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OBJECTIVES: Cohort studies must implement effective retention strategies to produce internally valid and generalizable results. Ensuring all study participants are retained, particularly those involved in the criminal legal system, ensures study findings and future interventions will be relevant to this group, who are often lost to follow-up: critical to achieving health equity. Our objective was to characterize retention strategies and describe overall retention among an 18-month longitudinal cohort study of persons on community supervision prior to and during the COVID-19 pandemic. METHODS: We implemented various retention strategy best-practices (e.g., multiple forms of locator information, training study staff on rapport building, study-branded items). During the COVID-19 pandemic, we developed and describe new retention strategies. We calculated overall retention and analyzed differences between those retained and lost to follow-up by demographic characteristics. RESULTS: Prior to the start of the COVID-19 pandemic, 227 participants enrolled across three sites (N = 46 North Carolina; N = 99 Kentucky; N = 82 Florida). Of these, 180 completed the final 18-month visit, 15 were lost to follow-up, and 32 were ineligible. This resulted in an overall retention of 92.3% (180/195). While most participant characteristics did not differ by retention status, a greater proportion of those experiencing unstable housing were lost to follow-up. CONCLUSION: Our findings highlight that when retention strategies are flexible, particularly during a pandemic, high retention is still achievable. In addition to retention best-practices (e.g., frequent requests for updated locator information) we suggest other studies consider retention strategies beyond the study participant (e.g., paying participant contacts) and incentivize on-time study visit completion (e.g., providing a bonus when completed the study visit on time).

In a research letter in this issue, Rempel et al. compared community water systems that serve the Kern Valley State Prison (KVSP) and three comparable rural communities in California that rely solely on groundwater sources. They found that for each of the four systems, arsenic concentrations in drinking water periodically exceeded the legal limit in violation of Safe Drinking Water Act regulations. The communities neighboring the prison benefited from local and federal remediation efforts. Yet, for people who were incarcerated, interventions such as free bottled water were often restricted.

Background: Throughout the first year of the COVID-19 pandemic, our research team monitored and documented policy changes in United States (U.S.) prison systems. Data sources included prison websites and official prison social media accounts. Over 2500 data sources relevant to the COVID-19 pandemic in U.S. prisons were located and summarized in to five different categories: 1) prevention, 2) case identification and intervention, 3) movement, 4) social communication and connection, and 5) programming, recreation, and privileges. Results: All state prison systems reportedly enacted multiple policies intended to limit the spread of COVID-19 during the pandemic. Document analysis revealed that the most commonly released policies were restrictions on social contacts and privileges, basic preventive measures (e.g., distribution of masks), and basic case identification measures (e.g., verbal screening and temperature checks). Utilization of social media for policy communication varied significantly across states, though relevant data was more often released on Facebook than Twitter. Conclusions: Together, our work provides foundational knowledge on the wide breadth of policies that were reportedly enacted in the first year of the pandemic that may be used as a base for quantitative work on policy effectiveness and examinations of implementation.

Risk of COVID-19 transmission is increased in prisons and surrounding communities. COVID-19 can spread rapidly in these facilities owing to crowding, inability to socially distance, poor ventilation, continuous admissions and releases, and daily work staff. High rates of chronic and immunocompromising conditions such as HIV among incarcerated persons are associated with greater risk of COVID-19.

Objective: The purpose is to determine whether a facilitated local change team (LCT) intervention improves linkage to medication for opioid use disorder (MOUD) and implementation outcomes, and whether participant-level outcomes are further enhanced by use of peer support specialists (PSS). Methods: This Type 1 hybrid implementation-effectiveness study involves a pre-post design (implementation study) followed by a randomized trial of PSS (effectiveness study). Participants are at least 114 justice and service staff from 7 sites in three states: probation officers, community treatment providers, a supervisor from each agency, and key stakeholders. The study will recruit up to 680 individuals on probation from seven adult community probation offices; eligible individuals will be recently committed, English speakers, with opioid use disorder (OUD). Core Implementation Study: The study will use the exploration, preparation, implementation, sustainability (EPIS) framework to guide system-change through facilitated LCTs of probation and community treatment staff given a core set of implementation strategies to set goals. The study will collect program-level and staff survey data at the end of each EPIS stage. Implementation outcomes: Organizational engagement in MOUD (primary), plus changes in staff knowledge/attitudes and organizational outcomes (secondary). Effectiveness Study of PSS: After completing implementation, the study will randomize adults on probation to receive PSS vs. treatment as usual, with assessments at baseline, 3, 6 and 12 months. Effectiveness outcomes include participant engagement in MOUD (primary), probation revocation, illicit opioid use, and overdoses. Other aims include identifying barriers and facilitators, and cost-benefit analysis of PSS. Adaptations in response to COVID-19 included moving many procedures to remote methods.

