Routine testing for blood-borne viruses in prisons: a systematic review

Area of Science:

• Public Health
• Infectious Diseases
• Health Policy

Background:

• Incarcerated populations exhibit a higher prevalence of blood-borne virus (BBV) infections compared to the general population.
• Prisons offer a unique setting for identifying and managing BBVs in high-risk, underserved individuals.
• Recent pilot programs in English prisons have introduced changes to BBV testing policies.

Purpose of the Study:

• To review existing evidence on routine human immunodeficiency virus (HIV), hepatitis B, and hepatitis C virus testing policies within correctional facilities.
• To quantify testing acceptance, coverage, result notification, and diagnosis rates associated with different prison BBV testing strategies.
• To inform revisions of BBV testing policies in English prisons based on empirical data.

Main Methods:

• A systematic literature search was conducted across five databases.
• Studies examining both opt-in and opt-out BBV testing policies in prison settings were included.
• Data on testing acceptance, coverage, and outcomes were extracted and analyzed.

Main Results:

• The review included 44 studies published between 1989 and 2013, predominantly from the USA (82%) and focusing on HIV testing (91%).
• HIV testing acceptance rates varied widely (22-98%), as did testing coverage (3-90%).
• Opt-out testing policies demonstrated higher uptake rates compared to opt-in policies, though evidence for hepatitis testing was limited.

Conclusions:

• Opt-out HIV testing policies in prisons can achieve substantial uptake, potentially exceeding that of opt-in strategies.
• Further research is needed to evaluate the effectiveness of hepatitis testing policies in correctional settings.
• Future policy development should carefully consider consent processes, testing types, and timing to optimize acceptability and effectiveness.