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Qureshi N, Javanbakht M, Tadesse M, Malek M, Cox G. Risk-Based HIV Testing at Los Angeles County Men's Central Jail. JOURNAL OF CORRECTIONAL HEALTH CARE 2018; 24:309-319. [PMID: 29976088 DOI: 10.1177/1078345818782707] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Incarcerated populations tend to be disproportionately affected by HIV and sexually transmitted infections (STIs), and men who have sex with men (MSM) are an especially high-risk subset of these populations. Despite the Centers for Disease Control and Prevention's recommendations for universal HIV screening, a lack of resources and high inmate turnover make it difficult to implement such guidelines in jails. From September 2013 to May 2016, the Infection Control Unit of the Los Angeles County Jail used existing resources to implement a voluntary, risk-based HIV educational and screening program targeting MSM inmates during early incarceration. The results revealed a high percentage of previously unknown HIV infections (8.5% = 57 of the 671 tested) and some unknown non-HIV STI cases. In the absence of resources for universal HIV screening, the risk-based approach is a sustainable and cost-effective approach for improving HIV surveillance in the correctional setting.
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Affiliation(s)
- Nazia Qureshi
- 1 Los Angeles County Department of Health Services, Correctional Health Services, Infection Control Unit, CA, USA
| | - Marjan Javanbakht
- 2 Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Martha Tadesse
- 1 Los Angeles County Department of Health Services, Correctional Health Services, Infection Control Unit, CA, USA
| | - Mark Malek
- 2 Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Garrett Cox
- 3 Los Angeles County Sheriff's Department, Infection Control and Epidemiology Unit, Men's Central Jail, Los Angeles, CA, USA
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2
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Cunningham WE, Weiss RE, Nakazono T, Malek MA, Shoptaw SJ, Ettner SL, Harawa NT. Effectiveness of a Peer Navigation Intervention to Sustain Viral Suppression Among HIV-Positive Men and Transgender Women Released From Jail: The LINK LA Randomized Clinical Trial. JAMA Intern Med 2018; 178. [PMID: 29532059 PMCID: PMC5885257 DOI: 10.1001/jamainternmed.2018.0150] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Diagnosis of human immunodeficiency virus (HIV) infection, linkage and retention in care, and adherence to antiretroviral therapy are steps in the care continuum enabling consistent viral suppression for people living with HIV, extending longevity and preventing further transmission. While incarcerated, people living with HIV receive antiretroviral therapy and achieve viral suppression more consistently than after they are released. No interventions have shown sustained viral suppression after jail release. OBJECTIVE To test the effect on viral suppression in released inmates of the manualized LINK LA (Linking Inmates to Care in Los Angeles) peer navigation intervention compared with standard transitional case management controls. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted from December 2012 through October 2016 with people living with HIV being released from Los Angeles (LA) County Jail. All participants were (1) 18 years or older; (2) either men or transgender women diagnosed with HIV; (3) English speaking; (4) selected for the transitional case management program prior to enrollment; (5) residing in LA County; and (6) eligible for antiretroviral therapy. MAIN OUTCOMES AND MEASURES Change in HIV viral suppression (<75 copies/mL) over a 12-month period. INTERVENTIONS During the 12-session, 24-week LINK LA Peer Navigation intervention, trained peer navigators counseled participants on goal setting and problem solving around barriers to HIV care and adherence, starting while the participants were still in jail. After their release, they continued counseling while they accompanied participants to 2 HIV care visits, then facilitated communication with clinicians during visits. RESULTS Of 356 participants randomized, 151 (42%) were black; 110 (31%) were Latino; 303 (85%) were men; 53 (15%) were transgender women; and the mean (SD) age was 39.5 (10.4) years. At 12 months, viral suppression was achieved by 62 (49.6%) of 125 participants in the peer navigation (intervention) arm compared with 45 (36.0%) of 125 in the transitional case management (control) arm, for an unadjusted treatment difference of 13.6% (95% CI, 1.34%-25.9%; P = .03). In the repeated measures, random effects, logistic model the adjusted probability of viral suppression declined from 52% at baseline to 30% among controls, while those in the peer navigation arm maintained viral suppression at 49% from baseline to 12 months, for a difference-in-difference of 22% (95% CI, 0.03-0.41; P = .02). CONCLUSIONS AND RELEVANCE The LINK LA peer navigation intervention was successful at preventing declines in viral suppression, typically seen after release from incarceration, compared with standard transitional case management. Future research should examine ways to strengthen the intervention to increase viral suppression above baseline levels. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01406626.
