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.