Comprehensive STD/HIV Screening for Incarcerated Women: Integration of Best Practices in a Jail Setting Melina R. Boudov, MA, Kirsten Wilson, Marisol Mejia, Sarah L. Guerry, MD Sexually Transmitted Disease Program, Los Angeles County Department of Public Health

Objectives To describe the implementation of a comprehensive STD/HIV screening program for incarcerated women To highlight potential solutions to challenges of screening in a correctional setting

Incarcerated Women High Priority for Public Health CDC Performance Measure: proportion of women in jail screened for syphilis Women in adult detention established as high risk for CT/GC and HIV Incarceration offers concentrated access

LAC DPH STD Program Women’s Jail Screening Project Routine CT/GC screening since 2000 Expanded to include syphilis and HIV testing in 2006 Screening population –Age 30 and under –Pregnant or possibly pregnant –Prostitution or other sex-related charge -Syphilis and HIV tests offered to others as able

Women in Los Angeles County Jail Over 162,000 booked into system per year About 12% female Almost 2,000 women on any given day 490 women are booked per week All females held at Century Regional Detention Facility (CRDF)

CRDF: Inmate Reception Center (IRC) Oblong room (35 x 15 yards), lined with holding cells, 1-25 people per cell No windows, doors, daylight Hectic, busy, tense – SCARED “new fish” Newest deputies: uniforms, badges, guns, and gas

CRDF IRC: Process and Staffing Deputies send clients to testing station Mobile cart as testing station, 9:00 PM - 5:00 AM Must track all supplies Minimal confidentiality or chance for counseling Two FT staff, one PT staff obtain consent, collect specimens, and keep logs

CRDF Screening Program October 2006 – December ,529 women screened for CT/GC –13% CT positive, 4% GC positive 3,965 women screened for HIV –25 new cases identified (0.6%) 3,982 women screened for syphilis –5% confirmed positive –34 cases of early syphilis

CT and GC Prevalence by Age October 2006 – December 2007

CT and GC Prevalence by Race/Ethnicity October 2006 – December 2007

Treatment Treatment for CT and GC confirmed for 62% (46% in custody) 33/34 Early Syphilis cases treated All HIV cases began treatment in custody, if still incarcerated All released HIV cases were referred for case management and health care

Challenges

Treatment: Challenges Low treatment rates for CT and GC –Rapid discharge –Highly transient population, very hard to find Excellent treatment for syphilis and HIV –Priority for jail nurse –dedicated field worker for few cases –rapid referrals for HIV case management

Treatment: Solutions Minimize laboratory turn around time Prompt treatment if still in custody Field Delivered Therapy –Immediately after release –Includes PDT

Challenge and Solutions: Jail Culture Competing agendas: security and control vs. health and welfare Solutions: consistency and communication –Always defer to security concerns –Cultivating and maintaining relationships –Face-to-face meetings –Regular reporting back –Recognizing support – in writing! –NORMALIZING program is key to success

Challenge: Limited Resources Solution: Program Collaboration Break down Public Health silos Multiple agencies fund aspects of program, e.g. HIV Working group meets monthly Daily communication among key players –Lab –Jail Nursing –Field staff

Conclusions Comprehensive STD/HIV routine screening program can be successful at a large County jail Common objectives of reaching incarcerated women can serve as organizing principles for necessary collaboration among multiple partners

Acknowledgements LAC STD Program Zakiya Hill Judith Melendez Kimberly Givan David De La Riva Sara Alvarez Marisol Mejia Kirsten Wilson Binh Goldstein Margarita Melogoza Peter R. Kerndt LAC AIDS Program Joanne Oliver Diana Perez Kamaria Gray LAC Sheriff’s Department Nurse Helen P. Johnson Nurse P Tunyapakorn Nurse MK Singh Mark Malek Karen Dalton Lieutenant Wilson LAC Public Health Laboratory Ruel Torres Ferdows Rashidian Sue Sabet