Researchers find jail-based surveillance screeing useful in monitoring HIV and sexually transmitted

By Jeff Sheehy

A study by the San Francisco Department of Public Health, conducted at the San
Francisco County Jail, has found that anonymous HIV screening of jail inmates
offers an opportunity to track the epidemic in at-risk groups, particularly
those who traditionally under-utilize health care services.

“This type of screening, called sentinel surveillance, offers an early warning
system to monitor the extent of HIV infection in a generally low socioeconomic
group that doesn’t often access screening services,” said the study’s lead
investigator, Willi McFarland, MD, PhD, of the San Francisco Department of
Public Health HIV Seroepidemiology Unit and the University of California, San
Francisco Center for AIDS Prevention Studies.

Research findings were reported today (July 11) at the XIII International AIDS
Conference in Durban, South Africa.

The on-going effort, funded by the Centers for Disease Control and Prevention,
involves a close collaboration of the San Francisco health department’s AIDS
Office, Sexually Transmitted Disease (STD) Prevention and Control Services, and
Forensic AIDS program.

Researchers conduct the HIV testing through an STD services screening program
established by the health department three years ago at the county jail. It
offers voluntary screening for gonorrhea, syphilis, and chlamydia within hours
of arrest to male inmates aged 18-35 and females 18-45. Most prisoners offered
the services have chosen to participate in the program, and it has detected a
higher number of STDs than are typically picked up in screening programs that
are available to populations outside the jail setting, said McFarland.

“We saw in this successful STD screening program an opportunity to conduct a
completely blinded HIV surveillance survey in high-risk groups brought to the
jail,” said McFarland.

The study, which began in June 1999, tested for HIV in residual blood samples
drawn for syphilis testing. Researchers did not track the patients by name, but
were able to follow demographic characteristics and behaviors that put
individuals at risk for HIV, such as intravenous (IV) drug use, or men having
sex with men.

At the Durban meeting, results were reported for the period June 1999 to
February 2000.

Researchers found HIV in about 2 percent of 3,019 inmates who underwent
screening—a rate about 5 times greater than would be expected in the general
heterosexual population of San Francisco. The highest levels of HIV infection
(19 percent) were found in men who had sex with men and were also IV drug
users. Men who had sex with men and did not inject drugs had a 16 percent level
of infection. HIV-positive inmates of either sex were also more likely to
report injection drug use, having sex with a man, and having sex with an
HIV-infected partner.

The researchers were also able to determine which groups appeared to have been
more recently infected with the virus, because the study used a new HIV
diagnostic test that can determine whether infection has occurred within the
last six months. Most recent infections found in the jail were associated with
drug use.

Rates of others STDs in the study population were 2 percent for gonorrhea, 7
percent for chlamydia, and 0.1 percent for syphilis.

Although this HIV surveillance screening program is conducted on an anonymous
basis and inmates do not find out their test results, confidential HIV
screening and treatment referral are available on request for inmates who want
to know their HIV status, said McFarland.

Study co-investigators included Andrea Kim, MPH, of the SF Department of Public
Health HIV Seroepidemiology Unit, who presented the findings at the Durban
meeting; Tim Kellogg, MA, also of the HIV Seroepidemiology Unit;  Charlotte
Kent, MPH, Robert Kohn, MPH, and Ameera Snell, BA, of the SF Department of
Public Health STD Prevention and Control program; Joe Goldenson, MD, of the SF
Department of Public Health, Forensic Services; and Keith Bordelon, MPH, and
Keith Sabin, PhD, MPH, of the US Centers for Disease Control and Prevention.
Jeffrey Klausner, MD, MPH, director of STD Control for the SF Department of
Public Health, is the co-principal investigator.