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Comparison of opt-in versus opt-out screening for sexually transmitted infections among jail inmates in a county correctional facility

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

Raees Shaikh, MPH , College of Public Health- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, NE
Kari Simonsen, MD , Section of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE
Anne O'Keefe, MD, MPH , Epidemiology, Douglas County Health Department, Omaha, NE
Mary Earley, CJM , Department of Corrections, Douglas County, Nebraska, Omaha, NE
Mark Foxall, PhD , Department of Corrections, Douglas County, Nebraska, Omaha, NE
Monirul Islam, MD, PhD , Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE
Austin Person , College of Medicine, University of Nebraska Medical Center, Omaha, NE
Cole Boyle , College of Public Health, University of Nebraska Medical Center, Omaha, NE
Uriel Sandkovsky, MD, FACP , Division of Infectious Diseases and HIV Clinic, University of Nebraska Medical Center, Omaha, NE
Chris Brown, MS, MPH, CPH , Biodefense Program, Department of Public & International Affairs, George Mason University, Fairfax, VA
Ruth Margalit, MD , College of Public Health, University of Nebraska Medical Center, Omaha, NE
  
Background: Jails constitute an ideal setting for routine opt-out screening and treatment of sexually transmitted infections (STI) such as chlamydia and gonorrhea. Yet, many jails rely only on opt-in STI screenings. Our aim was to compare an opt-out approach of universal screening at intake to an opt-in screening approach and to estimate the true prevalence of common STIs among jail inmates.

Methods: We used data from the Do-JuSTIce Service Learning project, an opt-in program that offers education and free screening to inmates in selected Douglas County Department of Corrections housing units (n=1963), and an opt-out pilot program where every inmate entering the jail over a week was offered screening (n=298). Multivariate logistic regression was used to compare odds of testing positive for chlamydia or gonorrhea, and to calculate their adjusted prevalence in the two programs.  

Results: The adjusted prevalence of chlamydia in the opt-out screening program was significantly higher than the opt-in program (10.10% vs. 5.70%, p=0.031) but gonorrhea prevalence in the two programs was not significantly different (1.55% vs. 0.89%, p=0.436). Odds of testing positive for chlamydia were significantly higher in the opt-out than the opt-in program (OR: 1.90, 95% CI: 1.16-3.10, p=0.012), which was not the case for gonorrhea (OR: 1.75, 95% CI: 0.54-5.62, p=0.345).

Conclusion: Findings from this study support implementation of universal STI screening of jail inmates.  Reviewing the existing policy and making resources available to implement such a program for jail inmates at the time of intake could be the first step in this direction.

Learning Areas:

Implementation of health education strategies, interventions and programs
Social and behavioral sciences

Learning Objectives:
Compare opt-in and opt-out STI screening approaches in a jail setting. Assess the prevalence of common STI's among jail inmate population.

Keyword(s): STDs/STI, Prisoners Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been involved with the STI education, screening and treatment Service Learning Project at the local correctional facility for about 2 years. As a coordinator, I have led two pilot projects at the jail, an STI screening pilot project presented in this paper and an HIV screening pilot project.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4084.0: Novel Approaches and Studies in Epidemiology, Health Geography, Research and Practice Poster Session