Chapel Hill, NC – When people leave prison, they enter one of the highest-risk periods for acquiring HIV—often with the least support, the fewest resources, and the greatest uncertainty about where to turn for care. It’s this critical gap that Lina Rosengren, MD, MPH, an infectious diseases physician and researcher with the Institute for Global Health and Infectious Diseases is determined to close.
“There has been very little investment in understanding how justice-involved populations can access biomedical interventions to prevent HIV,” said Dr. Rosengren, associate professor of medicine. “As they re-enter their communities from incarceration, they enter a period of extraordinary HIV vulnerability. Gilead has committed to helping us understand and support these individuals with access to one of the most exciting new long-acting medications for PrEP.”
In a unique partnership with Gilead that combines in-kind support with an implementation grant, leveraging UNC’s deep clinical roots in the prison system, Dr. Rosengren’s RELEASE study is poised to answer a critical question:
Can we reliably deliver long-acting HIV prevention to people before they ever lose contact with the carceral health system—and in doing so, fundamentally change their risk trajectory after release?
Long‑Acting PrEP at the Prison Gate
The RELEASE study is straightforward but novel–providing a long‑acting HIV prevention injection just before release that offers six months of protection during a period of high HIV vulnerability.
Within North Carolina’s prison, HIV prevention needs are relatively low—more than 99% of people living with HIV are virally suppressed, resulting in essentially no in‑prison transmission. After release, however, risk rises sharply due to unstable housing, disrupted healthcare, limited access to prevention services, and lack of awareness about HIV risk. The immediate post‑release period is consistently one of the highest‑risk moments for HIV acquisition.
RELEASE is designed as an implementation study rather than a traditional clinical trial. It seeks to identify the real‑world barriers to delivering long‑acting PrEP in a carceral setting and to build systems that support continuity of prevention once the initial protection period ends. The goal is not to prove drug efficacy, but to understand how this approach could actually work at scale.
Lenacapavir is a long‑acting HIV prevention shot given twice a year that received FDA approval in June 2025. In Phase 3 studies including cisgender women, men who have sex with men, and transgender people, the results showed close to 100% efficacy as PrEP.
Securing Drug Access Where No Payer Exists
One of the most striking aspects of Dr. Rosengren’s study is how it challenges the usual funding model for implementation studies. In the North Carolina prison system, Medicaid is suspended while prisons cover medical care needed during the incarceration period—but PrEP is not offered, in part because prisons do not formally recognize consensual sex and because in‑prison transmission rates are so low. As a result, no existing payer is positioned to cover a pre‑release dose of long‑acting PrEP, requiring the study to address—and innovate around—a gap where conventional implementation models break down.
To bridge this gap, Gilead has agreed to donate 50 doses of long-acting PrEP. The study will also examine how the upcoming 1115 Medicaid waiver—which may allow Medicaid to cover some services inside prisons—could create a sustainable payer path for PrEP in the future.
A Hidden Strength, Integrated Care and Research in Carceral Settings
Patients are seen at prison facilities through UNC’s robust statewide HIV and infectious disease telehealth network that delivers HIV care and high‑volume ID consultations across the state. As associate director of Infectious Diseases and HIV Services for the North Carolina Department of Adult Corrections, Rosengren works closely with program director Becky White, MD, to oversee telehealth operations and advance statewide care, while supporting advanced practice providers with complex HIV cases while also handling general infectious disease consults via telehealth. Christopher Sellers, MD, also provides on‑site, non‑HIV infectious disease consultations at Central Prison, managing hospitalized patients and ensuring continuity of care as individuals return to their home facilities.
The program is supported by a multidisciplinary team that includes Liz Aronin, NP, and Denise Carpenter, PA, who focus on HIV care; Amy Jones, PharmD, an infectious diseases pharmacist based at the prison; and collaborative partnerships with UNC specialty services such as OB‑GYN, surgery, podiatry, and others providing care within the prison system.
Anchored in Care for the Underserved
Dr. Rosengren says her career has been defined by a consistent commitment to underserved populations. She began working in prisons as a fellow in 2018, entering a high‑security facility that was initially intimidating. She stayed because of the lasting relationships she formed and the deep trust of her patients. Over years of care, she has guided individuals through long incarcerations and the anxiety of release, especially fears about losing access to HIV medications, spending significant time educating and reassuring them about ongoing, no‑cost care.
“One long-term patient, incarcerated for more than 20 years and preparing to leave, ended a telehealth visit by saying, ‘Thanks for being there for me. I’ll miss you, friend.’”
Rosengren says sustained connections like this—marked by gratitude, trust, and mutual respect—are the most meaningful moments in her work.