Background: We examined the impact of expanded access to medications for opioid use disorder (MOUD) in a unified prison and jail system on post-release, opioid-related overdose mortality. Methods: We developed a microsimulation model to simulate a population of 55,000 persons at risk of opioid-related overdose mortality in Rhode Island. The effect of an extended-release (XR) naltrexone only intervention and the effect of providing access to all three MOUD (i.e., methadone, buprenorphine, and XR-naltrexone) at release from incarceration on cumulative overdose death over eight years (2017–2024) were compared to the standard of care (i.e., limited access to MOUD). Results: In the standard of care scenario, the model predicted 2385 opioid-related overdose deaths between 2017 and 2024. An XR-naltrexone intervention averted 103 deaths (4.3% reduction), and access to all three MOUD averted 139 deaths (5.8% reduction). Among those with prior year incarceration, an XR-naltrexone only intervention and access to all three MOUD reduced overdose deaths by 22.8% and 31.6%, respectively. Conclusions: Expanded access to MOUD in prison and jail settings can reduce overdose mortality in a general, at-risk population. However, the real-world impact of this approach will vary by levels of incarceration, treatment enrollment, and post-release retention.

Individuals involved in the criminal justice (CJ) system continue to be at disproportionate risk for HIV infection, and often have a greater prevalence of substance use and sexual related risk behaviors relative to their non-CJ involved peers. Pre-exposure prophylaxis (PrEP), a once daily antiretroviral medicine, is an evidence-based approach for reducing the risk of contracting HIV but limited data exist regarding the use of PrEP among CJ populations, especially in the U.S. South. This study was conducted at the Pulaski County Regional Detention Facility (PCRDF) in Little Rock, Arkansas (AR), the largest county jail in the state. We explored knowledge about PrEP and HIV, perceptions about PrEP feasibility in both the jail and community settings and barriers to PrEP program implementation, through in-depth qualitative interviews with 21 jail detainees. We purposively sampled individuals based on specific self-reported risk behavior, including sexual risk (both heterosexual and same-sex) and drug related risk (e.g. IDU), among all eligible individuals. We identified five primary themes from the interviews: 1) accessing healthcare during community reentry was a low priority; 2) perception of risk and interaction with people with HIV was low; 3) there are many barriers to disclosing HIV risk behaviors in jail settings; 4) knowledge of PrEP is low but willingness to use is high; and 5) multiple barriers exist to PrEP uptake post-release. Our findings are contextually unique and therefore have important implications for future implementation of PrEP access either within jail settings or linkage to PrEP post release.

In the United States, the number of justice-involved individuals living with mental illnesses is large and growing; however, there is little information about internalized stigma experienced by this population. To address this gap, we assessed internalized stigma and its relationship with symptomatology and demographic and clinical characteristics among 108 probationers with severe mental illnesses. More than third of the sample reported high levels of internalized stigma, and more than half of the sample reported high scores on alienation and social withdrawal subscales. There was a positive and significant correlation between symptomatology and internalized stigma. Interventions to address internalized stigma among justice-involved people with mental illnesses are needed.

Historically, the incarceration of children has been used limitedly. The two reasons used to justify depriving youth of their freedom have been specific and serious threats to either public safety or to the young person’s own wellbeing (such as suicidal ideations). Incarceration should only be a last resort, with the standard being to place children in the least restrictive environment, such as in the community, because of the high risks of physical and mental health harms associated with detention.

Background: Medications for opioid use disorder (OUD) are the most effective treatment for OUD, but uptake of these life-saving medications has been extremely limited in US prisons and jail settings, and limited data are available to guide policy decisions. The objective of this study was to estimate the impact of screening and treatment with medications for OUD in US prisons and jails on post-release opioid-related mortality. Methods: We used data from the National Center for Vital Statistics, the Bureau of Justice Statistics, and relevant literature to construct Monte Carlo simulations of a counterfactual scenario in which wide scale uptake of screening and treatment with medications for OUD occurred in US prisons and jails in 2016. Results: Our model predicted that 1840 (95% Simulation Interval [SI]: -2757 – 4959) lives would have been saved nationally if all persons who were clinically indicated had received medications for OUD while incarcerated. The model also predicted that approximately 4400 (95% SI: 2675 – 5557) lives would have been saved nationally if all persons who were clinically indicated had received medications for OUD while incarcerated and were retained in treatment post-release. These estimates correspond to 668 (95% SI: -1008 – 1812) and 1609 (95% SI: 972 – 2037) lives saved per 10,000 persons incarcerated, respectively. Conclusions: Prison and jail-based programs that comprehensively screen and provide treatment with medications for OUD have the potential to produce substantial reductions in opioid-related overdose deaths in a high-risk population; however, retention on treatment post-release is a key driver of population level impact.

