, 453.1 vs 50.7 for syphilis, and 463.7 vs 44.3 per 100,000 person-years). Rates were significantly higher post-incarceration for syphilis and fatal overdose (Table 1). Across all conditions, 55% of individuals had documentation of substance use, 46% were people of color, and 40% resided in census tracts in the lowest income quartile. Conclusions: Incarcerated individuals in 2023 experienced disproportionately high rates of HIV, syphilis, and fatal overdose across WA The immediate effect of incarceration was an increased risk for these conditions, which is likely compounded other social and biological determinants. These findings underscore the crucial need for targeted interventions during and after incarceration toward reducing the burden of these syndemic conditions.

6.3 times higher than the rate among those not released from prison (5.4 per 100,000 person-years). Certain subpopulations exhibited significantly higher post-release HIV acquisition rates, including males (Rate Ratio 2.1 compared to females) and individuals with mental or behavioral health diagnoses (RR 1.8–3.0 depending on the diagnosis, compared to those without diagnoses). Some specific subgroups had HIV diagnosis rates 24–38 times higher than the general population, with incidence rates reaching as high as 198.8 per 100,000 person-years. Conclusions: People released from prison represent a population at significantly elevated risk for HIV acquisition. Routinely collected administrative data can serve as a valuable tool for identifying high-risk subpopulations and prioritizing prevention programs within correctional facilities.

Poster Abstracts

1103 WITHDRAWN

1102 HIV Acquisition After Prison Release in Washington State and Implications for Prevention Efforts Danika A. Troupe 1 , Steven J. Erly 1 , Helen E. Jack 2 , Courtney G. Bagdon-Cox 3 , Rachel M. Amiya 1 1 Washington State Department of Health, Olympia, WA, USA, 2 University of Washington, Seattle, WA, USA, 3 Washington State Department of Corrections, Tumwater, WA, USA Background: Individuals released from prison face a heightened risk of HIV acquisition. Despite this elevated risk, limited research has quantified HIV acquisition post-release or identified which subpopulations should be prioritized for targeted prevention efforts. Additionally, identifying high risk groups within correctional settings is challenging, as individuals may be reluctant to disclose risk behaviors like sexual activity and injection drug use, which are often criminalized in these environments. This study aims to estimate the risk of HIV acquisition after prison release using routinely collected administrative data and applies machine learning to identify subpopulations at the highest risk. Methods: We linked HIV surveillance data to administrative records of all individuals released from Washington State prisons between 1/1/2010 and 12/31/2021, calculating the incidence over the subsequent three years. A decision tree model was used to stratify risk based on demographic factors, reason for incarceration, mental health status, and substance use assessments. Results: Among 58,026 individuals released from prison, 120 were diagnosed with HIV. In the three years following release, 51 individuals acquired HIV, corresponding to an incidence rate of 32.5 per 100,000 person-years, which is

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