Type of Activity: Demonstration and program services to support the development and programmatic evaluation of a comprehensive, routine, opt-out HIV rapid testing jail based initiative.
Funding Mechanism: Cooperative Agreement
Total Available Funding: $980,000
Number of Awards Anticipated: 1-2
Length of Project Period: 1 year; October 2010 - October 2011
Federal Partners: None
Strategies to conduct STI and Hepatitis screening and provide Hepatitis B vaccination to inmates who screen preliminary positive for HIV should be explored. The services are to be provided during an initial health screening or medical intake evaluation. Effective prevention strategies implemented for high risk inmates, prior to or following release are to be explored.
This project funds the development and evaluation of a universal voluntary opt-out HIV rapid testing program which is consistent with CDC HIV testing guidelines and integrated into clinical services provided to all inmates undergoing an intake medical evaluation. STI urine-based screening and Hepatitis B vaccination complement the HIV screening component, and are provided to all inmates who screen preliminary positive for HIV. The project attempts to provide integrated services to jail inmates over the project period, to include screening, vaccination, and linkage to care. Creative strategies are being explored and implemented by clinical staff to provide screening services to high-risk inmates who are released before receiving a medical evaluation. These strategies include targeting inmates based upon charge (e.g. prostitution, drug, violence), or zip code of arrest.
Background: Addressing health disparities in the United States requires a concentrated approach to increase the availability of HIV, STI, and Hepatitis testing and prevention services for correctional populations; a population disproportionately represented by minorities and disproportionately impacted by HIV, STIs, and Hepatitis infections. In the US , an estimated 800,000 persons are detained in jails on a daily basis. People detained in jails usually serve less than 1 year, and approximately 50% are released within 72 hours. Due to repeat arrests and short durations of confinement, approximately 7-10 million jail releases occur annually. Many people entering correctional facilities have a history of high-risk sexual behaviors, substance abuse, or both. Rapid HIV testing, STI, Hepatitis B and Hepatitis C screening in jails is an effective strategy to reach high-risk individuals who may not seek testing while in the community. The significant cost-savings and considerable impact jail-based screening programs would have on reduction of community-level disease is a significant and largely untapped public health opportunity, particularly in urban areas with large correctional populations.
Grantee: Emory University, Rollins School of Public Health
Location of Project: Fulton County Jail, Atlanta, GA
A. Outcome Measures
- Number of persons screened for HIV (rapid testing), STIs (e.g., Gonorrhea, Chlamydia), Hepatitis B and Hepatitis C
- Number of persons provided HIV, STI, Hepatitis B and Hepatitis C test results and prevention counseling
- Number of persons testing HIV, STI, Hepatitis B, or Hepatitis C-positive who are linked to appropriate care, treatment and services in the facility or community
- Proportion of cases with co-morbidities associated with HIV, STD, (Chlamydia, Gonorrhea, Syphilis), and Hepatitis B and C virus
- Yield of new HIV cases
- Number of persons provided a dose of Hepatitis B vaccination at medical intake examination
- Develop a best practices/model for prevention education, screening and testing, vaccination, and linkage to care and treatment protocol for jails in the U.S.
B. Project Assessment and Evaluation: This project funds a large jail facility in a jurisdiction with high HIV prevalence (>1%), which has demonstrated experience integrating HIV testing programs and has the capacity to expand and evaluate a more fully integrated program. CDC project officers are continually monitoring the key outcome measures, and are making recommendations based upon testing and vaccination coverage. At the conclusion of the project, a detailed best practices/model testing, vaccination, and linkage to care and treatment protocol for jails in the U.S. will be developed by the applicant and CDC for dissemination.
Future Prospects: Continuation of project in future years is contingent upon the progress and success of the initial allocation.
CAPT Laurie Reid, RN, MS
Public Health Advisor, CDC, NCHHSTP, DHAP
Phone: (404) 639-8461