RESUMEN
U.S. clinical practice guidelines recommend directly observed therapy (DOT) as the standard of care for tuberculosis (TB) treatment (1). DOT, during which a health care worker observes a patient ingesting the TB medications, has typically been conducted in person. Video DOT (vDOT) uses video-enabled devices to facilitate remote interactions between patients and health care workers to promote medication adherence and clinical monitoring. Published systematic reviews, a published meta-analysis, and a literature search through 2022 demonstrate that vDOT is associated with a higher proportion of medication doses being observed and similar proportions of cases with treatment completion and microbiologic resolution when compared with in-person DOT (2-5). Based on this evidence, CDC has updated the recommendation for DOT during TB treatment to include vDOT as an equivalent alternative to in-person DOT. vDOT can assist health department TB programs meet the U.S. standard of care for patients undergoing TB treatment, while using resources efficiently.
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Telemedicina , Tuberculosis , Humanos , Estados Unidos , Terapia por Observación Directa , Tuberculosis/tratamiento farmacológico , Antituberculosos/uso terapéutico , Cumplimiento de la MedicaciónRESUMEN
Admissions to jails and prisons in the United States number 10 million yearly; persons entering locked correctional facilities have high prevalence of sexually transmitted infections (STIs). These individuals come disproportionately from communities of color, with lower access to care and prevention, compared with the United States as a whole. Following PRISMA guidelines, the authors present results of a systematic review of literature published since 2012 on STIs in US jails, prisons, Immigration and Customs Enforcement detention centers, and juvenile facilities. This updates an earlier review of STIs in short-term facilities. This current review contributed to new recommendations in the Centers for Disease Control and Prevention 2021 treatment guidelines for STIs, advising screening for Trichomonas in women entering correctional facilities. The current review also synthesizes recommendations on screening: in particular, opt-out testing is superior to opt-in protocols. Carceral interventions-managing diagnosed cases and preventing new infections from occurring (eg, by initiating human immunodeficiency virus preexposure prophylaxis before release)-can counteract structural racism in healthcare.
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Infecciones por VIH , Enfermedades de Transmisión Sexual , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Humanos , Tamizaje Masivo/métodos , Prevalencia , Prisiones , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Enfermedades de Transmisión Sexual/epidemiología , Estados Unidos/epidemiologíaRESUMEN
Background: The American Thoracic Society, U.S. Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America jointly sponsored this new practice guideline on the treatment of drug-resistant tuberculosis (DR-TB). The document includes recommendations on the treatment of multidrug-resistant TB (MDR-TB) as well as isoniazid-resistant but rifampin-susceptible TB.Methods: Published systematic reviews, meta-analyses, and a new individual patient data meta-analysis from 12,030 patients, in 50 studies, across 25 countries with confirmed pulmonary rifampin-resistant TB were used for this guideline. Meta-analytic approaches included propensity score matching to reduce confounding. Each recommendation was discussed by an expert committee, screened for conflicts of interest, according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.Results: Twenty-one Population, Intervention, Comparator, and Outcomes questions were addressed, generating 25 GRADE-based recommendations. Certainty in the evidence was judged to be very low, because the data came from observational studies with significant loss to follow-up and imbalance in background regimens between comparator groups. Good practices in the management of MDR-TB are described. On the basis of the evidence review, a clinical strategy tool for building a treatment regimen for MDR-TB is also provided.Conclusions: New recommendations are made for the choice and number of drugs in a regimen, the duration of intensive and continuation phases, and the role of injectable drugs for MDR-TB. On the basis of these recommendations, an effective all-oral regimen for MDR-TB can be assembled. Recommendations are also provided on the role of surgery in treatment of MDR-TB and for treatment of contacts exposed to MDR-TB and treatment of isoniazid-resistant TB.
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Antituberculosos/administración & dosificación , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/tratamiento farmacológico , Esquema de Medicación , Quimioterapia Combinada , Humanos , Tuberculosis Resistente a Múltiples Medicamentos/microbiología , Tuberculosis Pulmonar/microbiologíaRESUMEN
Globally, tuberculosis (TB) is the leading cause of infectious disease mortality; however, clinicians in the United States are increasingly unfamiliar with TB and the recommended tests and treatment for latent TB infection. Compared with adults, children who develop TB more often develop severe disease, and children < 2 years are particularly susceptible to developing TB disease after initial infection. Nurse practitioners who work in primary care are on the front lines of identifying children at high risk and obtaining testing and treatment. This article reviews the clinical course for identifying children at risk for TB and provides updated guidelines for testing and treatment.
