A Cross-Sectional,Retrospective Evaluation of Opt-Out Sexually Transmitted Infection Screening at Admission in a Short-Term Correctional Facility in Alberta,Canada
Restricted accessResearch articleFirst published online December, 2022
A Cross-Sectional,Retrospective Evaluation of Opt-Out Sexually Transmitted Infection Screening at Admission in a Short-Term Correctional Facility in Alberta,Canada
Incarcerated populations experience higher rates of sexually transmitted infections (STIs) than the general population, alongside inconsistent testing strategies. In response, universal opt-out STIs (chlamydia, gonorrhea, syphilis, and HIV) screening was implemented at admission in a short-term correctional facility in Alberta, Canada, for individuals ≤35 years. A cross-sectional, retrospective evaluation of testing outcomes between March 2018 and February 2020 was completed. Descriptive statistics were used to stratify STIs by gender, age group, and date for univariate analysis. Despite low uptake (31.2%), opt-out screening resulted in high positivity rates (14.9%, 10.8%, 29.5%, and 0.3%, respectively) and treatment completion (93.7%) while capturing a high proportion (52.6%) of asymptomatic cases. Opt-out screening at admission is feasible and can improve STI testing in high-risk individuals experiencing incarceration in Canada.
Alberta Health Services Department of STI Services. (2020). Correctional STI surveillance (Unpublished raw data).
7.
AndrinopoulosK., KerriganD., FigueroaJ. P., ReeseR., GaydosC. A., BennettL., BloomfieldB., PlunkettL., MaruC., & EllenJ. M. (2010). Establishment of an HIV/sexually transmitted disease programme and prevalence of infection among incarcerated men in Jamaica. International of Journal of STD and AIDS, 21(2), 114–119. https://doi.org/10.1258/ijsa.2009.008416
8.
ArriolaK. R. J., BraithwaiteR. L., KennedyS., HammettT., TinsleyM., WoodP., & ArboledaC. (2001). A collaborative effort to enhance HIV/STI screening in five county jails. Public Health Reports, 116(6), 520–529. https://doi.org/10.1093%2Fphr%2F116.6.520
9.
BeckwithC. G., BazermanL., CornwallA. H., PatryE., PoshkusM., FuJ., & NunnA. (2011). An evaluation of a routine opt-out rapid HIV testing program in a Rhode Island jail. AIDS Education and Prevalence, 23(Suppl. 3), 96–109. https://doi.org/10.1521/aeap.2011.23.3_supp.96
10.
BesneyJ. D., AngelC., PyneD., MartellR., KeenanL., & AhmedR. (2018). Addressing women's unmet health care needs in a Canadian remand center: Catalyst for improved health? Journal of Correctional Health Care. 24(3), 276–294https://doi.org/10.1177/1078345818780731
Centers for Disease Control and Prevention. (2010). Sexually transmitted diseases treatment guidelines, 2010: Persons in correctional facilities. Morbidity and Mortality Weekly Report, 59(RR-12), 11–12. https://www.cdc.gov/mmwr/pdf/rr/rr5912.pdf
ChadwickR. C., McGregorK., SneathP., RempelJ., HeB. L. Q., BrownA., SeifredG., McAuleyJ., KamatovicR. J., Al-HusariM., AhmedA., BertoloM., MunkleyD., & LutermanM. (2018). STI initiative: Improving testing for sexually transmitted infections in women. BMJ Open Quality. 7(4), e00046. https://doi.org/10.1136/bmjoq-2018-000461
15.
ColeJ., HottonA., ZawitzC., & KesslerH. (2014). Opt-out screening for Chlamydia trachomatis and Neisseria gonorrhoeae in female detainees at Cook County Jail in Chicago, IL. Sexually Transmitted Diseases, 41(3), 161–165. https://doi.org/10.1097/olq.0000000000000106
16.
