BackgroundDetention settings’ preparedness against respiratory virus outbreaks is essential, with implications for preventing illness and deaths from future pandemics. We sought to identify influenza outbreak prevention and management evidence in U.S. detention settings.MethodsWe conducted a scoping review, first searching PubMed, OVID, Google Scholar, Medline databases and the reference lists of identified manuscripts published on outbreak prevention and management of influenza in detention settings in English. Search terms included prison, jail, vaccine, influenza, outbreak, management, prevention, carceral.ResultsTwenty-five studies met the search criteria, ultimately narrowed down to seven studies. Four studies focused on prevention and three on management. The studies on prevention identified restructuring housing, vaccinations, and widespread screening to prevent outbreaks and highlighted the importance of collaboration between prison staff and public health departments. The management studies emphasized hygiene, isolation of sick individuals, and vaccination of unexposed patients. Staff expressed the concern that the public may view prisoners as low priority based on prior experiences with influenza vaccine shortages, with a spillover effect in obtaining vaccines and medications for staff. No studies mentioned decarceration as a prevention and mitigation measure.ConclusionThere is limited data on influenza outbreak prevention and management in detention settings. The approaches described are partially in line with public health recommendations but fall short due to lack of, and delays in resource allocation. There is an urgent need for researchers and public health officials to examine and report influenza outbreak prevention and mitigation strategies in detention settings to develop scalable interventions and a national standard for all detention settings.

Background Despite national guidelines on infectious disease testing and vaccination in prisons, there is heterogeneity on the implementation of these practices in jails. We sought to better understand perspectives on the implementation of opt-out vaccination for infectious diseases in jails by interviewing a broad group of stakeholders involved in infectious diseases vaccination, testing, and treatment in Massachusetts jails. Methods The research team conducted semi-structured interviews with people incarcerated in Hampden County Jail (Ludlow, MA), clinicians working in jail and community settings, corrections administrators, and representatives from public health, government, and industry between July 2021—March 2022. Results Forty-eight people were interviewed, including 13 people incarcerated at the time of interview. Themes that emerged included: misunderstandings of what opt-out means, indifference to the way vaccines are offered, belief that using the opt-out approach will increase the number of individuals who receive vaccination, and that opt-out provides an easy way for vaccine rejection and reluctance to accept vaccination. Conclusion There was a clear divide in stakeholders’ support of the opt-out approach, which was more universally supported by those who work outside of jails compared to those who work within or are incarcerated in jails. Compiling the perspectives of stakeholders inside and outside of jail settings on the opt-out approach to vaccination is the first step to develop feasible and effective strategies for implementing new health policies in jail settings.

Background COVID-19 shut down trial courts across the country, prolonging case resolution of charged, detained, and incarcerated people. We report on the implementation of rapid COVID-19 testing at Trial Courts in Massachusetts (MA), focusing on the outcomes of adoption and acceptability. Methods Guided by the Expert Recommendations in Implementing Change (ERIC) framework, we chose six strategies to guide implementation. After assembling a group of stakeholders, including representatives of the Trial Court, Department of Public Health (DPH) and vendors providing COVID-19 testing, we implemented rapid COVID-19 testing at Trial Court locations in December 2021. We collected data on (1) adoption of COVID-19 testing, (2) number of stakeholders who attended meetings, (3) number of tests performed at Trial Court sites, and (4) acceptability of COVID-19 testing using a QR-code anonymous survey. Results There was a high percentage of attendance at stakeholder meetings (> 70% at each meeting). 243 COVID-19 tests were conducted on eight occasions at four Trial Court sites between December 2021 and February 2022. Participants who responded to the QR-code survey reflected favorably on COVID-19 testing at MA Trial Court sites. Conclusion COVID-19 testing at Massachusetts Trial Court sites was possible through stakeholder engagement. Several cases of COVID-19 were identified prior to entry into the Trial Court. Funding for rapid COVID-19 testing should be provided to help keep trial courts open as the pandemic continues to evolve.

Background Despite national guidelines on infectious disease testing and vaccination in prisons, there is heterogeneity in operationalization. Previous literature has shown that using the “opt-out approach” to infectious diseases testing increases equitable access. Although opt-out testing is endorsed by national guidelines, there is little research on the acceptability from key stakeholders in jail healthcare. Additionally, perspectives on using the opt-out approach to vaccination are unknown. Interview Themes Themes and quotes that came out of semi-structured qualitative interviews. Methods We developed an interview guide based on the Theoretic Domains Framework. Guided by the 7Ps framework for stakeholder engagement, we conducted semi-structured interviews with key stakeholders in jail healthcare, including people incarcerated in Hampden County jail, clinicians working in jail and community settings, corrections officers, and representatives from public health, government, and industry. All persons eligible to receive a stipend were offered $50 for participation. Interviews were offered in the jail in English and in Spanish. Results Between July 2021—March 2022, 48/108 (44%) of people approached agreed to be interviewed including 13 incarcerated men. Most stakeholders agreed that infectious diseases testing and vaccination in jails are essential tools for mitigating the spread of disease. Major themes that emerged from stakeholder interviews included confusion about the wording of the “opt-out” approach, reluctance to operationalize “opt-out” testing because of concerns for coercion, and concern that it gives people any “easy out” from taking the test or vaccines. People who supported the operationalization of opt-out testing were more often stakeholders from the community, including public health experts, researchers, and clinicians. Conclusion Although “opt-out” testing is evidence-based, we found that key stakeholders who work and are incarcerated in jails did not understand the concept and did not support implementation. Our work is further evidence that successful implementation of public health strategies requires vetting from all key stakeholders in jail healthcare, especially people working and incarcerated in jail when developing strategies to improve healthcare. Disclosures Curt Beckwith, MD, Gilead Sciences, Inc: Grant/Research Support.

The goal of our project was to study the implementation of rapid BINAX COVID-19 testing at criminal justice re-entry sites, focusing on several framework-guided implementation outcomes. We implemented rapid COVID-19 testing at nine re-entry sites in four states (Massachusetts, New Hampshire, Rhode Island, and New York) and collected test results to measure the 1) adoptability and 2) implementability of COVID-19 testing at re-entry sites. We also collected data on the acceptability, appropriateness, and feasibility of the implementation of COVID-19 testing using an anonymous employee Qualtrics survey.Testing was available to symptomatic and exposed residents and employees. COVID-19 testing results were collected from October 2021 to March 2022. Guided by the Expert Recommendations in Implementing Change (ERIC) framework, we chose nine implementation strategies to address barriers during the implementation process. Eight testing sites used a total of 302 BINAX COVID-19 tests and reported a total of 26 positive cases. Across all testing sites, 47% of employees participated in the survey. Most survey participants agreed that the implementation of rapid COVID-19 testing at re-entry sites was acceptable, feasible and appropriate. COVID-19 testing at nine re-entry sites was possible through collaboration with CRJ leadership. Several cases of COVID-19 were identified, especially during the peak months of the pandemic. Funding and attention toward COVID-19 testing at re-entry sites should be provided to help prevent the spread of COVID-19 in re-entry sites and their surrounding communities.