摘要：HIV prevalence is higher in jails than in the community, yet many jails do not conduct HIV testing. Jails in Baltimore, Maryland; Philadelphia, Pennsylvania; and the District of Columbia have implemented innovative rapid HIV testing programs. We have summarized the results of these programs, including the numbers of persons tested, rapid and confirmatory HIV test results, and numbers of persons newly diagnosed with HIV. We have described facilitators and challenges of implementation. These programs confirmed that rapid HIV testing in jails was feasible and identified undiagnosed HIV infection. Challenges included limited space to provide confidential rapid HIV testing and rapid turnover of detainees. Implementation required collaboration between local governments, health agencies, and correctional institutions. These programs serve as models for expanding rapid HIV testing in jails. KEY FINDINGS ▪Despite barriers to implementation, all 3 jails successfully implemented and sustained rapid HIV testing programs. ▪After rapid HIV testing began, the proportion of detainees completing HIV testing at each site increased by 6- to 7-fold. ▪Rapid HIV testing programs identified persons with previously unrecognized HIV infection. ▪All 3 jail systems were able to provide care to HIV-infected persons who remained incarcerated. ▪Interventions to increase linkage to community HIV care are needed. ▪These jail systems successfully integrated the cost of rapid HIV testing and caring for additional HIV-infected persons identified through the expanded testing into existing budgets and through resources provided by the Centers for Disease Control and Prevention. INCARCERATED POPULATIONS are at increased risk for HIV infection compared with community populations. 1–3 This risk is attributable to multiple factors, including substance use, poverty, mental illness, and racial and health disparities. 4,5 In 2006, the Centers for Disease Control and Prevention (CDC) recommended that routine HIV testing be expanded in medical settings and in correctional facilities as part of the initial medical evaluation of inmates. 6 Jails, as opposed to prisons, may briefly incarcerate persons before they return to the community. A recent analysis of urban jails identified a median length of stay of less than 15 days for most inmates. 7 Rapid turnover of the jailed population, overcrowding, and limited resources create logistical barriers to HIV screening in jails. However, rapid HIV testing has created an opportunity to offer HIV screening to persons cycling through jails, and previous studies have reported the feasibility of rapid HIV testing in this setting. 8–12 Rapid HIV testing is conducted with either a blood specimen obtained by finger stick or venipuncture or an oral fluid specimen obtained by a swab. Rapid test results are available in approximately 20 minutes and need to be confirmed with a Western blot assay. Until recently, HIV testing in jails was rare. Over the past several years, large urban jails in Baltimore, Maryland; Philadelphia, Pennsylvania; and the District of Columbia have developed and implemented rapid HIV testing programs. We have summarized the rapid HIV testing experiences in these correctional facilities. We present rapid HIV testing results for a 12-month period during 2008 and 2009, including the proportion of persons completing rapid HIV testing, results of rapid and confirmatory testing, and number of persons with new HIV diagnoses. The experiences of these programs offer important lessons for other jail facilities interested in expanding HIV testing services consistent with CDC recommendations.