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Affiliation(s)
- William E Cunningham
- Department of Medicine, Division of General Internal Medicine and Health Services Research, Geffen School of Medicine, University of California, Los Angeles.,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles
| | - Terry Nakazono
- Department of Medicine, Division of General Internal Medicine and Health Services Research, Geffen School of Medicine, University of California, Los Angeles
| | - Mark A Malek
- Los Angeles County Sheriff's, Los Angeles, California.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Steve J Shoptaw
- Department of Family Medicine, Geffen School of Medicine, University of California, Los Angeles
| | - Susan L Ettner
- Department of Medicine, Division of General Internal Medicine and Health Services Research, Geffen School of Medicine, University of California, Los Angeles.,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
| | - Nina T Harawa
- Department of Medicine, Division of General Internal Medicine and Health Services Research, Geffen School of Medicine, University of California, Los Angeles.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles.,Charles R. Drew University College of Medicine, Los Angeles, California
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Harawa NT, Amani B, Rohde Bowers J, Sayles JN, Cunningham W. Understanding interactions of formerly incarcerated HIV-positive men and transgender women with substance use treatment, medical, and criminal justice systems. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 48:63-71. [PMID: 28804052 PMCID: PMC5620016 DOI: 10.1016/j.drugpo.2017.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 03/25/2017] [Accepted: 05/02/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Low levels of medical care engagement have been noted for HIV-positive people leaving systems of incarceration in the United States. Substance misuse frequently co-occurs with criminal justice involvement in individuals who are living with HIV. METHODS We analyzed data from in-depth interviews with 19 HIV-positive individuals who were currently or formerly incarcerated in order to elucidate challenges faced in accessing care and maintaining HIV treatment regimens when cycling out of (and often back into) custody. Our thematic analysis used an ecosocial framework to describe participants' shifts between substance use treatment, medical care, and criminal justice systems. RESULTS Dominant themes included the dramatic increase in HIV-treatment-related autonomy required following release from jail because of differences in care delivery between custody-based and community-based care systems; the important, but temporary stabilization provided by residential substance use treatment programmes; and the inconsistency of substance use treatment approaches with chronic care models of disease management. CONCLUSION Enhanced integration of criminal justice, medical care, and substance use treatment institutions in planning for reentry of HIV populations may ease the impact of the dramatic shifts in context that often dissuade linkage and retention. This integration should include coordination with custody release processes, periodic assessments for active substance misuse in HIV treatment settings, support for (re)establishing health-promoting social networks, and options for long-term, residential substance use treatment programmes.
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Affiliation(s)
- Nina T Harawa
- David Geffen School of Medicine at UCLA, Department of Medicine; 911 Broxton Avenue, 1st Floor, Los Angeles, CA 90024, United States; Charles R. Drew University, Department of Psychiatry and Human Behavior, 1731 E. 120th Street, Los Angeles, CA 90059, United States.
| | - Bita Amani
- Charles R. Drew University, Masters of Public Health Program, 1731 E. 120th Street, Los Angeles, CA 90059, United States
| | - Jane Rohde Bowers
- County of Los Angeles, Department of Health Services, Division of HIV and STD Programs, 600 S. Commonwealth Ave., 19th Floor, Los Angeles, CA 90005, United States
| | - Jennifer N Sayles
- Inland Empire Health Plan, 10801 Sixth Street, Suite 120, Rancho Cucamonga, CA 91729, United States
| | - William Cunningham
- David Geffen School of Medicine at UCLA, Department of Medicine; 911 Broxton Avenue, 1st Floor, Los Angeles, CA 90024, United States; UCLA Fielding School of Public Health, Department of Health Policy and Management, 650 Charles E. Young Dr. South, 16-035 Center for Health Sciences, Los Angeles, CA 90095-1772, United States
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Opt-Out HIV Testing of Inmates in North Carolina Prisons: Factors Associated with not Wanting a Test and not Knowing They Were Tested. AIDS Behav 2016; 20:859-69. [PMID: 26386591 DOI: 10.1007/s10461-015-1203-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Opt-out HIV testing is recommended for correctional settings but may occur without inmates' knowledge or against their wishes. Through surveying inmates receiving opt-out testing in a large prison system, we estimated the proportion unaware of being tested or not wanting a test, and associations [prevalence ratios (PRs)] with inmate characteristics. Of 871 tested, 11.8 % were unknowingly tested and 10.8 % had unwanted tests. Not attending an educational HIV course [PR = 2.34, 95 % confidence interval (CI) 1.47-3.74], lower HIV knowledge (PR = 0.95, 95 % CI 0.91-0.98), and thinking testing is not mandatory (PR = 9.84, 95 % CI 4.93-19.67) were associated with unawareness of testing. No prior incarcerations (PR = 1.59, 95 % CI 1.03-2.46) and not using crack/cocaine recently (PR = 2.37, 95 % CI 1.21-4.64) were associated with unwanted testing. Residence at specific facilities was associated with both outcomes. Increased assessment of inmate understanding and enhanced implementation are needed to ensure inmates receive full benefits of opt-out testing: being informed and tested according to their wishes.
