HIV testing in jails: Comparing strategies to maximize engagement in HIV treatment and prevention

Despite 15,000 people enter US jails yearly with undiagnosed HIV infection, routine HIV testing is not standard. Maximizing the yield and speed of HIV testing in short-term detention facilities could promote rapid entry or re-entry of people living with HIV (PLWH) into care. The goal of this study w...

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Bibliographic Details
Published in:PloS one 2023-06, Vol.18 (6), p.e0286805-e0286805
Main Authors: Levano, Samantha R, Epting, Mallory E, Pluznik, Jacob A, Philips, Victoria, Riback, Lindsey R, Zhang, Chenshu, Aseffa, Binyam, Kapadia, Aman R, Bowden, Chava J, Jordan, Beth, O'Donovan, Eleni, Spaulding, Anne C, Akiyama, Matthew J
Format: Article
Language:English
Subjects:
AIDS treatment
Analysis
Antibodies
Antigens
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Antiviral agents
Biology and Life Sciences
Care and treatment
Correctional institutions
COVID-19
Diagnosis
Discharge planning
Disease transmission
Drug therapy
Health aspects
HIV
HIV (Viruses)
HIV infection
HIV Infections - diagnosis
HIV Infections - drug therapy
HIV Infections - prevention & control
HIV Testing
Human immunodeficiency virus
Humans
Jails
Management
Medical diagnosis
Medical laboratories
Medical screening
Medical tests
Medicine and Health Sciences
Pandemics
Patients
Point-of-Care Systems
Point-of-Care Testing
Prison administration
Prisons
Social Sciences
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Summary:Despite 15,000 people enter US jails yearly with undiagnosed HIV infection, routine HIV testing is not standard. Maximizing the yield and speed of HIV testing in short-term detention facilities could promote rapid entry or re-entry of people living with HIV (PLWH) into care. The goal of this study was to evaluate the impact of third generation, rapid point-of-care (rPOC) vs. fourth generation, laboratory-based antigen/antibody (LBAg/Ab) testing on the HIV care cascade in a large urban jail during a planned transition. We used aggregate historical data to compare rPOC testing and LBAg/Ab testing in the D.C. Department of Corrections. We examined two time periods, January to August 2019 when rPOC testing was performed, and October 2019 to January 2020 after LBAg/Ab testing began. We calculated monthly rates of HIV tests performed, HIV test results received, HIV test results received among those tested, antiretroviral therapy (ART) initiation, and proportion of PLWH receiving discharge planning prior to release. We then conducted an interrupted time series analysis to assess the differences between testing periods. There were 14,237 entrants during the first time period and 7,569 entrants during the second. Transitioning from rPOC to LBAg/Ab testing increased the rate of test uptake by 38.5% (95% CI: 14.0, 68.3), decreased the rate of test results received among those tested by 13.1% (95% CI: -14.0, -12.1), and increased the combined rate of HIV tests performed and results received by 20.4% (95% CI: 1.5, 42.8). Although the rate of HIV testing was greater under LBAg/Ab, PLWH received results immediately through rPOC testing, which is critically important in short-stay enviroments. Increasing rPOC uptake would increase its value and combined testing may maximize the detection of HIV and receipt of results among persons passing through jails.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0286805