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Opt-out testing increased HIV testing among inmates

Strick LB. MMWR. 2011;60(24):811-813.

Issue: July 2011

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An opt-out HIV testing strategy increased acceptance of routine testing among inmates during intake at the Washington State Department of Corrections, according to new findings published in the Morbidity and Mortality Weekly Report.

Compared with 72% of inmates tested while opt-in testing was implemented, 90% of inmates were tested for HIV with opt-out testing.

“Routinely offering opt-out HIV screening to all inmates during the prison medical intake evaluation can increase HIV case identification, even in low prevalence settings,” the researchers wrote.

Before September 2007, the Washington State Department of Corrections provided HIV testing only upon request from inmates, which changed to opt-in testing after September 2007. During March 2010, the department of corrections then switched to an opt-out approach.

Lara B. Strick, MD,of the Washington State Department of Corrections and the University of Washington, and colleagues set out to assess the use of these three testing strategies and pooled intake medical evaluation HIV testing data among male inmates between January 2006 and December 2010.

Only 5% of 12,202 inmates requested testing for HIV at intake between January 2006 and Aug. 31, 2007; three inmates had newly diagnosed HIV (1.8 new diagnoses per year). During the opt-in testing period (Sept. 1, 2007, to March 15, 2010), 72% of 16,908 inmates agreed to HIV testing; 13 inmates had newly diagnosed HIV (5.1 new diagnoses per year). After implementation of opt-out testing (March 16 to Dec. 31, 2010), 90% of 5,168 inmates agreed to HIV testing; six inmates had newly diagnosed HIV (7.6 new diagnoses per year).

The median age of the 19 inmates with newly diagnosed HIV during the opt-in and opt-out testing periods was 35 years; 10 were white; eight reported heterosexual sex, and four were men who have sex with men; and six reported injection drug-use, according to the report.

In an accompanying editorial, CDC officials wrote: “The results of this study, together with published guidance from CDC, can be useful in developing and implementing comprehensive HIV services for prison inmates.”

Disclosure: The researchers report no relevant financial disclosures.

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