Could health systems, ASOs do rapid testing, prevention in jails?
Research will show whether it's feasible
The combination of rapid HIV testing and brief prevention messages could be a model for use in jails which house a high-risk population.
"We're looking at jails as a new venue for HIV testing," says Curt G. Beckwith, MD, assistant professor of medicine at the Alpert Medical School of Brown University in Providence, RI.
"Correctional facilities are where there's a high through-put with so many people taken to jails prior to sentencing," Beckwith says. "They're incarcerated for short periods of time, and then they're sent back to the community."
A small portion goes on to prison, but most return to the same community where they previously had engaged in high-risk behavior, he adds.
"So it's an opportune time while they're in jail to deliver HIV services," Beckwith says. "Over the last couple of years, a lot of large urban centers have expanded testing in jails."
Beckwith and co-investigators decided to study the standard HIV testing with minimal counseling versus using a combination of the rapid HIV test and a prevention intervention in jail settings.
Those receiving the rapid HIV test also received an intensive, individualized risk reduction counseling session, Beckwith says.
"We had two goals: the efficient diagnosis with rapid testing and efficient linkage to care, and we wanted to see if we can provide benefit to those who are HIV negative by providing them with risk reduction education and counseling," Beckwith says. "So when they're back in the community we could have some type of impact on their HIV risk behavior."
The pilot study enrolled 264 men who had been incarcerated for less than 48 hours. There were 132 in the standard arm and 132 in the intervention arm.1
"So it wasn't a big enough study to look at incidence," Beckwith says. "We had one new diagnosis in the rapid HIV test arm and none in the standard arm."
Investigators gave the men a post-HIV test risk assessment once they had returned to the community.
"They were given a monetary incentive for completing the follow-up visit," Beckwith says. "We followed up with 60% of them."
For this particular population and for a study with difficult logistics, 60% in the follow-up was a positive achievement, Beckwith adds.
The pilot study's main purpose was to see if it would be feasible to combine the rapid HIV test with a strong prevention intervention, and to lay the groundwork for future studies that would look at the intervention's efficacy, he notes.
"We're looking at whether we can combine testing services with some prevention activities or interventions," Beckwith says. "Historically, jails have not been a site for either of those activities, but now jails are being looked at for HIV testing, and that's the most important thing."
Different populations in jail, prison
HIV testing in prisons has taken place for a long time because prison populations are there for long durations of time, unlike the very transient populations found in jail settings, he adds.
Funded through the Center for AIDS Research (CFAR) with National Institutes of Health (NIH) money, the pilot study will hopefully lead to a bigger trial. The goal is to see if the combination of HIV testing and prevention will be cost effective and feasibly implemented in correctional settings, Beckwith explains.
If the model is successful, then it's the sort of intervention that could be funded through state correctional funding, state department of health funding, or grants from the Centers for Disease Control and Prevention.
"We had minimal staff for this study — just one person working inside the jail doing recruitment, testing, and counseling, and one or two other people trying to track them down and bring them in for assessment," Beckwith says. "Our goal was to not create something that's not feasible because we want to try to find that balance where it's effective, yet cost-effective enough that in the real world it could be implemented."
Typically, the HIV tester/counselor would recruit four to six inmates per week, selecting men who had been incarcerated for 48 hours or less. Then the counselor would have them complete a baseline risk assessment that takes 10 to 15 minutes and includes demographics, medical and personal history, and risk factors such as substance abuse and sexual risk, he says.
When this was completed, the person would be given the rapid HIV test via a mouth swab.
"While waiting for test results, the person would be given a complete counseling intervention that was based on the project RESPECT intervention," Beckwith says. "We used that as a guide to review with people about their specific risks for HIV and what steps we could take to reduce those risks."
The counselor would provide some insight into their situation and education and then give them the test results, which were almost entirely negative for HIV in the pilot study.
"Once they were released, we'd follow-up, have them complete another risk assessment, and provide further counseling," he says.
Rapid HIV testing makes sense for this population, Beckwith says.
"For jails and brief incarcerations, emergency rooms, and substance abuse treatment centers, the establishment of opt-out rapid HIV testing is warranted," he says. "More work needs to be done on the implementation, and we're not there yet, but we're moving in the right direction."
Reference
- Beckwith C, Liu T, Bazerman L, et al. HIV Risk behavior pre- and post-HIV testing and counseling in jail. Abstract presented at 48th Annual ICAAC/IDSA 46th Annual Meeting in Washington, DC:Oct. 25-28, 2008. Abstract: H-449.
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