Date of Award

9-27-2010

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Lloyd Cantley

Abstract

Background: Tens of millions of Americans enter jails annually. The Centers for Disease Control and Prevention now recommends routine HIV testing in prisons and jails. The logistics for performing routine HIV testing within jails, however, remains controversial. Specific Aims: 1) To simulate and explore the feasibility of future implementation of a routine opt-out HIV testing protocol using rapid testing methods in the often-chaotic jail setting. 2) To evaluate the optimal time to perform routine HIV testing among inmates who are competent to consent to testing, in a manner that not only maximizes public health but also attends to the safety and health status of individual inmates. Methods: Two prospective, controlled trials of routine opt-out HIV testing were conducted among 323 newly incarcerated female inmates in Connecticut's only women's jail (during August and September 2007) and 298 newly incarcerated male inmates in an urban men's jail in New Haven, Connecticut (during March and April 2008). Sequential entrants at both facilities were assigned to be offered routine opt-out HIV testing at one of three points after incarceration: immediate (same day), early (next day), or delayed (7 days). The primary outcome was the proportion of individuals in each group consenting to testing. Results: In the womenâs trial, 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. In the men's trial routine opt-out HIV testing was significantly higher for the early (53%: AOR=2.6; 95% CI=1.5 to 4.7) and immediate (45%: AOR=2.3; 95% CI=1.3 to 4.0) testing groups compared to the delayed (33%) testing group. The immediate and early testing groups, however, did not significantly differ (p=0.67). In multivariate analyses, factors significantly associated with routine opt-out HIV testing were assignment to the 'early' testing group (p=0.0003) and low (bond >=$5,000, immigration or federal charges or pre-sentencing >30 days) likelihood of early release (p=0.04). Two male subjects received preliminary positive results and one of them was subsequently confirmed HIV seropositive. Conclusions: In both correctional facilities, routine opt-out HIV testing in a jail setting was feasible, with highest rates of testing if performed within 24 hours of 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.

Comments

This is an Open Access Thesis.

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