Establishing an HIV Screening Program Led by Staff Nurses in a County Jail

Area of Science:

• Public Health
• Infectious Disease Control
• Jail Health Services

Background:

• Jail populations present a unique opportunity for human immunodeficiency virus (HIV) testing outside traditional healthcare settings.
• High population turnover in jails has historically hindered routine HIV screening efforts.

Purpose of the Study:

• To implement and evaluate a nurse-led, opt-out rapid HIV testing program for jail detainees.
• To identify undiagnosed HIV infections and facilitate linkage to care regardless of detainee entry time or length of stay.

Main Methods:

• A nurse-initiated, opt-out rapid HIV testing strategy was employed at Fulton County Jail.
• Testing utilized oral mucosal swabs initially, later transitioning to finger-stick methods.
• Program performance was assessed through offer/acceptance rates and linkage to care for newly diagnosed and previously known HIV-positive individuals.

Main Results:

• The HIV seroprevalence among entrants was at least 2.18%.
• Over a 12-month period, 89 new HIV cases were identified.
• The program achieved a 69.10% offer rate and an 81.32% acceptance rate, linking 458 individuals to care.

Conclusions:

• A nurse-led rapid HIV testing model is effective in identifying new HIV diagnoses within the jail setting.
• The program significantly reduced the number of undiagnosed HIV infections among detainees.
• The initiative successfully promoted linkage to HIV care, particularly for older detainees.