Pre-exposure prophylaxis (PrEP) may be an effective approach to prevent HIV among people who are currently incarcerated or who have been recently released from incarceration. However, awareness and interest in PrEP are largely unknown in this population. This study assessed 417 incarcerated men’s lifetime HIV risk engagement and gauged their interest and willingness to take PrEP. Twenty percent reported ever injecting drugs and 4% ever having sex with a man without a condom; 88% had never heard of PrEP. More White men had heard of PrEP, but higher percentages of men of color were interested in learning more about PrEP and willing to take PrEP to prevent HIV. Future interventions should focus on PrEP education and uptake among individuals who are incarcerated.

Objectives: The purpose of the present study was to examine associations between life stress and incarceration history in relation to sexual health risk practices among a sample of cisgender Black gay, bisexual and other men who have sex with men (MSM) in the Deep South. Methods: Using data from a sample of 355 cisgender Black MSM in Mississippi and Georgia, multivariable logistic regression analyses were conducted to examine associations between life stress and sexual risk practices. In addition, we assessed whether stress may interact with experiences of incarceration to influence sexual health risk practices. Results: After controlling for sociodemographic characteristics, stress was associated with some sexual risk practices (e.g. alcohol and drug use during sex and group sex). Further, when an interaction with incarceration was assessed, among participants who had been incarcerated, high compared with low levels of stress were associated with alcohol use during sex (adjusted odds ratio (aOR) 4.59, 95% confidence interval (CI) 2.11-9.99, P < 0.001), drug use during sex (aOR 3.92, 95% CI 1.79-8.60, P < 0.001), condomless sex with casual partners (aOR 2.83, 95% CI 1.31-6.12, P < 0.001), having six or more casual partners (aOR 2.77, 95% CI 1.09-7.06, P = 0.02) and participating in group sex (aOR 5.67, 95% CI 2.07-15.51, P < 0.001). Stress and incarceration produced a dose-response effect for each association; similar associations with stress were not observed among men who had not been incarcerated. Conclusions: Among people with experiences of incarceration, there are several possible ways our findings could be applied practically, including through safer sex and stress management interventions designed specifically for Black MSM following their release.

Media attention relevant to law enforcement use of force in the last decade finally alerted the scientific community to the need for more research regarding law enforcement discretion and decision making. The purpose of this study was to synthesize the existing literature to explore the motivating factors for law enforcement use of force. This study will utilize a social–ecological framework to systematically examine factors that impact officer decisions to use force at the individual and community levels. The paper includes recommendations for research and practice through an equity lens that highlights the disparate use of force against men of color in particular. Interventions, trainings, education, and research to stop the promotion of perceived safety over justice will be highlighted.

Purpose: Health and mortality of people released from incarceration have received increased attention, and yet little is known about the postrelease experiences of those hospitalized during incarceration. Methods: For persons incarcerated and released from the North Carolina (NC) state prison system between January 1, 2008, and June 30, 2015, we examined postrelease mortality from 2008 to 2016 by history of prison hospitalization. Results: Among 111,479 released persons, 0.9% (n = 1010) were hospitalized during their incarceration, and of those, 10.5% (n = 106) died during follow-up compared with 3.2% (3511/110,469) of other released persons. Those hospitalized in prison had a higher postrelease death rate (adjusted hazard ratio: 2.44), a lower 8-year conditional probability of survival (0.80 vs. 0.94), and were more likely to die from chronic causes (79.2% vs. 51.0%) than other released persons. The postrelease standardized mortality rate among men hospitalized in prison was 3.1 times higher than that of those not hospitalized and 7.1 times the rate of all NC men. Conclusions: People hospitalized during incarceration constitute a particularly vulnerable, yet relatively easily identifiable priority population to focus health interventions supporting continuity of care after prison release. Yet such efforts may be particularly challenging in NC and other Medicaid non-expansion states.

