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Undiagnosed HIV Infection Among New York City Jail Entrants, 2006: Results of a Blinded Serosurvey

Begier, Elizabeth M MD, MPH; Bennani, Yussef MPH; Forgione, Lisa MA; Punsalang, Amado PhD; Hanna, David B MS; Herrera, Jeffrey BA; Torian, Lucia PhD; Gbur, Maria MD; Sepkowitz, Kent A MD; Parvez, Farah MD, MPH

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1st, 2010 - Volume 54 - Issue 1 - p 93-101
doi: 10.1097/QAI.0b013e3181c98fa8
Epidemiology and Prevention

Objective: Since 2004, when all New York City jail entrants began being offered rapid testing at medical intake, HIV testing has increased 4-fold. To guide further service improvement, we determined HIV prevalence among jail entrants, including proportion undiagnosed.

Methods: Remnant serum from routine syphilis screening was salvaged for blinded HIV testing in 2006. Using HIV surveillance data and electronic clinical data, we ascertained previously diagnosed HIV infections before permanently removing identifiers. We defined “undiagnosed” as HIV-infected entrants who were unreported to surveillance and denied HIV infection.

Results: Among the 6411 jail entrants tested (68.9% of admissions), HIV prevalence was 5.2% overall (males 4.7%; females: 9.8%). Adjusting for those not in the serosurvey, estimated seroprevalence is 8.7% overall (6.5% males, 14% females). Overall, 28.1% of HIV infections identified in the serosurvey were undiagnosed at jail entry; only 11.5% of these were diagnosed during routine jail testing. Few (11.1%) of the undiagnosed inmates reported injection drug use or being men who have sex with men.

Conclusions: About 5%-9% of New York City jail entrants are HIV infected. Of the infected, 28% are undiagnosed; most of whom denied recognized HIV risk factors. To increase inmate's acceptance of routine testing, we are working to eliminate the required separate written consent for HIV testing to allow implementation of the Centers for Disease Control and Prevention-recommended opt out testing model.

From the New York City Department of Health and Mental Hygiene, New York, NY. Dr Farah Parvez was also associated with the National Center for HIV/AIDS, Viral Hepatitis, sexually transmitted disease, and TB Prevention, Centers for Disease Control and Prevention.

Received for publication May 12, 2009; accepted October 21, 2009.

Supported in part by cooperative agreement 5U62PS001026-02 with the Centers for Disease Control and Prevention.

Presented in part at the 15th Conference on Retroviruses and Opportunistic Infections, February 2008, Boston, MA. Abstract #: V-203.

F.P., L.T., E.B., and K.A.S. contributed to conceptualization of the study. Y.B., L.F., D.H., and J.H. contributed to data management. Y.B., L.F., L.T., and A.P. contributed to laboratory testing and oversight. Y.B., L.F., and D.B.H. conducted the data analysis. E.M.B., Y.B., and M.G. contributed to drafting the article. All authors contributed to the editing of the article.

Correspondence to: Elizabeth M. Begier, MD, MPH, Director for HIV Epidemiology and Field Services, New York City Department of Health and Mental Hygiene, 346 Broadway, Room 707, New York, NY 10013 (e-mail: ebegier@health.nyc.gov; bbegier@gmail.com).

© 2010 Lippincott Williams & Wilkins, Inc.