CrowleyD., Van HoutM. C., LambertJ. S., KellyE., MurphyC., & CullenW. (2018). Barriers and facilitators to hepatitis C (HCV) screening and treatment-A description of prisoners' perspective. Harm Reduction Journal. 15(1), 62. https://doi.org/10.1186/s12954-018-0269-z
17.
de la FlorC., PorsaE., & NijhawanA. E. (2017). Opt-out HIV and hepatitis C testing at the Dallas County Jail: Uptake, prevalence, and demographic characteristics of testers. Public Health Reports, 132(6), 617–621. https://doi.org/10.1177/0033354917732755
18.
FlaniganT. P., ZallerN., BeckwithC. G., BazermanL. B., RanaA., GardnerA., WohlD. A., & AlticeF. L. (2010). Testing for HIV, sexually transmitted infections, and viral hepatitis in jails: Still a missed opportunity for public health and HIV prevention. Journal of Acquired Immune Deficiency Syndromes, 55(Suppl. 2), S78–S83. https://doi.org/10.1097/qai.0b013e3181fbc94f
19.
Francis-GrahamS., EkekeN. A., NelsonC. A., LeeT. Y., HajS. E., RhodesT., VindrolaC., ColbournT., & RosenbergW. (2019). Understanding how, why, for whom, and under what circumstances opt-out blood-borne virus testing programmes work to increase test engagement and uptake within prison: A rapid-realist review. BMC Health Services Research. 19(1), 152. https://doi.org/10.1186/s12913-019-3970-z
20.
FrankJ. W., WangE. A., Nunez-SmithM., LeeH., & ComfortM. (2014). Discrimination based on criminal record and healthcare utilization among men recently released from prison: A descriptive study. Health Justice. 2, 6. https://doi.org/10.1186/2194-7899-2-6
21.
FranklinW. B., KataylM., MahajanR., & ParvezF. (2012). Chlamydia and gonorrhea screening using urine-based nucleic acid amplification testing among males entering New York City jails: A pilot study. Journal of Correctional Health Care, 18(2), 120–130. https://doi.org/10.1177/1078345811435767
22.
Government of Canada. (2019). 2. Statistical overview on the overrepresentation of indigenous persons in the Canadian Correctional System and legislative reforms to address the problem. In Spotlight on Gladue: Challenges, experiences, and possibilities in Canada's criminal justice system (chapter 2). Department of Justice Research and Statistics Division. https://justice.gc.ca/eng/rp-pr/jr/gladue/p2.html
23.
GratrixJ., SmyczekP., BertholetL., LeeM. C., PyneD., WoodsD., CourtneyK., & AhmedR. (2019). A cross-sectional evaluation of opt-in testing for sexually transmitted and blood-borne infections in three Canadian provincial correctional facilities: A missed opportunity for public health? International Journal of Prisoner Health. 15(3), 273–281https://doi.org/10.1108/IJPH-07-2018-0043
JavanbakhtM., BoudovM., AndersonL. J., MalekM., SmithL. V., ChienM., & GuerryS. (2014). Sexually transmitted infections among incarcerated women: Findings from a decade of screening in a Los Angeles County Jail, 2002–2012. American Journal of Public Health, 104(11), e103–e109. https://doi.org/10.2105/AJPH.2014.302186
26.
KavaseryR., MaruD. S., Cornman-HomonoffJ., SyllaL. N., SmithD., & AlticeF. L. (2009a). Routine opt-out HIV testing strategies in a female jail setting: A prospective controlled trial. PLoS One. 4(11), e7648. https://doi.org/10.1371/journal.pone.0007648
27.
KavaseryR., MaruD. S., Cornman-HomonoffJ., SyllaL. N., SmithD., & AlticeF. L. (2009b). A prospective controlled trial of routine opt-out HIV testing in a men's jail. PLoS One. 4(11), e8056. https://doi.org/10.1371/journal.pone.0008056
28.
KouyoumdjianF. G., MainC., CalzavaraL. M., & KieferL. (2011). Prevalence and predictors of urethral chlamydia and gonorrhea infection in male inmates in an Ontario correctional facility. Canadian Journal of Public Health, 102(3), 220–224. https://doi.org/10.1007/bf03404901
29.
