Undiagnosed HIV Infection Among New York City Jail Entrants, 2006: Results of a Blinded Serosurvey.

Undiagnosed HIV Infection Among New York City Jail Entrants, 2006: Results of a Blinded Serosurvey.

Since 2004, when all New York City jail entrants began being offered rapid testing at medical intake, HIV testing has increased 4-fold. To guide further service improvement, the authors determined HIV prevalence among jail entrants, including proportion undiagnosed. Remnant serum from routine syphilis screening was salvaged for blinded HIV testing in 2006. Using HIV surveillance data and electronic clinical data, they ascertained previously diagnosed HIV infections before permanently removing identifiers. They defined "undiagnosed" as HIV-infected entrants who were unreported to surveillance and denied HIV infection. Among the 6411 jail entrants tested (68.9% of admissions), HIV prevalence was 5.2% overall (males 4.7%; females: 9.8%). Adjusting for those not in the serosurvey, estimated seroprevalence is 8.7% overall (6.5% males, 14% females). Overall, 28.1% of HIV infections identified in the serosurvey were undiagnosed at jail entry; only 11.5% of these were diagnosed during routine offer testing. Few (11.1%) of the undiagnosed inmates reported injection drug use or being men who have sex with men. About 5%-9% of New York City jail entrants are HIV infected. Of the infected, 28% are undiagnosed; most of whom denied recognized HIV risk factors. To increase inmate's acceptance of routine testing, the authors are working to eliminate the required separate written consent for HIV testing to allow implementation of the Centers for Disease Control and Prevention-recommended opt out testing model.

Editors’ note: There is virtually no other setting in low prevalence countries in which HIV prevalence levels this high can be found - 2.5-3.5 times higher in men and 14-20 times higher in women than in the general population. The authors indicate that these are conservative estimates with the prevalence likely closer to 8.7% overall. They state that recommending HIV testing through a provider-initiated HIV testing approach could increase the testing uptake beyond the 69 per cent achieved here by their current routine offer of testing that requires a written consent. Unfortunately, they give no indication of what the package of care is for those who are diagnosed as HIV-positive nor what the prevention package is for any inmate undergoing testing. The blinded serosurvey is used simply to assess the level of undiagnosed HIV infection. This is a captive audience but a captive audience with basic human rights and prisons have an obligation to care for prisoners with a standard of care commensurate to that available in the community. Although a provider clinical staff survey has been done, no information is provided on inmates’ views of what motivates them to accept or decline HIV testing – information that is critical to the design of effective, rights-based programmes.