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In March 2020, during the early days of the COVID-19 pandemic, National Commission on Correctional Health Care (NCCHC) partnered with researchers from the Harvard Kennedy School and Harvard Law School to develop and deploy a weekly survey (https://www.ncchc.org/study-ofcovid-19-in-correctional-facilities) of correctional facilities around the nation to collect information about how the disease was affecting them. The study collected data for approximately 9 weeks. All information was self-reported. The survey requested data on cases and testing among inmates and staff and offered the opportunity to share concerns, policies, procedures, and other information. Our effort was a real-time emergency public health initiative, designed to gather as much immediately available data as possible. The response was tremendous, with 514 unique facilities reporting data at least one time. The final survey received responses from 85 unique facilities. The survey closed on June 9, 2020, and as of that date, we have obtained cumulative data on 296,574 incarcerated persons, 55,848 correctional staff, and 12,239 correctional health staff. Participation was voluntary, so the sample is not a random sampling of jails and prisons. The responding facilities cover the United States and are primarily jails (70%), followed by prisons (20%), juvenile detention centers (5%), and other. During the entire reporting period, facilities reported 1,878 cases among the incarcerated (633/ 100,000), 865 cases among correctional officers (1,549/100,000), and 156 cases among health staff (1,275/100,000). Moving beyond basic prevalence, the data have revealed shortfalls in testing as well as racial and ethnic disparities, which I'll explore below. Screening and Testing At the time the surveys began in March, 93% of reporting facilities said they screened inmates at intake; over the course of the study that rose to 97%. Screening for those already incarcerated increased from 46% to 56%. Staff screening also increased, from 79% to 89%.

Admissions to jails and prisons in the United States number 10 million yearly; persons entering locked correctional facilities have high prevalence of sexually transmitted infections (STIs). These individuals come disproportionately from communities of color, with lower access to care and prevention, compared with the United States as a whole. Following PRISMA guidelines, the authors present results of a systematic review of literature published since 2012 on STIs in US jails, prisons, Immigration and Customs Enforcement detention centers, and juvenile facilities. This updates an earlier review of STIs in short-term facilities. This current review contributed to new recommendations in the Centers for Disease Control and Prevention 2021 treatment guidelines for STIs, advising screening for Trichomonas in women entering correctional facilities. The current review also synthesizes recommendations on screening: in particular, opt-out testing is superior to opt-in protocols. Carceral interventions—managing diagnosed cases and preventing new infections from occurring (eg, by initiating human immunodeficiency virus preexposure prophylaxis before release)—can counteract structural racism in healthcare.

The importance of aggressive and accountable drug safety will only become more salient as the public and their elected representatives demand better accountability from industry. Individual corporations now have the opportunity to move first to counter perceptions of profit over safety and to ensure that their business practices adequately protect the public's health.

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