Journal of Correctional Health Care - April 2023 - 161

IMPLEMENTING OPT-OUT HIV TESTING
161
detained individuals were released within 3 days, primarily
those who were released on bail or citation (Austin,
2019).
Data were not collected for anyone who opted out of
testing or did not receive their test results. With respect
to the linkage-to-care measure, program staff followed
up with health care providers to determine whether or
not someone diagnosed in the jail attended a medical
visit in the community upon release. It is possible that
some individuals saw a medical provider within 90
days of diagnosis but jail staff were unable to confirm
the visit, thus leading to underreporting for this measure.
It is also possible that new HIV-positive cases were
misclassified. Since prior diagnosis was based on either
self-report or presence of a diagnosis in the state registry,
it is possible that someone had been diagnosed outside of
California and did not disclose their status may have been
misclassified as a new positive HIV case. Finally, for
those individuals who were not linked to care within 90
days, it is not known whether they did access care at a
later time.
Conclusion
In summary, routine opt-out HIV testing in Alameda
County jails was feasible, evidenced by the nearly
16,000 tests conducted over a 6-year period. The program
led to identification of both new HIV-positive cases and
previously diagnosed individuals who had fallen out of
care, supported linkage of those individuals to medical
care, and surpassed the CDC's benchmark of a 0.1% positivity
rate for cost-effectiveness. The results suggest that
routine testing in correctional settings may be an effective
strategy to identify undiagnosed HIV cases and
link those with HIV to medical treatment to meet the
goals of the National HIV/AIDS Strategy for the United
States 2022-2025 (The White House, 2021).
Authors' Note
Malvika Nair supported the authors in compiling files,
updating references, and addressing reviewer comments.
Author Disclosure Statement
The authors disclosed no conflicts of interest with respect
to the research, authorship, or publication of this
article.
Funding Information
This work was supported by Alameda County Department
of Public Health, Santa Rita Jail Health workers,
and Cardea Services.
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Journal of Correctional Health Care - April 2023

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