HIV opt-out screening in California state prisons achieves high rates of in-custody linkage to care and viral suppression for those diagnosed as HIV positive, and sustained viral suppression following release from prison, according to a study published in the Feb. 26 edition of Morbidity and Mortality Weekly Report.
Under the opt-out program, instituted in 2010, a medical care provider informs the inmate that an HIV test is routinely done, unless the inmate specifically declines the test. The 6-month assessment of the screening program in 2012 showed that 77% of the 17,436 inmates entering a reception center during that period were screened for HIV infection, with 135 (1%) testing positive, including 10 (0.1%) with newly diagnosed infection.
Kimberley D. Lucas of the California Correctional Health Care Services, and coauthors found that 134 (99%) of those who tested positive were linked to care within 90 days of their diagnosis and 122 (91%) began antiretroviral therapy; of those who initiated antiretroviral therapy (ART) and were still incarcerated the following year, 81 (98%) were still on the therapy and 71 (88%) had achieved viral suppression (Morb Mortal Wkly Rep. 2016 Feb 26;65:178-81).
Thirty-nine inmates were released on antiretroviral therapy and 14 (36%) had uninterrupted linkage to care. The authors noted that continuity of care remained a challenge for individuals with a history of incarceration.
“The CCHCS HIV opt-out screening program demonstrated that identifying HIV infection at entry resulted in high rates of linkage to care, retention on ART, and significant reduction in viral loads during incarceration,” the researchers wrote.
No conflicts of interest were declared.