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, Ravi Kavasery, Duncan Smith-Rohrberg Maru, Joshua Cornman-Homonoff, Laurie N Sylla, David Smith, Frederick L Altice

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.

Trial registration: ClinicalTrials.gov NCT00624247.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Disposition of Inmates Approached for…
Figure 1. Disposition of Inmates Approached for HIV Testing.
Figure 2. Rapid HIV Testing Swab Results…
Figure 2. Rapid HIV Testing Swab Results by Assigned Testing Group.
Figure 3. Time to Release Following Incarceration.
Figure 3. Time to Release Following Incarceration.

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