Comprehensive STD/HIV Screening for Incarcerated Women: Integration of Best Practices in a Jail Setting

Background:
Incarcerated women have high rates of STD/HIV. Delivering routine medical care, screening and follow-up remains a challenge.

Objective:
To describe the development and implementation of a comprehensiveSTD/HIV screening program as routine best practice for incarcerated women in the Los Angeles County Jail.

Method:
A collaborative work group was formed and included Infertility Prevention and Syphilis Elimination Projects, AIDS Program, andSheriff's Medical and other Custody staff with the goal of developing a comprehensive STD/HIV screening program for incarceratedwomen. An STD/HIV testing station was established in the InmateReception Center at the jail. Outcomes were assessed by review of lab testing records and daily program logs. A case surveillance database wasused to monitor treatment and partner services. Acceptance rates wereassessed by reviewing LAC Sheriff's Department inmate intake records and screening criteria.

Result:
Between October 2006 and June 2007, 5,459 women were screened for CT/GC, 2,534 women were screened for HIV, and 2,508 women were screenedfor syphilis. Disease rates for CT and GC were 14% and 4%, respectively,and 4% were positive for syphilis, and 1.5% were HIV positive. Treatment for CT was confirmed for 74% and 62% for GC. All syphilis positives received treatment, and all HIV cases were referred for case management and partner counseling and referral services.

Conclusion:
A comprehensive STD/HIV screening program was successfully introduced as routine practice in the intake process. This resulted in the identification and referral and/or treatment of substantial STD/HIV morbidity.

Implications:
Comprehensive STD/HIV screening in a jail setting provides concentrated access to high morbidity, hard-to-reach population, providing a highyield for case detection and treatment.