RESUMEN
OBJECTIVES: Sexually transmitted infections (STIs) are an important cause of morbidity among incarcerated women and female sex workers (FSW). Little is known about FSW incarcerated in New York City (NYC) jails. We reviewed jail health records to identify the STI and HIV prevalence among newly incarcerated FSW in NYC jails. We also examined the relationship of demographics and self-reported clinical and risk behaviour history with FSW status and compared FSW with non-FSW incarcerated women to identify FSW predictors and, guide NYC jail programme planning and policy. METHODS: We retrospectively reviewed routinely collected jail health record data to identify the prevalence of chlamydia (Ct), gonorrhoea (Ng) and HIV infection among women newly incarcerated in NYC jails in 2009-2010 (study period) and studied the relationship of STIs, demographics and self-reported clinical and risk behaviour history with FSW status. RESULTS: During the study period, 10 828 women were newly incarcerated in NYC jails. Of these, 10 115 (93%) women were tested for Ct and Ng; positivity was 6.2% (95% CI 5.7% to 6.7%) and 1.7% (95% CI 1.4% to 1.9%), respectively. Nine percent had HIV infection. Seven hundred (6.5%) were defined as FSW. FSW were more likely to have Ct (adjusted OR (AOR): 1.55; 95% CI 1.17 to 2.05; p<0.0001) but not Ng or HIV. FSW were more likely to report age 20-24 years, reside in boroughs other than Manhattan, ≥6 prior incarcerations, ≥2 incarcerations during the study period, condom use with current sex partners, multiple sex partners and current drug use. CONCLUSIONS: Women incarcerated in NYC jails had high rates of Ct, Ng, and HIV infection. FSW were at higher risk for Ct than non-FSW incarcerated women. These findings are being used to design targeted interventions to identify FSW, provide clinical and preventive services in jail and coordinate care with community partners.
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Prisioneros/estadística & datos numéricos , Trabajadores Sexuales/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Enfermedades de Transmisión Sexual/epidemiología , Adolescente , Adulto , Anciano , Infecciones por Chlamydia/epidemiología , Condones , Registros Electrónicos de Salud , Femenino , Gonorrea/epidemiología , Seropositividad para VIH/epidemiología , Humanos , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Prevalencia , Estudios Retrospectivos , Asunción de Riesgos , Autoinforme , Trabajadores Sexuales/legislación & jurisprudenciaRESUMEN
The authors assessed the risks of drug-related death, suicide, and homicide after release from New York City jails in 155,272 people who were incarcerated anytime from 2001 through 2005 and examined whether the mortality rate was associated with homelessness. Using jail records matched with death and single-adult homeless registries in New York City, they calculated standardized mortality ratios (SMRs) and relative risks. After adjustment for age, sex, race, and neighborhood, the risks of drug-related death and homicide in formerly incarcerated persons were 2 times higher than those of New York City residents who had not been incarcerated in New York City jails during the study period. These relative risks were greatly elevated during the first 2 weeks after release (for drug-related causes, SMR = 8.0, 95% confidence interval (CI): 5.2, 11.8; for homicide, SMR = 5.1, 95% CI: 3.2, 7.8). Formerly incarcerated people with histories of homelessness had higher rates of drug-related death (RR = 3.4, 95% CI: 2.1, 5.5) and suicide (RR = 2.1, 95% CI: 1.2, 3.4) than did persons without such histories. For individuals who died of drug-related causes, longer jail stays were associated with a shorter time until death after release. These results suggest that jail- and community-based interventions are needed to reduce the excess mortality risk among formerly incarcerated people.
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Homicidio/estadística & datos numéricos , Personas con Mala Vivienda/estadística & datos numéricos , Prisioneros/estadística & datos numéricos , Trastornos Relacionados con Sustancias/mortalidad , Suicidio/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Ciudad de Nueva York/epidemiología , Análisis de Regresión , Estudios Retrospectivos , Riesgo , Población Urbana/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: Breastfeeding rates of incarcerated women in the United States are unknown but are likely to be low. Little is known about the breastfeeding views and experiences of incarcerated women. This exploratory study examined the breastfeeding knowledge, beliefs, and experiences of pregnant women incarcerated in New York City jails. METHODS: Semistructured interviews were conducted with 20 pregnant women in a New York City jail. Research methods were inspired by grounded theory. RESULTS: Three main themes emerged from women's collective stories about wanting to breastfeed and the challenges that they experienced. First, incarceration removes women from their familiar social and cultural context, which creates uncertainty in their breastfeeding plans. Second, incarceration and the separation from their high-risk lifestyle makes women want a new start in motherhood. Third, being pregnant and planning to breastfeed represent a new start in motherhood and give women the opportunity to redefine their maternal identity and roles. CONCLUSIONS: Breastfeeding is valued by incarcerated pregnant women and has the potential to contribute to their psychosocial well-being and self-worth as a mother. Understanding the breastfeeding experiences and views of women at high risk for poor pregnancy outcomes and inadequate newborn childcare during periods of incarceration in local jails is important for guiding breastfeeding promotion activities in this transient and vulnerable population. Implications from the findings will be useful to correctional facilities and community providers in planning more definitive studies in similar incarcerated populations. (BIRTH 39:2 June 2012).
