Comparing HIV case detection in prison during opt-in vs. Opt-out testing policies

Routine HIV screening in health care settings, including prisons and jails, is recommended by the US Centers for Disease Control and Prevention to enhance the detection of HIV infection.1,2 A centerpiece of this strategy is opt-out HIV screening whereby patients are informed that testing will be conducted unless they decline the test. Although incarceration is considered an opportunity to detect HIV and initiate or restart HIV care,3–6 there are few data describing the performance of an opt-out testing policy in prisons, where HIV prevalence is several-fold that found in the general population.3In November 2008, the North Carolina Department of Public Safety (NCDPS) Division of Adult Correction changed its HIV screening policy for incoming inmates from opt-in to opt-out testing. At the time of the policy change, we were conducting a HIV seroprevalence study among incoming prisoners.7 The co-occurrence of the change in policy and our seroprevalence study provided a natural experiment to assess the impact of the testing policy on HIV case detection of both newly diagnosed and previously diagnosed cases.