The Broward County Health Department has decided to discontinue a 10-year-old program to give county jail inmates rapid-results HIV tests, saying the initiative "was not an effective use of public health resources."
The rate of positive results wasn't high enough to warrant continuing the program, a health department spokeswoman said. Meanwhile, an AIDS nonprofit official called the decision "outrageous," and the jail's health services contractor is looking for another agency to fill the gap.
Under the program, Health Department testers rotated among four jail sites one to four days a week, offering HIV screenings to any inmate who volunteered for one, Health Department spokeswoman Candy Sims said. Those tests yielded results in 15 minutes.
But "on or about Oct. 15," jail officials learned the Health Department's annual agreement to provide the testing had expired -- in December 2012 -- and was not being renewed, said Ron Gunzburger, general counsel for the Broward County Sheriff's Office. They were told the halt would be "effective in two weeks."
While it searches for another rapid-test provider, the jail's health services contractor, Armor Correctional Health Services, is providing conventional tests to inmates who request one, with results ready within 24 to 48 hours, sometimes "a little longer" for positive results, Gunzburger said.
The loss of rapid testing in Broward concerns Michael Kahane, chief of the AIDS Healthcare Foundation's southern bureau. He said inmates are a typically high-risk population -- especially in Broward, consistently home to the nation's worst HIV/AIDS rates.
"It was outrageous in my opinion for any health department to drop such a program, especially without a plan for continuity of services," said Kahane, whose agency provides HIV and AIDS treatment services for the jail. "If there's an opportunity to identify one person with HIV in Broward County and get them tested and into treatment to stop the spread of the disease, I think that's a worthwhile use of public health dollars."
HIV experts say conventional testing is not enough. "The conventional program is not equivalent to rapid testing," said Anne Spaulding, an assistant professor at Emory University's Rollins School of Public Health who has done extensive research on jail-based HIV testing programs. "The problem with conventional testing [is that] in most jails, 50 percent of the population leaves within 48 hours. Why do a test that won't be back until after the entrant leaves?"
The average length of stay at the Broward jail is about 35 days, sheriff's officials said. But that average includes inmates with yearlong sentences, and officials could not say how many inmates are back on the street within a few days.
"Inmates are provided information on how to obtain results should they be released in the 24-48 hours prior to that information being available," Gunzburger said.
Those efforts often are not effective, Spaulding said, because some inmates will not go to the trouble to find out the results once back in the community.
"Testing in jails is very important for the health of a community, because 95 percent of people going to jail are going to return to the community," she said. "So it's a very strategic place to do testing."
The AIDS Healthcare Foundation's Kahane said many inmates are transient, have a history of mental illness and typically lack regular access to health care -- all major risk factors for contracting and spreading the disease. Jail-based screenings may be best chance to get them tested, and into treatment, he said.
Through its county agencies, the Florida Department of Health provides rapid-results HIV testing in jails in 14 Florida counties, including Palm Beach and Miami-Dade, spokesman Nathan Dunn said.
The Broward health department's Sims said the effort "had a very low positivity rate, and it was determined that this program was not an effective use of public health resources."
Between 2010 and 2012, 20,402 inmates volunteered to be screened, and 96 tested positive -- a positivity rate of 0.4 percent to 0.56 percent a year, said Sims, adding that the initiative cost the agency $83,748 in 2012-13.
But Spaulding said such numbers "are generally considered a fairly robust yield," citing public health authority recommendations that jail HIV testing programs continue if 0.4 percent to 0.5 percent of tests return positive.
If someone doesn't "step up to fill the gap," the AIDS Healthcare Foundation will volunteer to resume the rapid testing program, Kahane said.
"We're a not-for-profit. I don't have the manpower to have someone there [at the jail] to do these tests, but we'll figure out a way to do it," Kahane said, "because it's the right thing to do."
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McClatchy-Tribune News Service
