Risk-Based HIV Testing at Los Angeles County Men’s Central Jail

Abstract

Incarcerated populations tend to be disproportionately affected by HIV and sexually transmitted infections (STIs), and men who have sex with men (MSM) are an especially high-risk subset of these populations. Despite the Centers for Disease Control and Prevention's recommendations for universal HIV screening, a lack of resources and high inmate turnover make it difficult to implement such guidelines in jails. From September 2013 to May 2016, the Infection Control Unit of the Los Angeles County Jail used existing resources to implement a voluntary, risk-based HIV educational and screening program targeting MSM inmates during early incarceration. The results revealed a high percentage of previously unknown HIV infections (8.5% = 57 of the 671 tested) and some unknown non-HIV STI cases. In the absence of resources for universal HIV screening, the risk-based approach is a sustainable and cost-effective approach for improving HIV surveillance in the correctional setting.

Costs and Consequences of Eliminating a Routine, Point-Of-Care HIV Screening Program in a High-Prevalence Jail

“…28 Similar to FCJ, a large, urban jail in Los Angeles has reported having to reduce an HIV testing program targeting men who have sex with men because of limited resources. 29 An additional potential barrier to obtaining funding for jail-based HIV screening programs is that jails usually incur the costs of the HIV screening program, whereas the benefits of averted HIV infections accrue to the health system and the larger community. Thus, even programs that are shown to be cost saving in economic evaluation may not be undertaken by the programs that must bear the cost.…”

Establishing an Epidemiologic Profile of Hepatitis C Virus Infection at the Los Angeles County Jail

“…18 Nevertheless, even a short period of incarceration can present an ideal opportunity to provide some level of HCV screening and education, as it does for screening of HIV and sexually transmitted infections; HCV screening in jails may also have a substantial impact on community health and disease prevention because of the rapid return of individuals into communities. 16,18 -20…”

“…18 Nevertheless, even a short period of incarceration can present an ideal opportunity to provide some level of HCV screening and education, as it does for screening of HIV and sexually transmitted infections; HCV screening in jails may also have a substantial impact on community health and disease prevention because of the rapid return of individuals into communities. 16,[18][19][20] The objective of this study was to establish an epidemiologic profile of HCV infection in a large urban jail population by retrospectively examining medical record data during a 20-year period and to identify risk factors most closely associated with HCV infection. Characterizing the strength of association of these risk factors and identifying the key demographic trends during the 20-year period can help in establishing targeted programs for risk factor screening, testing, and education as harmreduction measures to improve HCV surveillance, even in the absence of resources for universal screening.…”