Establishing an HIV Screening Program Led by Staff Nurses in a County Jail

Abstract

Context HIV testing in jails provides an opportunity to reach individuals outside the scope of traditional screening programs. The rapid turnover of jail populations has, in the past, been a formidable barrier to offering routine access to testing. Objective To establish an opt-out, rapid HIV testing program, led by nurses on the jail staff, that would provide undiagnosed yet infected detainees opportunities to learn their status regardless of their hour of entry and duration of stay. Design Jail nurses offered rapid, opt-out HIV testing Setting Fulton County Jail (FCJ) in Georgia, United States. Participants 30,316 persons booked to FCJ. Intervention In late 2010, we performed a preliminary evaluation of HIV seroprevalence. Starting January 1, 2011, HIV testing via rapid oral mucosal swab was offered to entrants. In March 2013, fingerstick was substituted. Detainees identified as positives were assisted with linkage to care. Main outcome measures To estimate an upper limit of overall HIV prevalence among entrants, we determined seroprevalence by age and gender group. To measure program performance, we checked offer and acceptance rates for tests and rate of linkage to care among previously known and newly identified HIV+ detainees. Results The initial seroprevalence of HIV in FCJ was at least 2.18%. Between March 2013 and February 2014, 89 new confirmed positives were identified through testing. During these 12 months, 20,947 bookings were followed by an offer of HIV testing (69.10% offer rate), and 17,035 persons accepted (81.32% acceptance rate). A total of 458 previously and newly identified persons were linked to HIV care. Linkage was significantly higher among those aged 40 years and older (p<0.05). Conclusions A nurse-led, rapid HIV testing model successfully identified new HIV diagnoses. The testing program substantially decreased the number of persons who are HIV-infected but unaware of their status and promoted linkage to care.

Jail, an unappreciated medical home: Assessing the feasibility of a strengths-based case management intervention to improve the care retention of HIV-infected persons once released from jail

“…We recruited participants from Fulton County Jail (FCJ) in Atlanta, Georgia, a 2500-bed mega-jail, where HIV population prevalence has been rising from 2–3% in 2011[ 12 ] to almost 5% in 2017 (range 100–130 infected persons/range 2500–2600 total population). Fulton County is one of two counties that make up Atlanta; the eastern 10% of the city is in DeKalb County.…”

Can TasP Approaches Be Implemented in Correctional Settings?: A review of HIV testing and linkage to community HIV treatment programs

“…29 Routine opt-out testing has been conceptualized as a policy measure to protect the public’s health as well as to preserve the privacy and human rights of the incarcerated individual by prioritizing access to health care screening, while maintaining the individual’s ultimate right to refuse. 30 Eight published articles examined the feasibility and/or efficacy of routine opt-out testing in correctional setting and found acceptance/uptake rates between 22% and 90%, 31–39 —with significant increases the uptake of HIV testing in studies that compared pre-routine opt-out testing protocols. Rates in detection of HIV cases ranged from 0.03 to 2%, with confirmed new cases ranging from 0.13% to 0.8%.…”

“…Two studies in jail and prison settings also examined differences between opt-in and opt-out strategies, and found increases between 18%–21% 8 after opt-out strategies were implemented. 34,39 Changes in detection of new HIV infections increased from 1.8 new cases per year during on-request testing to 5.1 with opt-in and to 7.6 opt-out testing policies. 34 …”

“…Eight published manuscripts, representing six different HIV testing initiatives, examined the feasibility and acceptability of providing (opt out) rapid HIV testing in jails; 32,33,37,39,42–45 again, no studies examined rapid testing in prisons. The advantage of this method of testing over traditional testing methods is that it increases the likelihood that test results are received by the inmate prior to turnover, transfer, or release; 13 rapid-testing can be available in as little as 20 minutes whereas traditonal testing methods can take from 7–14 days to get results.…”

“…Only two studies had comparison or baseline groups, noting an increase between 21%–67% in rates of HIV testing following implementation of rapid testing. 37,39 Spaulding and colleagues 39 also compared acceptance of different methods of rapid testing (oral swab or finger-stick) with each other as well as with traditional serum blood test. Acceptance rate of the serum test was 43.2% compared with 64.3% for rapid-oral HIV testing; rate of new preliminary positives was 0.43% with rapid-oral HIV testing.…”