Journal of Correctional Health Care - April 2023 - 158

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FELD ET AL.
rapid test, a confirmatory antigen/antibody blood test confirmed
the person's HIV status.
During a person's stay in custody, those who tested
positive for HIV through the program or disclosed their
HIV status received HIV care services and were linked
to care as part of their release planning. HIV care services
included meeting with the jail's HIV doctor, lab testing to
determine the appropriate medications for treatment, and
meeting with a discharge planner for linkage to care in
the community. Individualized care was provided based
on the person's specific health needs.
The discharge planner also connected individuals with
community resources and supports to assist their transition
back to the community. Upon release from custody,
all HIV-positive individuals were offered a 30-day supply
of antiretroviral medication along with information
about the importance of continuing medication after release,
and were linked to an appointment and case manager
by the discharge planner.
In addition to quantitative test-level data, program
staff maintained monthly logs to qualitatively capture
programmatic challenges, barriers, innovations, and successes.
Qualitative data from these logs supported ongoing
quality improvement efforts, in which staff would
review monthly testing trends and identify opportunities
for program improvement.
Method
Data Sources
For each negative HIV test conducted between 2012 and
2017, jail staff logged the type of test used (rapid oral
swab or conventional antigen/antibody blood draw) as
well as nonidentifiable patient demographic information,
including current gender, year of birth, race/ethnicity,
and residential zip code. Tests were administered to individuals
who had been in custody for 14 days or more during
their health and physical exam, or when medical
attention was requested through sick calls. People who
identified as living with HIV were offered repeat testing.
Data pertaining to a person's length of the stay in the jail
were not collected as part of this project. Data were not
collected on those who opted out of routine testing.
For any non-negative test result-preliminary positives,
confirmatory positives, or invalid results-additional data
were collected, including gender and sexual orientation
measures, housing and insurance status before incarceration,
testing history, and reported risk factors from the
last 12 months. These data were collected via an in-person
interview with the jail's discharge planner after a person
received a preliminary positive test result. Any rapid oral
swab that yielded a preliminary positive result was followed
up with a confirmatory antigen/antibody blood test.
For confirmed positive cases, data on each patient's
linkage-to-care status was updated by the jail's discharge
planner, as available. Individuals in the jail living with
HIV were assumed to be disengaged from HIV care. Linkage
to care was defined as having a medical appointment
within 90 days of diagnosis, either with an HIV doctor inside
the jail or in the community. A case manager in the
jail worked with each patient to set up an appointment
with the HIV doctor located at the jail. If the person had
been previously diagnosed, the case manager, with patient
consent, sought to obtain prior medical records from previous
medical providers and initiate care inside the jail.
Additionally, the case manager worked to identify and
link, or relink, patients to an HIV medical provider in the
community upon their release from custody. Although all
HIV-positive individuals in the jail were offered a 30-day
supply of antiretroviral medication upon release, data are
not available with respect to the proportion of individuals
who accepted and left custody with the medication.
Cardea received funding to support the jail's data
collection and reporting activities. The California OA
provided a de-identified data file to Cardea for the
2012-2017 time period to use for this analysis. The
Alameda County Sheriff's Office also provided Cardea
with jail census data to calculate average monthly
screening coverage.
Analysis
Descriptive analyses were conducted to summarize the
results of the routine testing program between 2012 and
2017. Frequencies of both newly identified and previously
known HIV cases were calculated. The positivity
rate was calculated using the total number of HIV positive
results divided by the total number of HIV tests conducted
during the study period. The proportion of
positive HIV cases linked to medical care was also calculated
for all positives and newly identified positive cases.
Demographics of individuals tested for HIV were stratified
by test result. An average monthly screening rate
was estimated using the average number of monthly
HIV tests over the average monthly jail census.
Results
Over a 6-year period, 15,906 HIV tests were conducted at
the Alameda County jails. Over half (54.9%) of tests used
rapid oral swab test technology (Table 1). Of the 15,819
people with negative tests, the median age was 32 years,
and nearly three quarters of tests were among men. Just
over half of negative tests (51.1%) were conducted
among non-Hispanic Black, 22.5% among Latinx, and
20.4% among non-Hispanic White individuals.
A total of 87 confirmed positive cases were identified
over the 5-year pilot, yielding a positivity rate of 0.55%.
Approximately half of the positive cases (n = 43) were
newly identified; the other half (n = 44) were among individuals
who were previously diagnosed but were not
Journal of Correctional Health Care - April 2023

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