Criminal History and LSI-R Scores of RSAT Participants in the State of Massachusetts: Impact of Offender Age on Program Completion and Rates of Offender Recidivism

The purpose of this study was to understand how offender age impacted residential substance abuse treatment (RSAT) program success in reducing rates of recidivism for offenders exiting the judicial system. Despite passing legislation in the 1980s and 1990s, which increased the penalties for certain crimes, offender recidivism remains high, with no apparent drop in the number of incarcerations and re-incarcerations, resulting in high costs and threats to the safety and quality of life experienced within communities. Social learning theory, behavioral decision theory, and biologically based theories of behavior were the theoretical foundations. Archival data collected from a RSAT grant program at between January 1, 1999 and June 6, 2001 were examined. Data related to participant scores on the Level of Service Inventory Revised (LSI-R), acquired prior to program placement and upon program completion, were compared with the number of incarcerations before and after program completion; charges for convictions already decided and/or pending convictions, age at admission(s) and age at the time of the offender\u27s first offense, and types of offenses (domestic or sexual) committed were explored in a factor analysis. Negative correlations identified included: sex offenders and their age at admission and between LSI-R scores and completing the RSAT program. Positive correlations identified included: new convictions and completing the RSAT program, age at admission to program and age of first offense, and date of first offense and sex offender variables. Implications for positive social change include reduced rates of recidivism among offenders with substance abuse problems

Enhanced infection prophylaxis reduces mortality in severely immunosuppressed HIV-infected adults and older children initiating antiretroviral therapy in Kenya, Malawi, Uganda and Zimbabwe: the REALITY trial

Meeting abstract FRAB0101LB from 21st International AIDS Conference 18–22 July 2016, Durban, South Africa. Introduction: Mortality from infections is high in the first 6 months of antiretroviral therapy (ART) among HIV‐infected adults and children with advanced disease in sub‐Saharan Africa. Whether an enhanced package of infection prophylaxis at ART initiation would reduce mortality is unknown. Methods: The REALITY 2×2×2 factorial open‐label trial (ISRCTN43622374) randomized ART‐naïve HIV‐infected adults and children >5 years with CD4 <100 cells/mm3. This randomization compared initiating ART with enhanced prophylaxis (continuous cotrimoxazole plus 12 weeks isoniazid/pyridoxine (anti‐tuberculosis) and fluconazole (anti‐cryptococcal/candida), 5 days azithromycin (anti‐bacterial/protozoal) and single‐dose albendazole (anti‐helminth)), versus standard‐of‐care cotrimoxazole. Isoniazid/pyridoxine/cotrimoxazole was formulated as a scored fixed‐dose combination. Two other randomizations investigated 12‐week adjunctive raltegravir or supplementary food. The primary endpoint was 24‐week mortality. Results: 1805 eligible adults (n = 1733; 96.0%) and children/adolescents (n = 72; 4.0%) (median 36 years; 53.2% male) were randomized to enhanced (n = 906) or standard prophylaxis (n = 899) and followed for 48 weeks (3.8% loss‐to‐follow‐up). Median baseline CD4 was 36 cells/mm3 (IQR: 16–62) but 47.3% were WHO Stage 1/2. 80 (8.9%) enhanced versus 108(12.2%) standard prophylaxis died before 24 weeks (adjusted hazard ratio (aHR) = 0.73 (95% CI: 0.54–0.97) p = 0.03; Figure 1) and 98(11.0%) versus 127(14.4%) respectively died before 48 weeks (aHR = 0.75 (0.58–0.98) p = 0.04), with no evidence of interaction with the two other randomizations (p > 0.8). Enhanced prophylaxis significantly reduced incidence of tuberculosis (p = 0.02), cryptococcal disease (p = 0.01), oral/oesophageal candidiasis (p = 0.02), deaths of unknown cause (p = 0.02) and (marginally) hospitalisations (p = 0.06) but not presumed severe bacterial infections (p = 0.38). Serious and grade 4 adverse events were marginally less common with enhanced prophylaxis (p = 0.06). CD4 increases and VL suppression were similar between groups (p > 0.2). Conclusions: Enhanced infection prophylaxis at ART initiation reduces early mortality by 25% among HIV‐infected adults and children with advanced disease. The pill burden did not adversely affect VL suppression. Policy makers should consider adopting and implementing this low‐cost broad infection prevention package which could save 3.3 lives for every 100 individuals treated