Mass incarceration in the United States is a civil rights, human rights, and public health crisis that is the result of social, political, and economic forces, rooted in enduring legacies of slavery and oppression along lines of race and class. We conceptualized this issue because we believe that the theories, methods, and ethical tenets of public health have a distinct role to play in contributing to a growing movement to end mass incarceration and its multilayered harms on health.

No other industrialized democracy has a carceral system that is as expansive, punitive, and racialized as that of the United States. More than 2.2 million people in 2018 were incarcerated in jails and prisons, a sixfold increase since the 1970s. Each year more than 600 000 people are released from prisons and more than 11 million cycle through jails, extending the effects of incarceration into households and shaping community health.

Purpose: Men who have sex with men (MSM) who are incarcerated are at increased risk for HIV acquisition, yet there are challenges associated with disclosing sexual identity/orientation among people who are incarcerated. Methods: The current study used semi-structured, qualitative interviews to explore attitudes and awareness of pre-exposure prophylaxis (PrEP) among 26 MSM who were incarcerated at the Rhode Island Department of Corrections. Results: Participants noted variable levels of willingness to disclose sexual identity/orientation. Conclusions: CJ institutions should consider involving medical staff and outside agencies when using the CDC PrEP guidelines or consider a WHO-based, rather than behavior-based, approach to determining candidacy for PrEP.

Populations at highest risk for acquiring HIV are more likely to pass through criminal justice (CJ) settings, and CJ-involved individuals are often at the intersection of multiple overlapping risk factors. The present study explored interest in, knowledge of, and barriers to PrEP uptake among gay, bisexual, and other men who have sex with men involved in the criminal justice system. Using semi-structured interviews, 26 participants who identified as MSM were asked about PrEP knowledge and interest, HIV risk, and incarceration experience. One theme that emerged across interviews was how institutional distrust in CJ settings may instill lack of trust in medical care after perceived mistreatment. Participants explained how lack of privacy fostered feelings that medical care was not confidential, care received was tied to status as an incarcerated person, and feelings of dehumanization led to distrust. Findings explore how distrust may hinder PrEP uptake and other HIV prevention efforts in CJ settings as well as after release. They highlight the need for greater privacy efforts and cultural humility, and explore how medical settings may function as spaces for people who are incarcerated to disclose HIV risk status. Few studies to our knowledge have examined the role of institutional distrust on men who have sex with men (MSM) in the context of pre-exposure prophylaxis (PrEP) interventions. The present study has implications for creating best practices to structure HIV prevention interventions in CJ settings.

The Rhode Island Department of Corrections (RIDOC) recently implemented the first state-wide, comprehensive medications for addiction treatment (MAT) program in the US. The objective of this study was to elucidate perceived barriers for individuals who participated in RIDOC's MAT program while incarcerated. Of the 588 individuals eligible for this study, 227 phone surveys were completed with 214 individuals. Data relevant to demographic characteristics, probation/parole status, retention in MAT treatment, MAT type received during incarceration, MAT treatment history, location where they received community treatment, perceived barriers to treatment, and future goals for MAT were collected. Simple percentages, frequencies, means, and standard deviations were calculated with SPSS. Most participants (82.4%) reported continuing MAT post-release and a majority (74.3%) received treatment at an opioid treatment program. Those who did not connect with treatment post-release reported transportation issues (23.1%) and not wanting to continue MAT (20.5%) as major reasons for not continuing treatment. The most commonly reported goal for treatment was to continue MAT long-term (43.5%). Results indicate that most participants linked to MAT treatment post-release. Participants reported reasons for why they did not continue MAT and had mixed intentions about continuing MAT in the future. Results provide identification of novel factors, such as side effects, time between release and treatment linkage, and family and friends' opinions that influence MAT continuation post-incarceration. Results highlight areas of exploration to influence treatment retention, including the role of probation/parole officers and the potential for peer support specialists to assist in reducing stigma and increasing interest in MAT.

People who are incarcerated are at increased risk for HIV (human immunodeficiency virus) acquisition upon release, and one possible intervention for prevention is the use of pre-exposure prophylaxis (PrEP) upon release. The present study assessed HIV risk perceptions as well as PrEP awareness and interest among 39 people who were incarcerated and enrolled in a structured Medication for Addiction Treatment (MAT) program at the Rhode Island Department of Corrections using semi-structured, qualitative interviews. Analysis was conducted using a generalized, inductive method in NVivo 12. While PrEP awareness was low across the study sample, some participants were interested in PrEP uptake or learning more about PrEP after they were provided with an overview of it. PrEP interest strongly related to current perceived HIV risk. Potential barriers included side effects, adherence, and reluctance to take medications in general. MAT programs for people who are criminal justice (CJ) involved may serve as useful linkage spaces to PrEP information, access, and retention.