KriegerD., AbeC., PottorffA., LiX., RichJ., & NijhawanA. E. (2019). Sexually transmitted infections detected during and after incarceration among people with human immunodeficiency virus: Prevalence and implications for screening and prevention. Sexually Transmitted Diseases, 46(9), 602–607. https://doi.org/10.1097/OLQ.0000000000001023
30.
KronfliN., BuxtonJ. A., JenningsL., KouyomdjianF., & WongA. (2019). Hepatitis C virus (HCV) care in Canadian correctional facilities: Where are we and where do we need to be? Canadian Liver Journal. 2(4), 171–183. https://doi.org/10.3138/canlivj.2019-0007
31.
LedermanE., BlackwellA., TomkusG., RiosM., StephenB., RiveraA., & FarabaughP. (2020). Opt-out testing pilot for sexually transmitted infections among immigrant detainees at 2 immigration and customs enforcement health service corps-staffed detention facilities, 2018. Public Health Reports, 135(Suppl. 1), 82S–89S. https://doi.org/10.1177%2F0033354920928491
32.
LucasK. D., EckertV., BehrendsC. N., WheelerC., MacGowanR. J., & Mohle-BoetaniJ. C. (2016). Evaluation of routine HIV opt-out screening and continuum of care services following entry into eight prison reception centers—California, 2012. Morbidity and Mortality Weekly Report, 65(7), 178–181. https://doi.org/10.15585/mmwr.mm6507a3
33.
LyW., CocohobaJ., ChyornyA., HalpernJ., AuerswaldC., & MyersJ. (2018). Perspectives on integrated HIV and hepatitis C virus testing among persons entering a northern California jail: A pilot study. Journal of Acquired Immune Deficiency Syndromes, 78(2), 214–220. https://doi.org/10.1097/qai.0000000000001664
McIntyreA. F., StudzinskiA., BeidingerH. A., & RabinsC. (2009). STD, HIV/AIDS, and hepatitis services in Illinois county jails. Sexually Transmitted Diseases, 36(2 Suppl.), S37–S40. https://doi.org/10.1097/OLQ.0b013e31815e4167
37.
McNallyM., & MartinD. (2017). First Nations, Inuit and Metis health: Considerations for Canadian health leaders in the wake of the truth and reconciliation commission of Canada report. Healthcare Management Forum, 30(2), 117–122. https://doi.org/10.1177/0840470416680445
38.
MohamedZ., Al-KurdiD., NelsonM., ShimakawaY., SelvapattN., LaceyJ., ThurszM. R., LemoineM., & BrownA. S. (2020). Time matters: Point of care screening and streamlined linkage to care dramatically improves hepatitis C treatment uptake in prisoners in England. International Journal of Drug Policy,. 75, 102608. https://doi.org/10.1016/j.drugpo.2019.102608
Owusu-EduseiK., GiftT. L., ChessonH. W., & KentC. K. (2013). Investigating the potential public health benefit of jail-based screening and treatment programs for chlamydia. American Journal of Epidemiology, 177(5), 463–473. https://doi.org/10.1093/aje/kws240
41.
PathelaP., HennessyR. R., BlankS., ParvezF., FranklinW., & SchillingerJ. A. (2009). The contribution of a urine-based jail screening program to citywide male chlamydia and gonorrhea case rates in New York City. Sexually Transmitted Diseases, 36(Suppl. 2), S58–S61. https://doi.org/10.1097/olq.0b013e31815615bb
42.
PollardA., LlewellynC., SmithH., RichardsonD., & FisherM. (2013). Opt-out testing for HIV: Perspectives from a high prevalence community in south-east England, UK. International Journal of STD and AIDS, 24(4), 307–312. https://doi.org/10.1177/0956462412472424
RedmanJ., & SterlingR. (2018). Treating HCV in a captive audience: Eradication efforts in the prison microenvironment. American Journal of Gastroenterology, 113(11), 1585–1587. https://doi.org/10.1038/s41395-018-0201-x
47.
