Opt-Out Screening for Chlamydia trachomatis and Neisseria gonorrhoeae in Female Detainees at Cook County Jail in Chicago, IL

Abstract

Women entering the Cook County Jail have high prevalence of GC/CT infections. Opt-out screening increased the number of GC and CT diagnoses made, and a high proportion of women were treated while incarcerated. Significant challenges remain in ensuring that screening is completed for all women who do not opt out and in providing treatment to women with short duration of incarceration.

Active Case Finding for Communicable Diseases in Prison Settings: Increasing Testing Coverage and Uptake Among the Prison Population in the European Union/European Economic Area

“…In 7 studies, opt-in testing at entry was compared with client-initiated testing. In all cases, the opt-in testing modality resulted in higher uptake rates across diseases ( 13 , 31 , 45 , 86 – 88 ). Kim et al ( 46 ) reported that patients with HCV detected through active case finding were twice as likely to be asymptomatic as compared with those detected through client-initiated testing (relative risk = 2.0; P = 0.09).…”

“…Opt-out testing was only described in studies conducted outside the EU/EEA and exclusively as a modality for HIV active case finding ( 13 , 29 ). Client-initiated testing was described as a complementary approach to opt-in offered during imprisonment for HIV ( 47 , 53 ) or reported as comparator in a few additional studies investigating the effect of different testing modalities for HCV ( 35 , 45 ), HIV ( 13 ), and STIs ( 31 , 85 – 89 ).…”

“…Whereas testing for syphilis was universal in all retrieved studies, testing for chlamydia, gonorrhea, and trichomoniasis was commonly targeted to women only ( 31 , 77 , 86 , 90 ), was symptom based for men or women ( 86 , 88 ), or targeted at young individuals, more frequently men, variably defined as younger than 25, or 30 or 35 years old ( 78 , 87 ). In 2 cost-effectiveness studies from outside the EU/EEA ( 89 , 91 ), various targeted testing approaches were compared, including symptom-based, universal, and age-based testing.…”

“…Relatively few studies investigated the effect of different active case finding interventions to increase testing uptake in prison settings. Most ( n = 9 studies) were focused on HIV active case finding ( 13 , 28 , 36 , 46 , 62 , 75 , 97 ), 5 on viral hepatitis ( 27 , 35 , 45 , 62 , 75 ), 4 on chlamydia and gonorrhea ( 29 , 31 , 86 , 87 ), 1 each on syphilis ( 75 ) and trichomoniasis ( 88 ), 2 on TB ( 58 , 98 ), and 2 involved a multidisease approach ( 62 , 75 ) ( Web Appendix 6, Web Tables 5–12 ).…”

“…In total, 9 studies investigated the effect of different test modalities on testing uptake; however, either no test of significance or no statistically significant results were reported for any of the studies. HIV was addressed in 3 studies ( 13 ), HCV in 1 ( 45 ), chlamydia and gonorrhea in 4 ( 29 , 31 , 86 , 87 ), and trichomoniasis in 1 ( 88 ). None of these studies were performed in the EU/EEA.…”