Abstract
BackgroundTen million Americans enter jails annually. The objective was to evaluate new CDC guidelines for routine opt-out HIV testing and examine the optimal time to implement routine opt-out HIV testing among newly incarcerated jail detainees.MethodsThis prospective, controlled trial of routine opt-out HIV testing was conducted among 323 newly incarcerated female inmates in Connecticut's only women's jail. 323 sequential entrants to the women's jail over a five week period in August and September 2007 were assigned to be offered routine opt-out HIV testing at one of three points after incarceration: immediate (same day, n = 108), early (next day, n = 108), or delayed (7 days, n = 107). The primary outcome was the proportion of women in each group consenting to testing.ResultsRoutine opt-out HIV testing was significantly highest (73%) among the early testing group compared to 55% for immediate and 50% for 7 days post-entry groups. Other factors significantly (p = 0.01) associated with being HIV tested were younger age and low likelihood of early release from jail based on bond value or type of charge for which women were arrested.ConclusionsIn this correctional facility, routine opt-out HIV testing in a jail setting was feasible, with highest rates of testing if performed the day after incarceration. Lower testing rates were seen with immediate testing, where there is a high prevalence of inability or unwillingness to test, and with delayed testing, where attrition from jail increases with each passing day.Trial RegistrationClinicalTrials.gov NCT00624247
Highlights
The prevalence of HIV infection in the United States is several-fold greater in correctional settings than in the general population
[3] Jails and prisons serve as important sites for HIV testing and treatment. [4,5,6,7] The Centers for Disease Control and Prevention’s (CDC) recent recommendation to implement routine opt-out HIV testing in all healthcare settings, including jails, has not been achieved due to logistical, financial and legal constraints.[8]
192 (59%) of 323 inmates assigned to testing groups provided verbal consent to be swabbed for HIV testing
Summary
Over 2.3 million people, or one in every 100 American adults, are incarcerated and their initial interface with the correctional system is usually via jail.[1,2] The prevalence of HIV infection in the United States is several-fold greater in correctional settings than in the general population. [3] Jails and prisons serve as important sites for HIV testing and treatment. [4,5,6,7] The Centers for Disease Control and Prevention’s (CDC) recent recommendation to implement routine opt-out HIV testing in all healthcare settings, including jails, has not been achieved due to logistical, financial and legal constraints.[8]. [12] Jails, compared to prisons, are characterized by higher rates of turnover,[13] shorter stays, a higher prevalence of acute intoxication and withdrawal, and a higher number of inmates presenting with uncontrolled mental illness, recent HIV risk behaviors [14,15] and suicidal behavior. Given the high attrition rate in jails, a major logistical challenge to implementing routine opt-out HIV testing is selecting the optimal time to conduct testing.[22] Newly incarcerated inmates might be too intoxicated or psychologically distressed to reliably consent to or opt out of routine testing, and may be unprepared to consider and respond to the consequences of a preliminary positive HIV test result.[12,23] Likewise, the public health challenge with postponing HIV testing is that many individuals experience relatively short stays in jail and will be released before being tested.[24,25]. The objective was to evaluate new CDC guidelines for routine optout HIV testing and examine the optimal time to implement routine opt-out HIV testing among newly incarcerated jail detainees
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