ABSTRACT
Incarcerated individuals are at high risk of HIV and tuberculosis (TB), though combined screening in the criminal justice system is limited. Newer blood tests for TB provide a unique opportunity to combine HIV and TB testing in corrections. Entering jail inmates were offered routine opt-out HIV testing along with TB screening, both via blood draw. Of the 529 individuals enrolled, 524 (99%) agreed to HIV testing. Testing identified 13 (2.5%) previously diagnosed HIV infections and one new positive. One quarter (138, 26%) of participants had never been tested for HIV and were more likely to be young, Hispanic, born outside of the United States, and incarcerated for the first time. Combined HIV/TB testing had high acceptability among individuals entering jail.
Subject(s)
HIV Infections/diagnosis , Patient Acceptance of Health Care/psychology , Prisoners/psychology , Tuberculosis/diagnosis , Adolescent , Adult , Age Factors , Female , HIV Infections/epidemiology , Hematologic Tests , Humans , Male , Mass Screening , Middle Aged , Soil , Tuberculosis/epidemiology , United States , Young AdultABSTRACT
BACKGROUND: Tuberculosis (TB) disproportionately affects immigrants, HIV-infected individuals, and those living in crowded settings such as homeless shelters and correctional facilities. Although the majority of jails and prisons use a tuberculin skin test (TST) for latent tuberculosis infection (LTBI) screening, limited data exist on the clinical performance and costs of the TST compared to interferon gamma release assays (IGRAs) in this setting. METHODS: A prospective pilot study comparing cost between TST and an IGRA (QuantiFERON Gold In-tube, QFT-GIT) for the detection of LTBI in a convenience sample of inmates entering the Dallas County Jail (DCJ) was conducted June-October 2014. Participants completed a risk questionnaire, TST placement, QFT-GIT testing, and were offered opt-out HIV-Ab testing. LTBI prevalence based on TST and QFT-GIT results, an evaluation of discordant results and a cost analysis are presented. RESULTS: A total of 529 subjects were enrolled. The majority were male (75 %), and 46 % were Black, 29 % White, and 24 % Hispanic. Most (85 %) had been previously incarcerated. Over 28 % of participants were released prior to TST reading, with paired QFT-GIT and TST results available for 351 subjects. Of these, nine (2.6 %) tested positive by TST and 47 (13.4 %) tested positive by QFT-GIT. It costs $23.27 more per inmate per year to screen with QFT-GIT than TST in this population, though the cost per LTBI case detected was nearly three times higher for TST than QFT-GIT ($1247 v $460). CONCLUSIONS: We found a substantially higher rate of QFT-GIT positivity compared to TST in this sample of individuals entering the Dallas County Jail. Although no gold standard exists, this finding may indicate under-recognized LTBI in this setting. QFT-GIT as an initial screening tool was more time-efficient, had four-fold fewer labor costs and provided results on more individuals when compared with the TST. The overall cost of QFT-GIT was $23.27 more per inmate per year, though the cost per LTBI case detected was nearly three times higher for TST than QFT-GIT. Further research is needed to determine the long-term performance of IGRA testing in the correctional setting and the public health implications of pairing QFT-GIT screening with other tests for communicable diseases.
Subject(s)
Interferon-gamma Release Tests/economics , Tuberculin Test/economics , Tuberculosis, Pulmonary/diagnosis , Adolescent , Adult , Costs and Cost Analysis , Female , Humans , Male , Middle Aged , Mycobacterium tuberculosis/immunology , Pilot Projects , Prevalence , Prisoners , Prisons , Prospective Studies , Texas , Tuberculin Test/methods , Tuberculosis, Pulmonary/epidemiology , Tuberculosis, Pulmonary/immunology , Young AdultABSTRACT
We conducted a systematic literature review of the data on HIV testing, engagement in care, and treatment in incarcerated persons, and estimated the care cascade in this group. We identified 2706 titles in MEDLINE, EBSCO, and Cochrane Library databases for studies indexed to January 13, 2015, and included 92 for analysis. We summarized HIV testing results by type (blinded, opt-out, voluntary); reviewed studies on HIV care engagement, treatment, and virological suppression; and synthesized these results into an HIV care cascade before, during, and after incarceration. The HIV care cascade following diagnosis increased during incarceration and declined substantially after release, often to levels lower than before incarceration. Incarceration provides an opportunity to address HIV care in hard-to-reach individuals, though new interventions are needed to improve postrelease care continuity.