RosenD. L., SchoenbachV. J., WohlD. A., WhiteB. L., StewartP. W., & GolinC. E. (2009). An evaluation of HIV testing among inmates in the North Carolina prison system. American Journal of Public Health, 99(Suppl. 2), S452–S459. https://doi.org/10.2105/AJPH.2007.133124
48.
RumbleC., PevalinD. J., & O'Moore, É. (2015). Routine testing for blood-borne viruses in prisons: A systematic review. European Journal of Public Health, 25(6), 1078–1088. https://doi.org/10.1093/eurpub/ckv133 48
49.
ShaikhR. A., SimonsenK. A., O'KeefeA., EarleyM., FoxalM., IslamK. M., PersonA., BoyleC., SandkovskyU., & MargalitR. (2015). Comparison of opt-in versus opt-out testing for sexually transmitted infections among inmates in a county jail. Journal of Correctional Health Care, 21(4), 408–416. https://doi.org/10.1177/1078345815600447
50.
SieckC. J., & DembeA. E. (2011). Results of a pilot study of pre-release STD testing and inmates' risk behaviors in an Ohio prison. Journal of Urban Health, 88(4), 690–699. https://doi.org/10.1007/s11524-011-9565-6
51.
SimonsenK. A., ShaikhR. A., EarleyM., FoxallM., BoyleC., IslamK. M., YoungerH., SandkovskyU., BertholdE., & MargalitR. (2015). Rapid HIV screening in an urban jail: How testing at exit with linkage to community care can address perceived barriers. Journal of Primary Prevention, 36(6), 427–432. https://doi.org/10.1007/s10935-015-0408-1
52.
SpauldingA. C., KimM. J., CorpeningK. T., CarpenterT., WatlingtonP., & BowdenC. J. (2015a). Establishing an HIV screening program led by staff nurses in a county jail. Journal of Public Health Management and Practice. 21(6), 538–545. https://doi.org/10.1097/PHH.0000000000000183
53.
SpauldingA. C., MacGowanR. J., CopelandB., ShresthaR. K., BowdenC. J., KimM. J., MargolisA., MustaafaaG., ReidL. C., HeilpernK. L., & ShahB. B. (2015b). Costs of rapid HIV screening in an urban emergency department and a nearby county jail in the southeastern United States. PloS One. 10(6), e0128408. https://doi.org/10.1371/journal.pone.0128408
54.
StevensonK. A., PodewilsL. J., ZishiriV. K., CastroK. G., & CharalambousS. (2020). HIV prevalence and the cascade of care in five South African correctional facilities. PLoS One. 15(7), e0235178. https://doi.org/10.1371/journal.pone.0235178
55.
SubramanianY., KhanM. N., BergerS., FoisyM., SinghA., WoodsD., PyneD., & AhmedR. (2016). HIV outcomes at a Canadian remand centre. International Journal of Prisoner Health, 12(3), 145–156. https://doi.org/10.1108/IJPH-12-2015-0041
56.
ThomasJ. C., & SampsonL. A. (2005). High rates of incarceration as a social force associated with community rates of sexually transmitted infection. Journal of Infectious Diseases, 191(Suppl. 1), S55–S60. https://doi.org/10.1086/425278
57.
WieheS. E., RosenmanM. B., AalsmaM. C., ScanlonM. L., & FortenberryJ. D. (2015). Epidemiology of sexually transmitted infections among offenders following arrest or incarceration. American Journal of Public Health, 105(12), e26–e32. https://doi.org/10.2105/AJPH.2015.302852
ZakariaD., ThompsonJ. M., JarvisA., & BorgattaF. (2010). Summary of emerging findings from the 2007 National Inmate Infectious Diseases and Risk-Behaviours Survey [Research report R-211]. Correctional Service of Canada. https://www.csc-scc.gc.ca/005/008/092/005008-0211-01-eng.pdf
