COVID-19 Testing and Prevention in Correctional Settings

This study worked with diverse correctional facilities across MN, RI, WA, and FL to characterize the incidence of COVID-19 disease progression and related outcomes. The goal was to identify barriers and facilitators to develop strategies to improve testing in these under-served populations by: Increasing the reach, access, uptake, and impact of COVID-19 testing among incarcerated people and staff in prison and jails. Individuals in congregate settings have been disproportionately affected by COVID-19, with correctional settings accounting for 39 of the 50 largest cluster outbreaks in the country to date. Schema of Correctional Facilities: Correctional facilities are amplifiers of infectious diseases for structural reasons: 1) Dormitory-style living and overcrowded conditions make social distancing nearly impossible 2) They have a focus primarily on security not health 3) Their medical departments are under-resourced and often disconnected from local public health agencies. Correctional facilities must be the focus of urgent intervention to understand the incidence of COVID-19, how it spreads in correctional facilities, and durable long-term strategies to reduce transmission, including testing and vaccines. However, the work from the COVID Prison Project showed that correctional systems have implemented a range of testing strategies, without coordination, such that synthesizing the information on COVID-19 incidence, outcomes and optimal testing strategies (including repeat testing and contact tracing) has been challenging. Incarcerated people decline testing due to concerns about confidentiality, implications for release, and fear of placement in solitary confinement. Through interviews, ethical concerns and potential solutions were identified for COVID-19 testing and vaccine strategies in correctional facilities using a community-engaged strategy. The project's work from the COVID Prison Project showed that correctional systems have implemented a range of testing strategies, without coordination, such that synthesizing the information on COVID-19 incidence, outcomes and optimal testing strategies (including repeat testing and contact tracing) was challenging. The goals of this study were to: (1) identify ethical concerns and potential solutions for COVID-19 testing and vaccine strategies in correctional facilities using a community-engaged strategy, and (2) characterize incidence of COVID-19, disease progression, and related-outcomes and effectiveness of testing and contact tracing in correctional facilities. Potential subjects had to be incarcerated at key facilities in Washington, Rhode Island, Minnesota, and Florida at the time of recruitment. These facilities were Everglades Correctional Institution and Homestead Correctional Institution in Florida, Shakopee and Stillwater correctional facilities in Minnesota, the Rhode Island Department of Corrections, and Yakima County Jail in Washington. Participating correctional facilities in Florida, Minnesota, Rhode Island, and Washington provided de-identified data on approximately 16,859 incarcerated adults and correctional staff. Data sources included de-identified data from medical records, administrative data, and policy documents pertaining to COVID-19. Three series of focus groups (6, 12, 18 months) across three distinct groups (incarcerated people, medical providers, and correctional leaders) and four sites amounted to 36 total focus groups over the study period. 74,812 COVID-19 tests were utilized to test and 16,859 incarcerated people and correctional staff were re-tested for active infection over a six-month period in the FL, MN, and RI state prison systems and the Yakima County Jail in WA.