Programming Connection

Pilot to Offer Anonymous, Rapid Point-of-care HIV Testing in Prisons 

Halton Region Health Department, Maplehurst Correctional Complex, Ontario Ministry of Community Safety and Correctional Services, Ontario Ministry of Health and Long-Term Care, Vanier Centre for Women
Halton Region, Ontario
2014

Quick Facts

Goal (immediate)

To determine the feasibility and acceptability of anonymous, rapid POC HIV testing in a prison setting; to offer anonymous, rapid POC HIV testing to inmates

Goal (ultimate)

To determine the feasibility and acceptability of anonymous, rapid POC HIV testing in a prison setting; to offer anonymous rapid POC HIV testing to inmates; to reduce the number of individuals who do not know their HIV status in an at-risk population

Population

Prisoners

Participants

Prisoners

Setting

Outreach

Required Resources
  1. Strong relationship between policy-makers in the ministries responsible for public health and correctional services.
  2. Strong relationship between public health testers and prison healthcare providers and buy-in from senior correctional service management.
  3. Committed healthcare staff to coordinate inmate requests for testing.
  4. Sites designated to offer anonymous HIV testing.
  5. Testers certified to perform the rapid POC HIV test and with some experience in prison settings.
  6. Mini portable clinic with all the supplies necessary to perform rapid POC HIV testing.
Scope and Duration

156 clients; six months (October 2011 – March 2012)

Date Started

2011

Region

Halton Region, Ontario

Recruitment

Requests

Challenges
  1. Timing. Working around the routine of the prison was challenging. The window of opportunity for testing (visiting hours) was short. In addition, testers could have to wait for up to 45 minutes for inmates to be escorted to the testing room. Some appointments were missed as a result of inmates being released, being in court or being moved at the last minute.
  2. Space. Testers did not have dedicated space at Maplehurst to offer HIV testing. Nine times during the pilot project, there were no rooms available for the testing to take place and the clinic was cancelled.
  3. Low testing volume at Vanier. Testing rates at Vanier were very low. Although this needs further inquiry, it may be because inmates at Vanier have more timely access to healthcare or because they have already been reached with testing.
Evaluation

The HIV testing pilot was evaluated in two ways: through a self-administered client survey and through an analysis of HIV testing data. Seventy-eight percent of inmates completed the qualitative survey offered at the end of each testing session.

HIV testing data were submitted to the Ontario public health laboratory for collection and tracking. At the end of the project, the number tested, number positive, exposure category and other demographic information were reviewed as part of the evaluation.

The evaluation results demonstrate that access to anonymous, rapid POC HIV testing filled a gap in testing services for prisoners:

  • 156 inmates tested through the project.
  • 98% of those who completed the survey said they were completely satisfied with the HIV testing service.
  • 42% of those who accessed this service reported they had never before tested for HIV. This result suggests the pilot reached an at-risk population in need of testing services.
  • 52% of those who were tested said they chose to be tested during this project because the results were available immediately.
  • 41% said they chose to test because they could do so anonymously.

The number of reactive results was lower than anticipated for this high-risk population (only one reactive test occurred). However, the HIV positivity rate for the project was 0.60 percent, which is three-fold greater than the positivity rate for standard nominal testing in Ontario, suggesting that a broader program may have resulted in greater numbers of HIV diagnoses.

Overall, the pilot project was considered a success. It demonstrated that it was feasible to offer anonymous, rapid POC HIV testing in a prison setting in Ontario. The Ministry of Community Safety and Correctional Services, the AIDS Bureau and Halton Region believe that this pilot showed that public health and correctional services can partner effectively to lower barriers to anonymous, rapid POC HIV testing for inmates.