Evaluation of large jail STD screening programs in the US, 2008-2009

Background: A small number of large jails hold the majority of all jail inmates, and young adults in jails are at high risk for STDs because they often engage in unprotected sex, have multiple sex partners, and use drugs. Overall, in the US, sexually experienced women 20-29 years have a chlamydia (CT) prevalence of 2.6%. By comparison, adult women in jail have an average prevalence of 8.5%, indicating the disproportionate burden of infection in this subpopulation. Despite this high burden of infection, CT screening is not performed in most large jails. To understand barriers and facilitators to implementing screening programs, we performed an evaluation of 14 STD screening programs in large jails that have a daily census of 1000 or more inmates.

Methods: Twelve jurisdictions were chosen based on size, geographic location, screening program, and the convenience. Site visit reports; observations, and interviews were conducted with key stakeholders, such as health department staff, corrections staff, and jail health staff.

Findings: Only 5 of the 14 sites provided comprehensive chlamydia screening: Philadelphia (95%), San Francisco (80%), New York City (71%), Wayne County (63%), and Los Angeles (62%); Four locations conducted gender based screening for CT: Los Angeles, New York City, Philadelphia, and San Francisco; Eight locations screened for syphilis, but offered limited screening for CT: Alameda County CA, Baton Rouge LA, Dallas TX, DeKalb County GA, Houston TX, Las Vegas NV (two sites), and Phoenix AZ. The evaluation identified a number of challenges to integrating STD screening programs into the jail health environment. These included: funding, length of time to get laboratory results, inability to treat infected inmates prior to release, and security issues competing against public health priorities. Some facilitators for implementing successful STD screening programs identified were: having good and open communication between health and security staff, implementing intake screening, identifying a ‘champion' for STD screening, having an opt-out screening process in place, and including screening and treatment requirements in jail medical provider contracts.

Conclusions: Although many challenges were identified with establishing STD screening programs in jail settings; a number of large jails have successfully implemented these programs. A key component to all these successful programs is a strong and mutually respectful relationship between public health and corrections (security and health/medical). We found that a strong relationship and working creatively as a team can take implementation of this important public health program one step closer to reality.