The grants were part of a project to expand the use of HIV tests to jail prisoners nationwide, with the goal of identifying and preventing HIV infections. It is estimated that 25 percent of all people infected with HIV will eventually pass through a jail or prison, and that 25 percent of people infected do not know they have the disease.
The CDC-funded study ran from January 2004 to March 2006 and involved testing male and female prisoners at jails in Florida, New York, Louisiana and Wisconsin. The study participants received the OraQuick rapid HIV test, which provides results in about 20 minutes. Traditional blood tests can take weeks. For jail prisoners who remain in custody for very short periods of time, the rapid tests are seen as more practical and effective.
Participation by prisoners was said to be voluntary and required written informed consent.
Among the four pilot states, Wisconsin had the lowest prevalence of positive HIV test results. Nationwide it is estimated that 0.6 percent of the population has HIV/AIDS, according to the Kaiser Family Foundation. It is projected there are 40,000 new HIV infections in the U.S. each year. Wisconsin reported a positive rate of .27 percent among the prisoners tested, compared to an average 1.1 percent at the other test sites.
As a selected site, the Wisconsin Division of Public Health received a $389,000 grant from the CDC to test 4,500 prisoners at the Milwaukee House of Correction and Rock County Jail. To conduct the testing the state hired STD Specialties, which also performs traditional HIV tests. As an outside entity it can provide services to infected prisoners after their release.
“That was the driving force for using a community-based group for testing,” said Miche Llanas, a coordinator of Wisconsin’s HIV/AIDS program. “This staff had much more flexibility for being able to work outside the facility.” Wisconsin jail prisoners who tested positive were referred to community healthcare agencies, and given $50 upon release to cover transportation to those agencies for follow-up treatment.
While the CDC’s multi-state project utilized rapid HIV tests, which were first approved by the FDA in 2002, such tests were already in use at other correctional facilities. For example, they have been used at New York City jails since January 2004. Beginning in December 2006, the Palm Beach County, Florida jail began using an oral fluid (saliva) version of the OraQuick test as part of a joint effort involving the county health department and the jail’s medical provider, Armor Correctional Health Care.
The CDC study did not examine the effectiveness or accuracy of the OraQuick rapid HIV test. In June 2008 it was reported that the New York City Health Department had discontinued using the oral fluid version of the OraQuick test, following unusually high false positive results in late 2005 and again from Nov. 2007 to April 2008. The high number of false positives occurred in oral rapid HIV tests, not in finger-stick (blood) versions of the test.
Sources: Journal Sentinel, Morbidity and Mortality Weekly Report (June 20, 2008), New York Times, Palm Beach Post, www.cdc.gov
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