Routine Jail-Based HIV Testing --- Rhode Island, 2000--2007

Routine Jail-Based HIV Testing --- Rhode Island, 2000--2007
Weekly
June 25, 2010 / 59(24);742-745


The prevalence of human immunodeficiency virus (HIV) infection among incarcerated persons in the United States (1.5%) is approximately four times greater than the prevalence among persons in community settings (0.4%) (1). In 2006, CDC recommended HIV testing in correctional facilities and elsewhere as part of routine medical evaluation (2). However, jail-based testing can be difficult logistically because of rapid turnover among detainees. In 2009, the Rhode Island Department of Corrections (RIDOC) reviewed its HIV testing program to assess HIV case identification, characterize HIV risk factors, and estimate the proportion of detainees who might not have been tested if testing had been delayed. RIDOC reviewed records of HIV testing of jail detainees during 2000--2007. During this period, 102,229 HIV tests were administered (representing an estimated 40,000--60,000 unique jail detainees), and HIV infection was newly diagnosed in 169 detainees, including 80 (48%) with unknown HIV risk factors. HIV testing was completed within 24 hours of jail admission. If HIV testing had been delayed for 7 days, 72 detainees (43%) would have been released before they could be tested, resulting in a delay in their HIV diagnosis and care, and continued risk for HIV transmission. To maximize case identification, all detainees should be offered voluntary HIV testing early in their incarceration as part of the first clinical evaluation, regardless of reported risk factors.

RIDOC is a unified state correctional system with six facilities for males and two for females. All pretrial detainees and all sentenced offenders (regardless of sentence length or crime) first pass through a centralized state jail that processes approximately 17,000 detainees each year. At any given time, the total inmate population in the RIDOC system is approximately 3,000--3,500, including 1,100 housed in the jail. Since 1991, the jail routinely has offered HIV testing to every person admitted as part of the initial medical evaluation conducted within 24 hours of admission. The RIDOC testing program uses a conventional laboratory-based HIV enzyme immunoassay (EIA) with Western blot confirmatory testing on blood specimens. HIV testing is voluntary (opt-out), and informed consent is obtained to conduct HIV counseling and testing. HIV test results are available in 7--14 days, and persons with a confirmed HIV-positive result who remain incarcerated are notified by the RIDOC HIV clinical nurse. All persons with confirmed HIV infection receive prevention counseling at RIDOC, referral to specialized HIV care within the correctional facility, and linkage to community care upon release. All HIV test results are reported to the Rhode Island Department of Health (RIDOH), and persons with positive test results who are released before notification are contacted in the community by a RIDOH outreach worker who provides results, prevention counseling, and referral to HIV care.

To determine the number and characteristics of persons with newly identified HIV infection and estimate the proportion of detainees who might not have been tested if testing had been delayed, RIDOC examined jail incarceration and HIV testing data from 2000--2007. A newly identified case of HIV infection was defined in a person with a positive confirmed HIV test at RIDOC who had no record of a previous positive HIV test result according to RIDOH HIV surveillance data. Data from 2000--2007 were selected because reporting of positive HIV test results to RIDOH using unique identifiers began in 2000.

During 2000--2007, the RIDOC jail had 140,739 admissions and conducted 102,229 (73%) HIV tests (Table 1). Because some detainees had multiple arrests and multiple HIV tests, the total number of HIV tests performed represents an estimated 40,000--60,000 unique persons (an exact number was not available). Of the 102,229 tests, a total of 169 detainees had a newly identified HIV infection that had not been reported previously to RIDOH. Of the 169, a total of 72 (43%) were released within 7 days after incarceration, including 49 who were released within 48 hours (Table 1); 97 (57%) detainees were incarcerated for >7 days. From 2000 to 2007, a statistically significant decreasing trend (from 33 to 13) was observed in the number of newly identified HIV infections at RIDOC, using linear regression (p = 0.001).

Of the 168 detainees with newly identified HIV infection for whom data were available, 151 (90%) were men, and 133 (79%) were aged 30--49 years (Table 2). By race/ethnicity, 62 (37%) were Hispanic, 58 (35%) were non-Hispanic black, and 46 (27%) were non-Hispanic white. Eighty (48%) did not specify an HIV risk factor; 44 (26%) were injection-drug users (IDUs), and 27 (16%) were men who have sex with men (MSM).

Reported by
CG Beckwith, MD, JD Rich, MD, TP Flanigan, MD, Alpert Medical School of Brown Univ, Providence; M Poshkus, MD, N Aucoin, AM Bandieri, P Threats, Rhode Island Dept of Corrections, Cranston; S Chowdhury, MBBS, MPH, P Loberti, MPH, L Minuto, MEd, Rhode Island Dept of Health. R MacGowan, MPH, A Margolis, MPH, C Courtenay-Quirk, PhD, W Chow, Div of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC.

Editorial Note

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Routine Jail-Based HIV Testing --- Rhode Island, 2000--2007