Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, Connecticut, United States of America.
PLoS One. 2009 Nov 25;4(11):e8056. doi: 10.1371/journal.pone.0008056.
Approximately 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.
This 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.
Routine 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 > or = $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.
In 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.
ClinicalTrials.gov NCT00624247.
每年约有 1000 万美国人入狱。疾病控制与预防中心现在建议在这些环境中常规进行选择退出的 HIV 检测。然而，在监狱内进行常规选择退出 HIV 检测的后勤工作仍存在争议。本研究的目的是评估使用选择退出策略对新入狱的监狱囚犯进行常规 HIV 检测的最佳时间。
这是一项在康涅狄格州纽黑文市的一家城市男子监狱中对 298 名新入狱的男性囚犯进行的前瞻性、对照性常规选择退出 HIV 检测试验。2008 年 3 月和 4 月的三周内，将进入男子监狱的 298 名连续囚犯分为三组，在入狱后接受三种选择退出 HIV 检测时间：立即（同一天，n = 103）、早期（次日，n = 98）或延迟（7 天，n = 97）。主要结局是每组中同意检测的男性比例。
早期（53%：AOR = 2.6；95%CI = 1.5 至 4.7）和立即（45%：AOR = 2.3；95%CI = 1.3 至 4.0）检测组的常规选择退出 HIV 检测率显著高于延迟（33%）检测组。然而，立即和早期检测组之间没有显著差异（p = 0.67）。在多变量分析中，与常规选择退出 HIV 检测显著相关的因素是分配到“早期”检测组（p = 0.0003）和低（保释金> = 5000 美元、移民或联邦指控或审前> 30 天）提前释放的可能性（p = 0.04）。两名受试者收到初步阳性结果，其中一名随后被确认为 HIV 血清阳性。
在这个男性监狱中，人员流失率很高，常规选择退出 HIV 检测不仅可行，而且在入狱后 24 小时内进行时，HIV 检测率最高。
ClinicalTrials.gov NCT00624247。