As the epidemic of opioid use in the United States continues to shift fromprescription opioids to illicit drugs, more people living with opioid use disorder are encountering the criminal justice system. Most US correctional facilities do not continue or initiate medications for addiction treatment (MAT). This is especially unfortunate given the higher rates of opioid overdose immediately after release from incarceration.

Studies evaluating the association between human immunodeficiency virus (HIV) infection continuum of care outcomes [antiretroviral (ART) adherence, retention in care, viral suppression] and health literacy have yielded conflicting results. Moreover, studies from the southern United States, a region of the country disproportionately affected by the HIV epidemic and low health literacy, are lacking. We conducted an observational cohort study among 575 people living with HIV (PLWH) at the Vanderbilt Comprehensive Care Clinic (Nashville, Tennessee). Health literacy was measured using the brief health literacy screen, a short tool which can be administered verbally by trained clinical personnel. Low health literacy was associated with a lack of viral suppression, but not with poor ART adherence or poor retention. Age and racial disparities in continuum of care outcomes persisted after accounting for health literacy, suggesting that factors in addition to health literacy must be addressed in order to improve outcomes for PLWH.

Purpose of Review: We reviewed the HIV and opioid literature relevant to harm reduction strategies for those with criminal justice experience. Recent Findings: Opioid use in the United States has risen at an alarming rate recently. This has led to increased numbers of people who inject drugs, placing new populations at risk for HIV, including those who have criminal justice experience. In recent years, there has been a gradual decrease in the number of individuals under the supervision of the criminal justice system. However, concurrently, there has been a rise in the number of individuals incarcerated in jails in rural counties that are at the center of the current opioid epidemic. Summary: We provide a number of harm reduction strategies that could be implemented in correctional settings such as access and linkage to medication-assisted treatment, connection to syringe exchange programs and safe injection facilities (where available), and the repackaging of pre-exposure prophylaxis as a harm reduction tool.

Overdose is the leading cause of unintentional injury-related death. Rhode Island (RI) has the highest rate of illicit drug use nationally and the 5th highest overdose mortality rate. RI has experienced an outbreak of fentanyl-related overdoses. In incarcerated populations, risk of overdose is greatly elevated. However, little is known about fentanyl-related overdose post-release. In the current analyses, we identify changes in fentanyl-related fatal overdose among those who died in 2014 and 2015 who were incarcerated in the year before death. We linked data from the RI Office of the Medical Examiner with records from the RI Department of Corrections. We calculated risk ratios and 95% confidence intervals using log-binomial regression to compare risk of fentanyl-involved overdose death. We also compared median time to death since release, median sentence length, and median number of incarcerations in 2014 and 2015. Results indicate that the risk of dying of a fentanyl-related overdose increased (RR: 1.99 (95% CI: 1.11–3.57, p = 0.014)) from 2014 to 2015 among those with past year incarceration. This study is one of the first to describe fentanyl-related fatal overdose among those with past year incarceration. In 2015 the median sentence was longer among those with a fentanyl-related overdose death and the median time from release to death among all who had past year incarceration extended past 90 days. Access to medications for addiction treatment, overdose education, and naloxone should be available during community re-entry and extended beyond the early post-release period.

To the Editor—Antiretroviral therapy (ART) has decreased human immunodeficiency virus (HIV) morbidity and mortality. However, efficacy is dependent upon adherence, which is influenced by behavioral, social, and structural factors. Among these, incarceration can negatively impact ART adherence.

