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OPT-OUT HIV/HCV TESTING AMONG JAIL INMATES
Carolina De La Flor1, Esmaeil Porsa2, Ank E. Nijhawan1
1Univ of Texas Southwestern Med Cntr, Dallas, TX, USA,2Parkland Hlth and Hosp Systems, Dallas, TX, USA
Incarceration provides an opportunity to provide HIV/HCV screening in high-risk and hard-to-reach individuals. The Centers for Disease Control recommends routine opt-out HIV testing in jails and prisons, however only 19% of prisons and 35% of jails offer this service. HCV testing is recommended for those born between 1945-1965 ('baby boomer' cohort) and with risk factors such us injection drug use, and incarceration. The aim of our study is to describe the results of an opt-out combined HIV and HCV testing program in a criminal justice setting.
Opt-out HIV/HCV testing was offered to individuals entering the Dallas County Jail between October 2015 and July 2016 at the time of a scheduled blood draw. Basic demographics were collected on all participants. For those who tested HIV positive, risk factors, prior engagement in care (seen by an HIV provider within 6 months previous to incarceration), and re-engagement in care (receipt of HIV care during incarceration) were assessed.
HIV opt-out testing Overall, 1.3% (41/3155) had a positive HIV screening test. Of these, 24% were false positives (positive 4th generation Ag/Ab test with negative HIV1/2 Ab differentiation test). Of those remaining, 16% were newly diagnosed, of whom 100% were linked to care. Among those previously known to be HIV-positive, one-third were not engaged in care before incarceration though 88% were linked back to HIV care in jail. HCV opt-out testing Overall, 16% (500/3042) had a positive HCV Ab screening test. Mean age was 49, 80% were men, and our cohort was racially diverse (43% White, 42% Black, and 15% Hispanic). One-third of inmates self-reported HCV positivity before being tested. Only 52% of the HCV-positive were baby boomers. Racial differences were observed within the baby boomer group, with 74% of blacks v. 35% of whites belonging to this cohort.
Routine opt-out HIV/HCV testing in a jail setting identified multiple HIV and HCV infections. New HIV diagnoses were relatively rare, though linkage to care and re-engagement in HIV care was high. The rate of HCV Ab positivity was high and one-third was already aware of this diagnosis. Testing only those in the baby boomer cohort would have missed approximately half of HCV infections, predominantly among whites. Opt-out HIV/HCV screening in the criminal justice system is a unique opportunity to reach underserved individuals, who may otherwise not seek testing and are at high risk of transmitting these infections.