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. 2023 Jun 23;18(6):e0286805.
doi: 10.1371/journal.pone.0286805. eCollection 2023.

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

Samantha R Levano  1 , Mallory E Epting  1 , Jacob A Pluznik  1 , Victoria Philips  1 , Lindsey R Riback  2 , Chenshu Zhang  2 , Binyam Aseffa  3 , Aman R Kapadia  4 , Chava J Bowden  1 , Beth Jordan  3 , Eleni O'Donovan  4 , Anne C Spaulding  1 , Matthew J Akiyama  2
Affiliations

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

Samantha R Levano et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

We thank all incarcerated persons who contributed data to this study. Additionally, we thank the staff at Unity Health Care and the D.C. Department of Corrections who collected individual participant data and contributed to the data reports that informed the results of this manuscript. This study was funded by the National Institute of Health (NIH) via the Einstein-Rockefeller-CUNY Center for AIDS Research (P30-AI124414); and Gilead Sciences; however, the content of this manuscript reflects the views of the authors and not the official views of either funding source. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Total number of entrants and rate of HIV testing and results received, Washington D.C.
Department of Corrections jail, 2019–2020.
See this image and copyright information in PMC

References

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