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Leidel S, McConigley R, Boldy D, Wilson S, Girdler S. Australian health care providers' views on opt-out HIV testing. BMC Public Health 2015; 15:888. [PMID: 26369954 PMCID: PMC4570459 DOI: 10.1186/s12889-015-2229-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/04/2015] [Indexed: 12/03/2022] Open
Abstract
Background Opt-out HIV testing is a novel concept in Australia. In the opt-out approach, health care providers (HCPs) routinely test patients for HIV unless they explicitly decline or defer. Opt-out HIV testing is only performed with the patients’ consent, but pre-test counselling is abbreviated. Australian national testing guidelines do not currently recommend opt-out HIV testing for the general population. Non-traditional approaches to HIV testing (such as opt-out) could identify HIV infections and facilitate earlier treatment, which is particularly important now that HIV is a chronic, manageable disease. Our aim was to explore HCPs’ attitudes toward opt-out HIV testing in an Australian context, to further understanding of its acceptability and feasibility. Methods In this qualitative study, we used purposeful sampling to recruit HCPs who were likely to have experience with HIV testing in Western Australia. We interviewed them using a semi-structured guide and used content analysis as per Graneheim to code the data. Codes were then merged into subcategories and finally themes that unified the underlying concepts. We refined these themes through discussion among the research team. Results Twenty four HCPs participated. Eleven participants had a questioning attitude toward opt-out HIV testing, while eleven favoured the approach. The remaining two participants had more nuanced perspectives that incorporated some characteristics of the questioning and favouring attitudes. Participants’ views about opt-out HIV testing largely fell into two contrasting themes: normalisation and routinisation versus exceptionalism; and a need for proof versus openness to new approaches. Conclusion Most HCPs in this study had dichotomous attitudes toward opt-out HIV testing, reflecting contrasting analytical styles. While some HCPs viewed it favourably, with the perceived benefits outweighing the perceived costs, others preferred to have evidence of efficacy and cost-effectiveness. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2229-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stacy Leidel
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Ruth McConigley
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Duncan Boldy
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Sally Wilson
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Sonya Girdler
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
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Rumble C, Pevalin DJ, O'Moore É. Routine testing for blood-borne viruses in prisons: a systematic review. Eur J Public Health 2015. [PMID: 26219884 PMCID: PMC4668329 DOI: 10.1093/eurpub/ckv133] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: People in prison have a higher burden of blood-borne virus (BBV) infection than the general population, and prisons present an opportunity to test for BBVs in high-risk, underserved groups. Changes to the BBV testing policies in English prisons have recently been piloted. This review will enable existing evidence to inform policy revisions. We describe components of routine HIV, hepatitis B and C virus testing policies in prisons and quantify testing acceptance, coverage, result notification and diagnosis. Methods: We searched five databases for studies of both opt-in (testing offered to all and the individual chooses to have the test or not) and opt-out (the individual is informed the test will be performed unless they actively refuse) prison BBV testing policies. Results: Forty-four studies published between 1989 and 2013 met the inclusion criteria. Of these, 82% were conducted in the USA, 91% included HIV testing and most tested at the time of incarceration. HIV testing acceptance rates ranged from 22 to 98% and testing coverage from 3 to 90%. Mixed results were found for equity in uptake. Six studies reported reasons for declining a test including recent testing and fear. Conclusions: While the quality of evidence is mixed, this review suggests that reasonable rates of uptake can be achieved with opt-in and, even better, with opt-out HIV testing policies. Little evidence was found relating to hepatitis testing. Policies need to specify exclusion criteria and consider consent processes, type of test and timing of the testing offer to balance acceptability, competence and availability of individuals.
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Affiliation(s)
- Caroline Rumble
- 1 Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - David J Pevalin
- 2 University of Essex, Wivenhoe Park, Colchester CO4 3SQ, UK
| | - Éamonn O'Moore
- 3 Health and Justice, Public Health England, Reading RG1 7EB, UK
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Javanbakht M, Boudov M, Anderson LJ, Malek M, Smith LV, Chien M, Guerry S. Sexually transmitted infections among incarcerated women: findings from a decade of screening in a Los Angeles County Jail, 2002-2012. Am J Public Health 2014; 104:e103-9. [PMID: 25211762 DOI: 10.2105/ajph.2014.302186] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We describe and report findings from a screening program to identify sexually transmitted infections (STIs) and HIV among female inmates in Los Angeles County Jail. METHODS Chlamydia and gonorrhea screening was offered to entering female inmates. Women were eligible if they were (1) aged 30 years or younger, or (2) pregnant or possibly pregnant, or (3) booked on prostitution or sex-related charges. Voluntary syphilis and HIV testing was offered to all women between 2006 and 2009. This analysis reports on data collected from 2002 through 2012. RESULTS A total of 76,207 women participated in the program. Chlamydia prevalence was 11.4% and gonorrhea was 3.1%. Early syphilis was identified in 1.4% (141 of 9733) and the overall prevalence of HIV was 1.1% (83 of 7448). Treatment levels for early syphilis and HIV were high (99% and 100%, respectively), but only 56% of chlamydia and 58% of gonorrhea cases were treated. CONCLUSIONS Screening incarcerated women in Los Angeles County revealed a high prevalence of STIs and HIV. These inmates represent a unique opportunity for the identification of STIs and HIV, although strategies to improve chlamydia and gonorrhea treatment rates are needed.
