Abstract:
Rapid HIV Testing in Jail and Associated HIV Risk-Behavior Change

HIV counseling and testing (C&T) in correctional settings provides access to persons at increased risk of HIV infection. Jails, which act as the portal of entry to correctional systems, provide an opportunity to offer comprehensive HIV C&T services to this at-risk population. Jail HIV C&T programs that utilize standard HIV testing may have difficulty delivering HIV test results and post-test counseling because jail detainees may be incarcerated for short periods of time. Rapid HIV testing, which can provide test results within a single HIV C&T session, can be utilized in the jail setting to facilitate test result delivery and concurrent risk reduction counseling. Studies to date have demonstrated improved test result delivery with rapid HIV testing in the jail setting. However, whether improved test result delivery in jail decreases HIV-related risk behavior following release from jail has not been evaluated. The goal of this study is to determine the feasibility of performing a randomized controlled trial in jail that will compare rapid HIV testing to standard testing with respect to HIV­related risk behavior following release from jail.

This study will compare standard HIV C&T performed routinely upon jail entrance at the Rhode Island Department of Corrections with a rapid HIV C&T intervention performed within 48 hours of jail entry in order to assess differences in HIV risk behavior following release from jail. Participants will undergo a baseline quantitative risk assessment including data on sexual activity (anal or vaginal intercourse), condom use and substance abuse during the six weeks prior to incarceration. Participants will then be randomized to either a rapid HIV testing and counseling intervention with delivery of test results (study arm) or no intervention (control arm). The rapid HIV testing intervention will consist of rapid HIV testing, delivery of test results, and a brief HIV counseling intervention modelled after the Centers for Disease Control and Prevention Project Respect study.

All subjects will undergo a follow-up behavioral assessment six weeks following their release from jail. Chi­square test of proportions will determine if the proportion of subjects within the study group differs from the control group with regard to outcome variables at baseline and at the follow-up assessment. Logistic regression analyses will be performed using group and pre-test questionnaire responses as independent variables and covariates will include, but will not be limited to, demographic variables, the length of incarceration (time between jail entrance and release), and whether or not standard HIV test results were received prior to the follow-up interview. The recruitment goal is 300 participants. This is a preliminary study that, in addition to assessing the outcome of behavior change, will assess: 1) the feasibility of performing a randomized controlled trial utilizing rapid HIV testing in jail; 2) the sample size needed to determine differences in self-reported HIV risk behavior; and 3) the estimated proportion of detainees released from jail who will return for follow-up behavioral assessments. This independent research supported by a CFAR Developmental Grant will be directly applicable to an NIH career development award (K23) resubmission in 2006.