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Lactancia Materna/psicología , Bienestar Materno/psicología , Apego a Objetos , Mujeres Embarazadas/psicología , Prisioneros/psicología , Prisiones/organización & administración , Adulto , Femenino , Humanos , Recién Nacido , Ciudad de Nueva York , Periodo Posparto/psicología , Embarazo , Adulto JovenRESUMEN
BACKGROUND: With noninvasive specimen types, males can be more easily screened for Chlamydia trachomatis and Neisseria gonorrhoeae infections. Long-standing universal screening of males attending New York City (NYC) sexually transmitted diseases (STD) clinics has yielded a substantial number of chlamydia cases. In 2005, screening was expanding to another large group at high risk for STD: males =35 years old entering 6 adult jails. METHODS: Surveillance data and data from laboratory practice surveys were examined to evaluate changes in the reported burden of chlamydia and gonorrhea in NYC males over time. Citywide data for male chlamydia and gonorrhea cases were analyzed by report year and provider type (STD clinic, adult jail, juvenile detention, private-sector provider) from 2004 through 2006. RESULTS: In the first year of the adult jail screening program, the number of chlamydia cases among males =35 years old reported from the jails increased by 1636%, surpassing all other providers in numbers of cases contributed, and increasing the citywide reported male chlamydia case rate by 59%. Adult jails reported 40% more cases than all 10 NYC public STD clinics combined. In 2006, adult jails continued to contribute a similar proportion to citywide male chlamydia case reports. In the first year of the jail screening program, there was an approximately 10-fold increase in the number of gonorrhea cases reported from jails. CONCLUSIONS: Young men in adult jails have a large burden of chlamydial infection. Correctional screening and treatment programs present an important opportunity to improve the health of inmates and interrupt disease transmission.
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Infecciones por Chlamydia/epidemiología , Gonorrea/epidemiología , Delincuencia Juvenil , Tamizaje Masivo/estadística & datos numéricos , Prisiones , Orina/microbiología , Adolescente , Adulto , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/prevención & control , Chlamydia trachomatis/aislamiento & purificación , Femenino , Gonorrea/diagnóstico , Gonorrea/prevención & control , Humanos , Masculino , Tamizaje Masivo/métodos , Neisseria gonorrhoeae/aislamiento & purificación , Ciudad de Nueva York/epidemiología , Vigilancia de la Población/métodos , Prisioneros , Prisiones/estadística & datos numéricos , Adulto JovenRESUMEN
OBJECTIVES: To evaluate sex and age correlates of chlamydia prevalence in incarcerated populations. METHODS: Cross-sectional analysis of chlamydia prevalence by demographic characteristics from incarcerated females and males entering selected juvenile and adult correctional facilities (jails) in the United States in 2005. RESULTS: A total of 97,681 and 52,485 incarcerated persons aged >/=12 years were screened for chlamydia in 141 juvenile and 22 adult correctional facilities, respectively. Overall, chlamydia prevalence was high in females (14.3% and 7.5%) in both juvenile and adult facilities when compared with that in males (6.0% and 4.6%). The chlamydia prevalence was higher in incarcerated females than in incarcerated males for persons =35 years, and prevalence was highest among females aged =25 years (range, 11.3%-15.6%). In juvenile facilities, prevalence did not steadily increase with age in females (12.8% in 12-14 years, 15.1% in 15-17 years, and 14.3% in 18-20 years) whereas in males prevalence steadily increased with age (2.4% in 12-14 years to 8.7% in 18-20 years). In females and males the highest prevalence in juvenile facilities was in incarcerated blacks (18.4% and 9.6%, respectively). In adult facilities, the prevalence was consistently highest in younger detainees: in females it was 15.6% in 18- to 20-year olds compared with 1.5% in those >40 years; in males it was 8.8% in 18- to 20-year olds compared with 1.4% in those >40 years. CONCLUSIONS: The consistently high chlamydia prevalence among females in juvenile facilities and females (=25 years) in adult facilities supports a screening policy in correctional settings consistent with Centers for Disease Control and Prevention and US Preventive Services Task Force guidelines. Although the prevalence of chlamydia in males is substantial, chlamydia prevalence in females exceeds that of males =35 years, and thus screening females for chlamydia in these facilities should take priority over screening males.