BACKGROUND: Women experiencing incarceration (WEI) engage in high rates of sex- and drug-related behavior that places them at risk for HIV. Pre-exposure prophylaxis (PrEP) is an efficacious means of reducing HIV acquisition. There is a general lack of knowledge regarding PrEP among women at elevated risk, and only a small percentage of at-risk women are currently engaged in PrEP care. The period of incarceration represents an opportunity to identify at-risk women, initiate PrEP during incarceration, and establish linkage to community-based PrEP care upon release from incarceration. Further, post-release is a time period that is particularly risky, and there are numerous barriers, including substance use, that may impede linkage to community-based care in the absence of intervention. The current protocol describes plans for the development and pilot randomized controlled trial (RCT) of an intervention to promote PrEP uptake during incarceration and facilitate linkage to community-based PrEP care post-release. METHODS/DESIGN: The motivational interviewing-navigation (MI-NAV) study intervention is being developed, refined, and tested over three phases within the framework of the social ecological model. All phases of the study are being conducted at a women's correctional facility and community-based PrEP provider located in the Northeastern region of the United States. Phase 1 consists of individual qualitative interviews to be conducted with key stakeholders (n = 6-10) from the community-based PrEP care site and (n = 6-10) from the women's correctional facility, as well as with (n = 18-30) WEI. Recruitment for Phase 1 was initiated in November 2017. In Phase 2, MI-NAV will be piloted with a small cohort (n = 8-12) of WEI and will be refined based upon participant feedback. During Phase 3, a pilot RCT of MI-NAV and a standard of care condition will be conducted with 80 WEI. RCT participants will complete baseline and follow-up assessments 1, 3, and 6 months post-release. The primary study outcome is linkage to community-based PrEP care, verified via medical records. DISCUSSION: This study will develop and evaluate a psychosocial intervention (MI-NAV) to promote PrEP uptake and facilitate linkage to community-based PrEP care among women at-risk for HIV. It is expected that, as a result of this project, the feasibility, acceptability, and preliminary efficacy of MI-NAV will be determined. If found to be efficacious, this intervention has the potential to reduce HIV acquisition in a high-need, underserved community. Clinical trial registration NCT03281343.

Importance: Restrictive housing, otherwise known as solitary confinement, during incarceration is associated with poor health outcomes. Objective: To characterize the association of restrictive housing with reincarceration and mortality after release. Design, Setting, and Participants: This retrospective cohort study included 229 274 individuals who were incarcerated and released from the North Carolina prison system from January 2000 to December 2015. Incarceration data were matched with death records from January 2000 to December 2016. Covariates included age, number of prior incarcerations, type of conviction, mental health treatment recommended or received, number of days served in the most recent sentence, sex, and race. Data analysis was conducted from August 2018 to May 2019. Exposures: Restrictive housing during incarceration. Main Outcomes and Measures: Mortality (all-cause, opioid overdose, homicide, and suicide) and reincarceration. Results: From 2000 to 2015, 229 274 people (197 656 [86.2%] men; 92 677 [40.4%] white individuals; median [interquartile range (IQR)] age, 32 years [26-42]), were released 398 158 times from the state prison system in North Carolina. Those who spent time in restrictive housing had a median (IQR) age of 30 (24-38) years and a median (IQR) sentence length of 382 (180-1010) days; 84 272 (90.3%) were men, and 59 482 (63.7%) were nonwhite individuals. During 130 551 of 387 913 incarcerations (33.7%) people were placed in restrictive housing. Compared with individuals who were incarcerated and not placed in restrictive housing, those who spent any time in restrictive housing were more likely to die in the first year after release (hazard ratio [HR], 1.24; 95% CI 1.12-1.38), especially from suicide (HR, 1.78; 95% CI, 1.19-2.67) and homicide (HR, 1.54; 95% CI, 1.24-1.91). They were also more likely to die of an opioid overdose in the first 2 weeks after release (HR, 2.27; 95% CI, 1.16-4.43) and to become reincarcerated (HR, 2.16; 95% CI, 1.99-2.34). Conclusions and Relevance: This study suggests that exposure to restrictive housing is associated with an increased risk of death during community reentry. These findings are important in the context of ongoing debates about the harms of restrictive housing, indicating a need to find alternatives to its use and flagging restrictive housing as an important risk factor during community reentry.

Background Transgender persons are highly victimized, marginalized, disproportionately experience incarceration, and have alarmingly increased rates of HIV infection compared to cis-gender persons. Few studies have examined the HIV care continuum outcomes among transgender women (TW), particularly TW who are involved with the criminal justice (CJ) system. Methods To improve our understanding of HIV care continuum outcomes and risk behaviors among HIV-infected TW who are involved with the CJ system, we analyzed data from the National Institute on Drug Abuse-supported Seek, Test, Treat, Retain (STTR) Data Harmonization Initiative. Baseline data were pooled and analyzed from three U.S. STTR studies to examine HIV risk and care continuum indicators among CJ-involved HIV-infected TW compared to cisgender men (CM), matched on age (within 5 years) and study at a ratio of 1:5. Results Eighty-eight TW and 440 CM were included in the study. Among matched participants, TW were more likely to report crack and cocaine use compared to CM (40%,16% respectively, p