Below are summaries of two studies of HIV testing in jails, with links to the full text.
This information came to me via Robert Malow, who does an excellent service of sending comprehensive, digested information on recent published studies on HIV prevention. He can be reached at rmalow@bellsouth.net.
Very best,
Julie
Julie Davids
Co-Director
Community HIV/AIDS Mobilization Project (CHAMP)
New York, NY / Providence, RI
www.champnetwork.org
(212) 937-7955 x 70 / (646) 431-7525 mobile
"When it comes to prevention, we do not have to choose between values and science….We
should lift the federal ban on needle exchange, which could dramatically reduce rates of
infection among drug users.”
Barack Obama, Open letter to
LGBT Americans, November 2007
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Routine Opt-Out HIV Testing Strategies in a Female Jail Setting: A Prospective Controlled Trial
Ravi Kavasery, Duncan Smith-Rohrberg Maru, Joshua Cornman-Homonoff, Laurie N. Sylla, David Smith, Frederick L. Altice*
Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, United States of America
PLoS ONE 4(11): e7648. doi:10.1371/journal.pone.
Abstract
Background
Ten 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.
Methods
This 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.
Results
Routine 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.
Conclusions
In 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.
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A Prospective Controlled Trial of Routine Opt-Out HIV Testing in a Men's Jail
Ravi Kavasery, Duncan Smith-Rohrberg Maru, Laurie N. Sylla, David Smith, Frederick L. Altice*
Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, Connecticut, United States of America
PLoS ONE 4(11): e8056. doi:10.1371/journal.pone.
Approximately 10 million Americans enter jails annually. The Centers for Disease Control and Prevention now recommends routine opt-out HIV testing in these settings. The logistics for performing routine opt-out HIV testing within jails, however, remain controversial. The objective of this study was to evaluate the optimal time to routinely HIV test newly incarcerated jail detainees using an opt-out strategy.
Methods
This prospective, controlled trial of routine opt-out HIV testing was conducted among 298 newly incarcerated male inmates in an urban men's jail in New Haven, Connecticut. 298 sequential entrants to the men's jail over a three week period in March and April 2008 were assigned to be offered routine opt-out HIV testing at one of three points after incarceration: immediate (same day, n = 103), early (next day, n = 98), or delayed (7 days, n = 97). The primary outcome was the proportion of men in each group consenting to testing.
Results
Routine opt-out HIV testing was significantly higher for the early (53%: AOR = 2.6; 95% CI = 1.5 to 4.7) and immediate (45%: AOR = 2.3; 95% CI = 1.3 to 4.0) testing groups compared to the delayed (33%) testing group. The immediate and early testing groups, however, did not significantly differ (p = 0.67). In multivariate analyses, factors significantly associated with routine opt-out HIV testing were assignment to the ‘early’ testing group (p = 0.0003) and low (bond ≥$5,000, immigration or federal charges or pre-sentencing >30 days) likelihood of early release (p = 0.04). Two subjects received preliminary positive results and one of them was subsequently confirmed HIV seropositive.
Conclusions
In this men's jail where attrition was high, routine opt-out HIV testing was not only feasible, but resulted in the highest rates of HIV testing when performed within 24 hours of incarceration.
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Int J Public Health. 2009 Dec 1. [Epub ahead of print]
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