Pathways From Recent Incarceration to Antiretroviral Therapy Adherence: Opportunities for Interventions to Support Women Living With HIV Post Release From Correctional Facilities.

The study is observational, so the pathways cannot be interpreted as causal, and reverse directionality between incarceration and the mediators is possible. ART adherence was self-reported rather than measured by viral load, and self-report can be affected by social desirability. Only 8.9% of participants had recent incarceration at baseline, and the authors could not stratify the path analysis by race or gender identity because of small numbers. The sample was drawn from one Metro Vancouver cohort of marginalized women living with HIV, with high rates of Indigenous identity, mental health diagnosis and substance use, so it may not represent other settings. The study identified associations with housing, substance use and violence, but it did not test whether housing, harm-reduction or violence services improve ART adherence.

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Do not conclude that incarceration itself directly caused poor ART adherence or that housing, substance-use or violence services will improve adherence. The direct path from recent incarceration to adherence was not significant, and this observational study used self-reported adherence and cannot prove causation.