Journal of Correctional Health Care - April 2023 - 159

IMPLEMENTING OPT-OUT HIV TESTING
159
Table 1. Characteristics of Individuals Screened for HIV in Alameda County Jails, 2012-2017
Total testsa
Negative tests
Total
Test technology, n (%)
Rapid oral swab
Conventional blood draw
Median age (range)
Gender, n (%)
% Male
% Female
% Trans female
Race/ethnicity, n (%)
Asian
Non-Hispanic Black/African American
Latino
Non-Hispanic White
Missing, declined/unknown race/ethnicity
15,906
8,730 (54.9)
7,176 (45.1)
11,480 (72.2)
4,420 (27.8)
-
303 (1.9)
8,142 (51.2)
3,567 (22.4)
3,250 (20.4)
546 (3.4)
aInvalid, indeterminate, and false positive tests are not shown.
engaged in HIV care. The demographics of the positive
cases were similar to those with negative test results, although
the median age was slightly older (36 years) for
positive cases, and a greater proportion of positive
cases were among non-Hispanic Black individuals
(60.9%). Transgender women accounted for 2.3% of positive
cases; the measure for current gender within the negative
testing data was limited to only binary male/female
response options.
The average estimated monthly screening rate of everyone
booked into the jail, based on the average number
of monthly HIV tests over the average monthly jail census,
was 5.6%. This relatively low screening rate reflects
the high volume of individuals in custody for fewer than
14 days, before having an opportunity to access opt-out
testing.
The overall positivity rate was 0.55% for any positive
test result and 0.27% for newly identified cases (Table 2).
Over 79% of positive cases were confirmed by program
staff to be linked to medical care within 90 days, either
to the HIV medical provider inside the jail or in the community
upon release, depending on the patient's preference
and length of stay in the jail.
Upon diagnosis, individuals with a positive result were
asked about their HIV risk factors from the prior 12
months. Nearly three-quarters of patients provided factors
or behaviors from the past 12 months contributing
to risk, with male-to-male sexual contact being the
most commonly reported risk factor across all people
who tested positive (40.2%). Male-to-male sexual contact
combined with intravenous drug use along with heterosexual
intercourse were more frequently cited risk factors
among new positive cases, compared to the risk factors
reported by all positive cases (14.0% vs. 9.2%, and
7.0% vs. 2.3%, respectively).
Overall, approximately a quarter (27.5%) of those who
tested positive reported no risk factors within the last
year. There were one to two people newly diagnosed
each year with no reported risk factors between 2012
and 2017 (data not shown due to small sample size),
with the exception of 2014 when there were none.
Among newly diagnosed positive cases where no risk
factor was reported from the last year (n = 12), demographics
were similar to the overall population of
newly diagnosed cases with respect to gender. Median
age was moderately younger (33 years) among those
newly diagnosed with no reported risk factors, and a
greater proportion were white (42% vs. 27.9% of all
newly diagnosed positive cases).
Table 2. Positivity Rate, Linkage to Care, and Reported Risk
Factors Among Individuals Who Tested Positive for HIV
in Alameda County Jails, 2012-2017
All positives (%)
Positivity rate
Linked to care within 90 days
Male-to-male sexual contact
and intravenous drug use
Stimulant drug use
Intravenous drug use
Heterosexual intercourse
Transgender
Sex work
STD diagnosis
Sex worker partner
No reported/indicated risk
STD, sexually transmitted disease.
0.55
79.3
Reported risk factors from the last 12 months
Male-to-male sexual contact
40.2
9.2
4.6
3.4
2.3
2.3
2.3
1.1
1.1
27.5
Newly identified
positive cases (%)
0.27
79.1
27.9
14.0
4.7
4.7
7.0
2.3
4.7
2.3
2.3
27.9
15,819
8,704 (55.0)
7,115 (45.0)
11,416 (72.2)
4,399 (27.8)
-
302 (1.9)
8,089 (51.1)
3,555 (22.5)
3,231 (20.4)
544 (3.4)
87
26 (29.9)
61 (70.1)
32 Years (17-78) 32 Years (17-78) 36 Years (19-70)
64 (73.6)
21 (24.1)
2 (2.3)
1 (1.1)
53 (60.9)
12 (13.8)
19 (21.8)
2 (2.2)
Positive cases Newly identified positive cases
43
2 (4.7)
41 (95.3)
37 Years (19-62)
31 (72.1)
11 (25.6)
1 (2.3)
1 (2.3)
22 (51.2)
7 (16.3)
12 (27.9)
1 (2.3)
Journal of Correctional Health Care - April 2023

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