According to the 2009 study “A Prospective Controlled Trial of Routine HIV Testing in Men’s Jails,” conducted by Kavasery et al., 10 million individuals enter American jails every year (2009). This study presented as a static group comparison design that focused on a population-based intervention, early opt-out HIV testing. Opt-out testing is a tool used to administer testing that involves an individual having to communicate his or her want to opt-out of the test as opposed to requesting the test be done, or opt-in testing.
There is an importance in testing detainees for HIV while within facility walls. Information published in 2011 by the U.S. Department of Health and Human Services states those individuals who are detained “often lack accurate information about HIV, including awareness of behaviors that may have put them at risk and knowledge of means for protecting themselves from becoming infected” (HRSA, 2011). It is important to note that the Center for Disease Control and Prevention has begun recommending that HIV testing be implemented and routinely distributed within correctional facilities. The organization states that jails and prisons are one of the first places individuals are diagnosed with HIV (CDC, 2014). Not all U.S. states are required to test detainees (Figures 1-3). Early Opt-Out HIV Testing creates an even test administration rate across all 50 states. The purpose of the Kavasery study was to “evaluate the optimal time to routinely HIV test newly incarcerated jail detainees using the opt-out strategy”(2009). Testing was conducted at three points: immediate, or same day as entry; early, the next day; and delayed, within seven days
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Models
Social Influence Level Theory
Early opt-out testing will produce successful results through early detection of HIV, reducing contraction rates both within and outside of the facility. This intervention also fosters elimination of social stigma by routinely testing for HIV. The Social Influence Level Theory is reflected within this study. Opt-out testing reshapes social constructs and norms.
Population- Based Approach
This approach to early testing is a population-based approach; there is no screening for risk and each detainee is assumed to have the right to be tested. This approach relates directly to the Social Influence Level Theory in that it works within the population to create a social norm within the facility.
Results
“In this men’s jail where attrition was high, routine opt-out HIV testing was not only feasible, but resulted in the highest rates of HIV testing when performed within 24 hours of incarceration” (Kavasery, 2009). The Kavasery study found that opt-out testing was significantly most likely to be conducted in the early stages of entrance as opposed to delayed testing.
The risks of not conducting within the immediate and delayed timeframes are (Kavasery, 2009):
- Newly incarcerated individuals may be under the influence and unable to consent.
- Newly incarcerated individuals may be psychologically distressed to consent or be unprepared or unable to respond to test results.
- Risk of detainees being released if in for a short period of time
For more information on HIV in Correctional Settings, please visit here
RE-AIM
Reach
Early opt-out testing is easily accessible for detainees in that these individuals are not required to actively seek out testing by asking or seeking services. The services are presented to the detainees upon entrance of the facility and are incorporated into other routine entrance tests. The hassle of asking for the test in eliminated by presenting the test in an opt-out approach. These tests are of no cost to the detainee, eliminating any financial burden to the individual. This program. This approach to early testing is a population-based approach; there is no screening for risk and each detainee is assumed to have the right to be tested.
Efficacy
This intervention has been proven to successfully work under real life conditions. The study refers to the individuals who did not take the test, which states the percentage of individuals within the facility who did not participate in testing did so due to multiple reasons:
“Stratified by testing group assignment, the reasons that inmates were not swabbed are depicted[…] In the immediate group, 5 (10% of those not swabbed in that group) were medically incompetent or did not have the capacity to consent, compared with none in the ‘early’ and in the ‘delayed’ testing groups. In the ‘delayed’ testing group, 48 (75% of those not tested) were no longer available for testing compared with none in the ‘immediate’ and 24 (57% of those not tested) in the ‘early’ groups. Among the 77 competent subjects who declined testing, 18 (23%) stated they were not interested in general, 15 (19%) did not perceive themselves to be at risk, 12 (16%) self-reported they were already HIV-infected (confirmed by medical record review), and 11 (14%) stated they were recently tested” (Kavasery, 2009).
Adoption
The government, on a macro level, as well as medical and intake personnel within the facilities, on a micro level, are able to oversee adoption of this program. The testing can be routinely administered during the intake process within correctional facilities. As stated, this will be a routine test that will be fully integrated into the intake process. There is
Implementation
Implementation of this intervention will be facilitated by public health organizations, the government, and well-trained staff. A 2008 article titled HIV Testing in State Correctional Systems explains implementation of HIV testing within facilities:
“In states where the legislature or general assembly has responded to the issue of HIV testing in the correctional system, a particular statute or code section will typically require or authorize some form of voluntary or mandatory HIV testing. The specificity of the laws regarding HIV testing is unique to each state and varies greatly among states. For example, in both California and Illinois, an entire chapter of codified law has been devoted specifically to how and when inmates will be tested for HIV. However, in other states, inmate testing is mentioned only briefly within the provisions of another interrelated statute.
In states where the legislature has delegated the prison HIV testing issue to an administrative agency, such as the department of corrections or department of health, administrative regulations promulgated by those agencies typically will govern the method of testing in the state correctional system” (2008).
Guidelines and Recommendations made by the CDC may be accessed here
Maintenance
This intervention can be maintained over time. Funding support will be needed to sustain this program as well as support from state and national health organizations and funds. The CDC as well as a handful of other organizations are dedicated to supporting HIV prevention:
“The CDC announced a five-year HIV prevention funding opportunity for health departments in states, territories, and select cities. Providing funding to health departments has long been a central component of CDC’s HIV prevention strategy, and is CDC’s single largest investment in HIV prevention” (CDC, 2013).