A Prospective Controlled Trial of Routine Opt-Out HIV Testing in a Men's Jail

BackgroundApproximately 10 million Americans enter jails annually. The Centers for Disease Control and Prevention now recommends routine opt-out HIV testing in these settings. The logistics for performing routine opt-out HIV testing within jails, however, remain controversial. The objective of this study was to evaluate the optimal time to routinely HIV test newly incarcerated jail detainees using an opt-out strategy.
MethodsThis prospective, controlled trial of routine opt-out HIV testing was conducted among 298 newly incarcerated male inmates in an urban men's jail in New Haven, Connecticut. 298 sequential entrants to the men's jail over a three week period in March and April 2008 were assigned to be offered routine opt-out HIV testing at one of three points after incarceration: immediate (same day, n = 103), early (next day, n = 98), or delayed (7 days, n = 97). The primary outcome was the proportion of men in each group consenting to testing.
ResultsRoutine opt-out HIV testing was significantly higher for the early (53%: AOR = 2.6; 95% CI = 1.5 to 4.7) and immediate (45%: AOR = 2.3; 95% CI = 1.3 to 4.0) testing groups compared to the delayed (33%) testing group. The immediate and early testing groups, however, did not significantly differ (p = 0.67). In multivariate analyses, factors significantly associated with routine opt-out HIV testing were assignment to the ‘early’ testing group (p = 0.0003) and low (bond ≥$5,000, immigration or federal charges or pre-sentencing >30 days) likelihood of early release (p = 0.04). Two subjects received preliminary positive results and one of them was subsequently confirmed HIV seropositive.
ConclusionsIn this men's jail where attrition was high, routine opt-out HIV testing was not only feasible, but resulted in the highest rates of HIV testing when performed within 24 hours of incarceration.
Trial RegistrationClinicalTrials.gov NCT00624247

背景：每年约有1000万美国人进入看守所。美国疾病控制与预防中心（Centers for Disease Control and Prevention, CDC）目前推荐在这类场所开展常规选择退出式HIV检测（opt-out HIV testing）。然而，在看守所内实施常规选择退出式HIV检测的流程仍存在争议。本研究的目的是评估采用选择退出策略，对新羁押的看守所在押人员进行常规HIV检测的最佳时机。
方法：本项针对常规选择退出式HIV检测的前瞻性对照试验，于2008年3月至4月在康涅狄格州纽黑文市一所男性城区看守所开展，研究对象为298名新羁押的男性在押人员。该三周内连续入组的298名男性看守所入所者，被分配至羁押后三个时间点之一接受常规选择退出式HIV检测：即刻组（入所当日，n=103）、早期组（次日，n=98）或延迟组（羁押7天后，n=97）。本研究的主要结局指标为各组同意接受检测的人员比例。
结果：与延迟组（33%）相比，早期组（53%；调整后比值比（Adjusted Odds Ratio, AOR）=2.6；95%置信区间（Confidence Interval, CI）=1.5~4.7）和即刻组（45%；AOR=2.3；95% CI=1.3~4.0）的常规选择退出式HIV检测参与率显著更高。但即刻组与早期组的检测参与率无显著差异（p=0.67）。多变量分析显示，与常规选择退出式HIV检测参与率显著相关的因素包括：被分配至“早期”检测组（p=0.0003），以及早期释放可能性较低（保释金≥5000美元、涉及移民或联邦指控、预审羁押时长超过30天，p=0.04）。本研究中有2名受试者初筛结果呈阳性，其中1名后续经确认确认为HIV血清学阳性。
结论：在本次脱失率较高的男性看守所研究中，常规选择退出式HIV检测不仅具备可行性，且在羁押后24小时内开展检测时，HIV检测参与率达到最高。
试验注册：ClinicalTrials.gov NCT00624247