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Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis , Delincuencia Juvenil , Tamizaje Masivo , Prisiones/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Niño , Infecciones por Chlamydia/diagnóstico , Estudios Transversales , Femenino , Política de Salud , Humanos , Masculino , Tamizaje Masivo/métodos , Prevalencia , Prisioneros , Distribución por Sexo , Estados Unidos , Adulto JovenRESUMEN
The health of people ever incarcerated in New York City (NYC) jails during 2001 to 2005 was characterized by matching jail, shelter, mortality, sexually transmitted infection, HIV, and tuberculosis (TB) data from the NYC Departments of Health and Mental Hygiene, Correction, and Homeless Services. Compared with nonincarcerated people and those living in the lowest income NYC neighborhoods, those ever incarcerated had higher HIV prevalence and HIV case rates. Ever-incarcerated females also had higher rates of gonorrhea and syphilis than nonincarcerated females. Ever-incarcerated people who used the single adult homeless shelter system had higher HIV, gonorrhea, and TB case rates and all-cause mortality rates than ever-incarcerated people without shelter use, when adjusting for other variables. People ever incarcerated in NYC jails are at risk for conditions of public health importance. Sex-specific jail- and community-based interventions are needed.
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Prisioneros/estadística & datos numéricos , Enfermedades de Transmisión Sexual/epidemiología , Tuberculosis/epidemiología , Poblaciones Vulnerables/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Personas con Mala Vivienda/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Prevalencia , Adulto JovenRESUMEN
BACKGROUND: Few studies have been conducted in Vietnam on the epidemiology of healthcare-associated infections or antimicrobial use. Thus, we sought to determine the prevalence of and risk factors for surgical-site infections (SSIs) and to document antimicrobial use in surgical patients in a large healthcare facility in Vietnam. METHODS: We conducted a point-prevalence survey of SSIs and antimicrobial use at Cho Ray Hospital, Ho Chi Minh City, a 1,250-bed inpatient facility. All patients on the 11 surgical wards and 2 intensive care units who had surgery within 30 days before the survey date were included. RESULTS: Of 391 surgical patients, 56 (14.3%) had an SSI. When we compared patients with and without SSIs, factors associated with infection included trauma (relative risk [RR], 2.65; 95% confidence interval [CI95], 1.60 to 4.37; P < .001), emergency surgery (RR, 2.74; CI95, 1.65 to 4.55; P < .001), and dirty wounds (RR, 3.77; CI95, 2.39 to 5.96; P < .001). Overall, 198 (51%) of the patients received antimicrobials more than 8 hours before surgery and 390 (99.7%) received them after surgery. Commonly used antimicrobials included third-generation cephalosporins and aminoglycosides. Thirty isolates were identified from 26 SSI patient cultures; of the 25 isolates undergoing antimicrobial susceptibility testing, 22 (88%) were resistant to ceftriaxone and 24 (92%) to gentamicin. CONCLUSIONS: Our data show that (1) SSIs are prevalent at Cho Ray Hospital; (2) antimicrobial use among surgical patients is widespread and inconsistent with published guidelines; and (3) pathogens often are resistant to commonly used antimicrobials. SSI prevention interventions, including appropriate use of antimicrobials, are needed in this population.
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Antiinfecciosos/uso terapéutico , Infección de la Herida Quirúrgica/tratamiento farmacológico , Infección de la Herida Quirúrgica/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Prescripciones de Medicamentos , Femenino , Humanos , Lactante , Tiempo de Internación , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina , Prevalencia , Factores de Riesgo , Infección de la Herida Quirúrgica/microbiología , Infección de la Herida Quirúrgica/prevención & control , Resultado del Tratamiento , Vietnam/epidemiologíaRESUMEN
This article describes a pilot screening program to detect Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (Ng) sexually transmitted infections (STIs) in adolescent and adult males newly incarcerated in New York City jails using urine-based nucleic acid amplification technology (NAAT). Between December 8 and 22, 2003, 2,417 males were tested; 162 (6.7%) were found positive for Ct and/or Ng STIs, with 138 (86.8%) exhibiting no STI signs or symptoms and 102 (63%) treated prior to jail release. Younger age, positive urine leukocyte esterase test, and ≥11 recent sex partners were predictors of STI. Urine-based screening and treatment was feasible in this setting and identified STI that would otherwise have been undetected. Jails may thus be important venues for targeted male STI screening.
