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Overview
High rates of HIV and sexually
transmitted diseases (STDs) have been
documented among persons entering the
correctional system. Currently, only a
fraction of jails routinely test for HIV on
entry. People incarcerated for fewer than 30
days are unlikely to receive traditional HIV
counseling and testing, and, if they do,
they may be released before their test
results from traditional testing are
available. Routine rapid testing would
facilitate initial testing, delivery of
results, confirmatory testing, and
appropriate referral to care, treatment, and
prevention services within the facility or
in the community. This project focuses on
short-stay correctional facilities, from
which inmates are more likely to be released
before results from traditional testing are
available.
All persons who test positive for HIV
will be eligible to participate in the 3-
and 6-month program evaluation component of
the demonstration project. The interviewer
will assess the status of referrals made and
ask about the participant’s specific
HIV-related risk factors. At the completion
of the 6-month assessment, participants will
be screened for gonorrhea and chlamydia
through urine samples; project staff will
make every attempt to notify participants of
their test results and make appropriate
referrals for treatment.
Goals
The goals of this project are to
- increase access to voluntary HIV
testing,
- increase the proportion of
HIV-positive inmates who know they are
infected.
- increase the proportion of
HIV-positive inmates who are linked to
prevention, care, and treatment
services, and
- prevent new HIV infections.
Collaborator Sites
Florida—Broward County Jail
System (five facilities). The
Broward County Health Department will offer
rapid HIV testing 4 days a week to male and
female inmates during intake and/or at
inmates’ request. Approximately 10,000
inmates are expected to be tested during the
demonstration project. These inmates will be
notified of their test results at the time
of testing.
Those with negative test results will
receive appropriate prevention counseling
and, if desired, documentation of their
negative result. Inmates with a reactive
rapid test result will be offered
confirmatory HIV testing and appropriate
prevention counseling. Inmates who are HIV
positive will be linked upon their release
to services through the Jail Release Linkage
Project.
Louisiana—Orleans
Parish Prison (OPP). Male and
female inmates incarcerated for more than 72
hours will be offered routine voluntary
rapid HIV testing, result notification, and
prevention counseling. Approximately 12,000
inmates are expected to be tested during the
project period. The Department of
Correction’s medical staff will offer
rapid HIV testing daily. Inmates with a
reactive rapid test result will be offered
confirmatory HIV testing; persons confirmed
as HIV positive are immediately scheduled
for an appointment with the in-house medical
staff and are seen by an infectious disease
specialist. During their incarceration,
inmates who are HIV positive have access to
medications and special diets and, if
needed, additional services at Charity
Hospital’s HIV clinic.
New York State—Dutchess,
Westchester, Orange, Sullivan, and Rockland
County Jails. Male and female
inmates undergoing a medical evaluation and
held for more than 24 hours will be
routinely offered voluntary, anonymous rapid
HIV testing, result notification, and
prevention counseling. Approximately 8,750
inmates are expected to be tested during the
project period. Inmates will be eligible for
testing unless they identify themselves as
HIV positive, have mental health issues that
affect their ability to provide consent,
have been tested within the previous 30
days, or are scheduled to be released within
24 hours of admission. Persons testing
anonymously will be able to change their
test status to “confidential” without
having to retest. Persons with a reactive
result to the rapid test will be referred
for confirmatory testing. Those who test
positive will be referred to available care,
treatment, and prevention services offered
within the facility, through case management
referrals, or by Family Services Inc., a
community-based organization that provides
services at the jails and makes linkages to
community programs upon release.
Wisconsin—Milwaukee
House of Corrections and Rock County Jail.
Male and female inmates entering these two
facilities will be offered routine voluntary
rapid HIV testing, prevention counseling,
result notification, confirmatory testing
for reactive results, and discharge planning
for referrals to community resources upon
release. Approximately 8,000 inmates are
expected to be tested during the project
period. Rapid testing is available 4 days a
week and is provided by contractors (STD
Specialties and AIDS Network). Inmates are
notified of their test results at the time
of testing, and those with reactive rapid
test results are offered confirmatory HIV
testing. Discharge planning staff will refer
and link HIV-positive inmates to medical
evaluation, treatment, and prevention
services in the community; they will also
monitor the discharged inmates’ use of
these services by maintaining monthly
contacts, overseeing risk assessments, and
supervising STD screening 6 months after
testing.
Project Milestones
- Research Funding Announcement
developed: April 2003
- Interim Technical Guidance for
Grantees published: July 2003
- Contractors selected: August 2003
- Investigator meetings: November 2003
- Rapid testing implemented at all
sites: January 2004
Data Collection
Counseling and testing data are entered
on the state’s site-specific Counseling
and Testing Survey (CTS) data collection
forms. Supplemental program referrals and 3-
and 6-month program evaluation data will be
collected for all persons who are identified
as HIV positive and consent to participate
in the evaluation component of the
demonstration project. Data are submitted to
CDC monthly via a secure data network.
Results to Date
From late December 2003 through June
2004, 5,226 persons were tested as part of
this project. At most sites, inmates who
know they are HIV positive are retested if
they do not have documentation of a positive
test result. This documentation is needed
for referral into services. Of those tested,
108 (2.1%) inmates tested positive, 50 of
whom were new positives.
All four sites have begun to submit CTS
data to CDC. Valuable lessons have already
been learned through this project. Florida
and Louisiana will be able to conduct more
tests in a shorter period of time for two
reasons. First, they practice
“juggling”—client A is counseled and
rapid test administered; while client A is
waiting for test results, client B is
counseled and given the rapid test; while
client B is waiting for test results, Client
A is given his/her test results, and so on.
This practice allows staff members to make
more efficient use of their time. Second,
the inmate populations at the facilities are
larger than those at the other sites. |
