Health care utilization by people with HIV on release from provincial prison in Ontario, Canada in 2010: a retrospective cohort study

Limited evidence suggests that at the time of release from prison, people with HIV face barriers to health care, which may contribute to worsening HIV clinical outcomes. We aimed to describe health care utilization for people with HIV released from provincial prison in Ontario in 2010, and to compare rates of use with prisoner and general population controls. We used Ontario's administrative health records and data from the Ontario Ministry of Community Safety and Correctional Services on all persons released from provincial prison in 2010. We matched each person with HIV released from provincial prison by age and sex with three controls in each of three groups: people with no HIV released from provincial prison, people with HIV in the general population, and people with no HIV in the general population. We compared rates of use of primary care, non-primary ambulatory care, emergency departments, and hospitalization in the year after the first release from provincial prison in 2010 and in the corresponding period for matched controls. We identified 330 persons with HIV released from provincial prison in 2010. Their median time to first HIV-ambulatory care visit after prison release was 177 days (SD 136-239). Compared to all control groups, people with HIV released from provincial prison had higher rates of primary care use, unscheduled emergency department visits and hospital admissions at 30, 90 and 365 days after release. People with HIV released from provincial prison have a long time to first contact with HIV ambulatory care, and higher rates of health care utilization across health care settings. Interventions are required to facilitate post-release linkage to care for this population.