Uptake of Opt-Out Testing for Women Detainees in Cook County Jail, Chicago, Illinois, 2011-2014

Issue: Large jails present logistical challenges to implementing CDC-recommended HIV opt-out testing in which all members of a population are tested unless they formally decline or are known to be infected.  More often, jails offer only post-intake HIV opt-in testing that requires detainees’ formally acceptance.

Description: Detainees often reside in HIV high-prevalence communities and have elevated risk behaviors, thus jails are well situated to identify and link to care persons with undiagnosed or not-currently-treated infections.  Chicago’s Cook County Jail (CCJ), among the largest single-facility U.S. jails, began implementing opt-out HIV testing in April 2011 as a routine component of intake processing.  Detainees give written consent for all health services with an option to decline HIV/STI testing.  Opt-in testing after intake remains available.  For logistical reasons, opt-out testing began with women detainees (n~11,000 admissions annually).

Lessons Learned: Before HIV opt-out testing, 15%-30% of women tested annually under a post-intake opt-in protocol.  After opt-out was instituted it accounted for 72%-84% of all HIV tests annually, and the total proportion of women tested increased to 51% in 2012 and 42% in 2013, but declined to 24% in 2014 due to logistical issues.  Opt-out testing yielded an HIV prevalence of 1.26% between 2012-2014, with 18% of those infections newly diagnosed.  HIV-positive results were more likely to be newly diagnosed infections under opt-out compared to opt-in (18% vs. 11%, respectively). 

Recommendations:  HIV opt-out testing modified to address concerns specific to jail detainees can increase the diagnoses of new and untreated infections in a high-risk population.