Background In 1999 North Carolina initiated STI screening programs in seven county jails as part of the CDC Syphilis Elimination Effort (SEE). All jails were willing to permit screening programs for syphilis but only two also screened for HIV. In 2007 the SEE funding was depleted and the 7 SEE jail projects were converted to HIV screening under the CDC Expanded Testing Initiative (ETI). New jails were added (n=21) and several have added screening for other STIs. Testing is supported by 10 local health departments and 5 non-traditional testing sites which assure treatment for STDs and make referrals for HIV care services.
Methods From January to June 2010, STI screening data for 28 jails was analysed. All jails tested for HIV and syphilis, one jail added HCV screening and another jail added NAAT testing for gonorrhoea and chlamydial infection. Reactive syphilis tests and positive HIV tests were verified against surveillance records to determine whether or not they were previous cases or newly diagnosed infections. Positive tests for Neisseria gonorrhoeae and Chlamydia trachomatis were considered to be new infections. Positive tests for HCV are considered prevalent infections. All data were analysed using SAS 9.1.3.
Results Under SEE, only two jails screened for both HIV and syphilis. From 2002 to 2005, 3626 inmates were screened. There were 46 (1.3%) HIV-positive inmates and 158 (4.4%) with reactive syphilis tests. Of those 158, 30 were confirmed new syphilis cases (0.83% case rate). Under ETI, 28 jails screened 4688 inmates for syphilis and 4662 for HIV in just 6 months (January–June, 2010, see Abstract P1-S6.28 table 1). HIV positivity rates were similar for men and women (p=0.90) but women were more likely than men to be both a syphilis reactor (OR 4.8 95% CI 2.8 to 8.2) and a new case (OR 5.9 95% CI 1.9 to 17.9). Among all positive tests, there were no comorbid patients.
Conclusions The jail setting proves to be an important setting for detecting new syphilis cases, particularly among women, and for identifying HIV-positive inmates. Many of these HIV positives were not new diagnoses but may represent persons who need referrals for care and treatment. Screening for HCV and combined Ct/Gc screening was also productive and should be expanded to other jails. Due to the high concentration of persons who trade sex for drugs or money in jail settings, it is especially important that these HIV and STI cases be identified and referred for treatment and partner services to prevent ongoing transmission.
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