Rapid HIV screening in a jail setting: Addressing perceived barriers through a pilot project - PowerPoint Presentation

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Rapid HIV screening in a jail setting: Addressing perceived barriers through a pilot project

Raees A.

Shaikh1, Kari A Simonsen1, Mary Earley2, Mark Foxall2, Cole Boyle1, KM Islam1, Heather Younger3, Uriel Sandkovsky1, Elizabeth Berthold4, Ruth Margalit1.1University of Nebraska Medical Center, Omaha NE., 2Douglas County Department of Corrections, Omaha NE., 3Nebraska Department of Health and Human Services, Lincoln, NE., 4Douglas County Health Department, Omaha NE.,

Background

The prevalence of HIV among the incarcerated population in the US is twice the prevalence in the general

population, accounting

for approximately 17% of incarcerated individuals

annually.

1,2

The prevalence of high-risk sexual behaviors including multiple sexual partners, unprotected sex, and substance abuse is higher among inmates compared to the general US public.1,3 From a public health perspective, jails provide a critical point of contact to reach a unique high-risk population with a higher burden of HIV and poor access to healthcare in the community.4,5 Therefore, routine support for HIV testing and linkage to care for jail inmates is warranted.6 Presently, only 36% of jails offer routine HIV testing, despite recommendations by the Centers for Disease Control and Prevention for adult correctional facilities to provide HIV testing.7 In most jails, including Douglas County Department of Corrections (DCDC) in Omaha, Nebraska, screening is performed at inmate request or when HIV symptoms are present. This results in only an estimated 20% of jail inmates getting tested for HIV during their detention. Since 2009, DCDC has partnered with the University of Nebraska Medical Center and state and local health departments in an attempt to provide additional STI testing and treatment opportunities to inmates.

Methods

Table 1. Non-participation results (n=205)

We used the established partnership to conduct a feasibility study which offered rapid HIV screening at jail release, with linkage to care for DCDC inmates on a voluntary basis. The results obtained from the project address the perceived barriers to feasibility and acceptability of such rapid exit HIV screenings in the jail setting.

Table 2. HIV testing participant demographics and risk factors (n =302)

Results

Among 507 inmates who were offered screening, 302 (60%) participated and 205 (40%) declined. The most common reason for non-participation was “recently tested” (60.38%) followed by “other” (26.57%). All 302 participants received the results of their test before being released. One participant screened positive for HIV and was linked to community-based care. A majority of participants (57.62%) reported previous testing for HIV. Self-reported high risk sexual behaviors included sex without condoms (88.74%), multiple lifetime partners (73.18%), and sex while intoxicated or under the influence of drugs (66.23%). More than a quarter of the participants also reported having sex either with an anonymous partner or with a person with unknown HIV status (27.81% and 27.48% respectively). Previous STI diagnosis was reported by 20.20% and 5.96% reported prior use of intravenous drugs.

References

Maruschak, L. M., & Beavers, R. (2009). HIV in prisons, 2007–08. Bureau of Justice Statistics Bulletin, 1-12. Spaulding, A. C., Seals, R. M., Page, M. J., Brzozowski, A. K., Rhodes, W., & Hammett, T. M. (2009). HIV/AIDS among inmates of and releasees from US correctional facilities, 2006: Declining share of epidemic but persistent public health opportunity. PLoS One, 4(11), e7558. Workowski. (2013). Chlamydia and gonorrhea. Annals of Internal Medicine, 158; 8(3). ITC2-1.Centers for Disease Control and Prevention. (2012b). Sexually transmitted disease surveillance 2012. Atlanta: US department of health and human services.Culbert, G. J. (2011). Understanding the health needs of incarcerated men living with HIV/AIDS: A primary health care approach. Journal of the American Psychiatric Nurses Association, 17(2), 158-170.Westergaard, R. P., Spaulding, A. C., & Flanigan, T. P. (2013). HIV among persons incarcerated in the US: A review of evolving concepts in testing, treatment and linkage to community care. Current Opinion in Infectious Diseases, 26(1), 10. Centers for Disease Control and Prevention. (2012a). Centers for Disease Control. (2009). HIV Testing Implementation Guidance: Correctional Settings, January 2009: 1–38.

Pilot Project: The DCDC implemented a policy offering rapid HIV testing at release during 2013, with a target sample of 300 inmates. Inmates being processed for release were brought to a private area where the details of the project were explained, screening procedures detailed, and testing offered. Those declining completed a voluntary declination questionnaire. Otherwise, test procedures were explained and informed consent for testing was signed. All participating inmates were provided results and post-test counseling. Positive screening test results resulted in immediate linkage to community-based care for confirmatory testing at the county STI clinic.Variables: Participants completed a questionnaire providing demographic characteristics (age, gender, education level, etc.) and a self-reported history of sexual and health behaviors. Screening was performed using OraQuick® ADVANCE Rapid HIV-1/2 (OraSure Technologies) which reports results in 20 minutes. Feasibility of the testing procedures was based on feedback from the jail medical and discharge personnel, and the student volunteers performing the tests.

Purpose

Conclusions

The

most challenging perceived barriers to offering HIV screenings at the time of intake or during incarceration for many jails are logistic and financial

concerns.

All of the participants in this project received their test results before their release, demonstrating the feasibility of offering rapid HIV screenings during exit proceedings. This pilot allowed for direct involvement of community partners who provided testing supplies and linkage to care providers in the community; and reduced the potential burdens of increased workload and resource-utilization in the medical ward in the jail for management of HIV during brief incarceration periods in asymptomatic inmates.The exit testing approach provides an alternative to intake testing with the advantages of having direct linkage to community-based agency and clinical support immediately accessible. The partnership thereby alleviated the manpower, logistical, and financial concerns of the corrections team and provided access to HIV testing for an at-risk and difficult to reach population. These results could inform and support future efforts to provide routine exit screening at the DCDC jail, and provide a framework for other communities striving to improve non-traditional access to HIV testing.

 %Non-participation proportion 40.44%  Non participation reasons  Recently tested60.38% Already know status5.80% Do not wish to know7.25% Other26.57%

% in sample or Mean

Rapid HIV Test Result

Reactive

0.33%

Non-Reactive

99.67%

Age in years

32.28

Gender

Male

73.84%

Female

26.16%

Race and Ethnicity

Non-Hispanic White

41.61 %

Non-Hispanic Black

36.24 %

Hispanic

13.76 %

Non-Hispanic American Indian/Alaskan

Native

5.37

%

Non-Hispanic Asian/Hawaiian/Pacific

Islander

1.34

%

Other/Unknown

1.68 %

Previously Tested for HIV

57.62 %

Risky Sexual Behavior

Had Sex without Condom

88.74 %

Had Sex with Multiple Partners

73.18%

Had Sex with IV Drug User

7.62

%

Had Sex with HIV+ Person

0.99

%

Exchanged Sex for Drug/Money

2.65

%

Had Sex with Someone Exchanging Sex for Drug/Money

3.97

%

Had Sex while Intoxicated/High

66.23 %

Had Sex with Person of Unknown HIV Status

27.48%

Had Sex with Anonymous Partner

27.81%

Ever Been Diagnosed with STI

20.20%

IV Drug Use History

Had Ever Used IV Drugs

5.96

%

Had Shared Drug Injection Equipment

0.66

%