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Affiliation(s)
- Marjan Javanbakht
- Marjan Javanbakht, Laura J. Anderson, and Lisa V. Smith are with Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles. L. V. Smith is also with Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, Los Angeles. Melina Boudov, Michael Chien, and Sarah Guerry are with Division of HIV and STD Programs, Los Angeles County Department of Public Health. Mark Malek is with Infection Control and Epidemiology Unit, Medical Services Bureau, Los Angeles County Sheriff's Department, Los Angeles
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Beckwith C, Bazerman L, Gillani F, Tran L, Larson B, Rivard S, Flanigan T, Rich J. The feasibility of implementing the HIV seek, test, and treat strategy in jails. AIDS Patient Care STDS 2014; 28:183-7. [PMID: 24617960 DOI: 10.1089/apc.2013.0357] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
To successfully implement the Seek, Test, and Treat (STT) strategy to curb the HIV epidemic, the criminal justice system must be a key partner. Increasing HIV testing and treatment among incarcerated persons has the potential to decrease HIV transmission in the broader community, but whether it is feasible to consider the implementation of the STT within jail facilities is not known. We conducted a retrospective review of Rhode Island Department of Corrections (RIDOC) medical records to assess whether persons newly diagnosed in the jail were able to start ART and be linked to community HIV care after release. From 2001 to 2007, 64 RIDOC detainees were newly diagnosed with HIV. During their index incarcerations, 64% were informed of positive confirmatory HIV test results, 50% completed baseline evaluations, and 9% began ART. Linkage to community care was confirmed for 58% of subjects. Subjects incarcerated for >14 days were significantly more likely to receive HIV test results and complete baseline evaluation (p<0.001). A similar association was not observed for ART initiation until incarceration length reached 60 days (p<0.001). There was no association between incarceration length and linkage to care. This comprehensive analysis demonstrates that length of incarceration impacts HIV test result delivery, baseline evaluation, and ART initiation in the RIDOC. Jails are an important venue to "Seek" and "Test"; however, completing the "Treat" part of the STT strategy is hindered by the transient nature of this criminal justice population and may require new strategies to improve linkage to care.
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Affiliation(s)
- Curt Beckwith
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Lauri Bazerman
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
| | - Fizza Gillani
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
| | - Liem Tran
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
| | - Brita Larson
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
| | - Saul Rivard
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
| | - Timothy Flanigan
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Josiah Rich
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Costumbrado J, Stirland A, Cox G, El-Amin AN, Miranda A, Carter A, Malek M. Implementation of a hepatitis A/B vaccination program using an accelerated schedule among high-risk inmates, Los Angeles County Jail, 2007–2010. Vaccine 2012; 30:6878-82. [DOI: 10.1016/j.vaccine.2012.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 08/11/2012] [Accepted: 09/03/2012] [Indexed: 10/27/2022]
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Beckwith CG, Nunn A, Baucom S, Getachew A, Akinwumi A, Herdman B, DiBartolo P, Spencer S, Brown D, Lesansky H, Kuo I. Rapid HIV testing in large urban jails. Am J Public Health 2012; 102 Suppl 2:S184-6. [PMID: 22401524 DOI: 10.2105/ajph.2011.300514] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
HIV prevalence is higher in jails than in the community, yet many jails do not conduct HIV testing. Jails in Baltimore, Maryland; Philadelphia, Pennsylvania; and the District of Columbia have implemented innovative rapid HIV testing programs. We have summarized the results of these programs, including the numbers of persons tested, rapid and confirmatory HIV test results, and numbers of persons newly diagnosed with HIV. We have described facilitators and challenges of implementation. These programs confirmed that rapid HIV testing in jails was feasible and identified undiagnosed HIV infection. Challenges included limited space to provide confidential rapid HIV testing and rapid turnover of detainees. Implementation required collaboration between local governments, health agencies, and correctional institutions. These programs serve as models for expanding rapid HIV testing in jails.
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Affiliation(s)
- Curt G Beckwith
- Division of Infectious Diseases, The Miriam Hospital/Alpert Medical School of Brown University, Providence, RI 02906, USA.
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