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Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/epidemiología , Gonorrea/diagnóstico , Gonorrea/epidemiología , Prisiones/estadística & datos numéricos , Adulto , Infecciones por Chlamydia/microbiología , Infecciones por Chlamydia/orina , Gonorrea/microbiología , Gonorrea/orina , Humanos , Masculino , Ciudad de Nueva York , Técnicas de Amplificación de Ácido Nucleico , Proyectos Piloto , Conducta Sexual , Factores Socioeconómicos , UrinálisisRESUMEN
Correctional facilities typically house large numbers of persons in close and crowded conditions for long periods. Clusters of communicable diseases ranging from simple viral upper respiratory infections to more serious threats, such as tuberculosis (TB), infections with methicillin-resistant Staphylococcus aureus, and influenza, often emerge in these surroundings. The recent H1N1 influenza pandemic highlights the importance of outbreak prevention and containment preparedness, particularly in congregate settings. In this commentary, the authors propose that the TB control model can provide valuable lessons for infection control practitioners to prepare for, identify, investigate, and control outbreaks of communicable diseases to prevent transmission in correctional facilities and to the surrounding community.
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Brotes de Enfermedades/prevención & control , Control de Infecciones/organización & administración , Prisiones/organización & administración , Tuberculosis/prevención & control , Centers for Disease Control and Prevention, U.S. , Enfermedades Transmisibles Emergentes/prevención & control , Notificación de Enfermedades , Brotes de Enfermedades/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud , Humanos , Gripe Humana/prevención & control , Staphylococcus aureus Resistente a Meticilina , Modelos Organizacionales , Grupo de Atención al Paciente/organización & administración , Técnicas de Planificación , Guías de Práctica Clínica como Asunto , Medición de Riesgo , Infecciones Estafilocócicas/prevención & control , Tuberculosis/epidemiología , Tuberculosis/transmisión , Estados Unidos/epidemiologíaRESUMEN
About 25% of New York City jail inmates are tested for HIV despite a universal offer of rapid testing at medical intake. Health care workers were surveyed to examine provider-related challenges to testing at medical intake. Of the 291 eligible staff, 215 (73.9%) responded. Most (87.0%) felt confident recommending rapid HIV testing; however, only 85.5% of medical professionals and 70.8% of nurses felt confident providing negative rapid HIV test results. Identified barriers are those common to other medical settings (insufficient staffing, inadequate privacy or space, and ''too much'' paperwork) and those specific to correctional settings (limited time for medical intake and competing Department of Correction priorities). Staff have been given extended training to address their lack of confidence with key aspects of the HIV testing process, including providing negative results.
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Infecciones por VIH/diagnóstico , Personal de Salud/organización & administración , Personal de Salud/psicología , Percepción , Prisiones/organización & administración , Actitud del Personal de Salud , Femenino , Humanos , Masculino , Ciudad de Nueva York , Políticas , Rol ProfesionalRESUMEN
OBJECTIVE: Since 2004, when all New York City jail entrants began being offered rapid testing at medical intake, HIV testing has increased 4-fold. To guide further service improvement, we determined HIV prevalence among jail entrants, including proportion undiagnosed. METHODS: Remnant serum from routine syphilis screening was salvaged for blinded HIV testing in 2006. Using HIV surveillance data and electronic clinical data, we ascertained previously diagnosed HIV infections before permanently removing identifiers. We defined "undiagnosed" as HIV-infected entrants who were unreported to surveillance and denied HIV infection. RESULTS: Among the 6411 jail entrants tested (68.9% of admissions), HIV prevalence was 5.2% overall (males 4.7%; females: 9.8%). Adjusting for those not in the serosurvey, estimated seroprevalence is 8.7% overall (6.5% males, 14% females). Overall, 28.1% of HIV infections identified in the serosurvey were undiagnosed at jail entry; only 11.5% of these were diagnosed during routine jail testing. Few (11.1%) of the undiagnosed inmates reported injection drug use or being men who have sex with men. CONCLUSIONS: About 5%-9% of New York City jail entrants are HIV infected. Of the infected, 28% are undiagnosed; most of whom denied recognized HIV risk factors. To increase inmate's acceptance of routine testing, we are working to eliminate the required separate written consent for HIV testing to allow implementation of the Centers for Disease Control and Prevention-recommended opt out testing model.