Enhancing a Universal Testing and Treatment Strategy in Jail to Promote Viral Load Suppression Among Justice-involved People Living With HIV

This study will be the first to assess the feasibility, process measures, and estimate cost-effectiveness of a rapid Universal Testing and Treatment (rUTT) intervention in a large urban jail located in Washington, DC - 1 of the 50 communities targeted for End the HIV Epidemic (EtHE) efforts. The aim is to determine the most effective HIV diagnostic test to use for routine opt-out testing in the correctional setting.

The investigators hypothesize that the combination of opt-out POC and Ag/Ab tests offered at intake will maximize the yield of PLWH detected, provision of test results, ART initiation, viral suppression, and cost-effectiveness.

The investigators will examine administrative, de-identified, aggregate data for approximately 3000 individuals (based on 500 individuals currently accepting HIV testing per month) over 6 months. For individuals who provide consent to release their jail medical records after incarceration, the investigators will retrieve the mean time from: 1) positive test to receipt of test results, 2) receipt of test results to first dose of ART in jail, 3) receipt of post-test counseling to meeting the discharge planner, and 4) ART initiation to viral suppression defined as a viral load <200 copies/mL. The investigators will calculate the implementation costs of each strategy using observation of staff time, market values for items used in the intervention, and process measure data collected through chart review (for individuals who consent to release their jail medical records after incarceration). Units of resource items, such as staff time and diagnostic tests, will be multiplied by their unit costs to calculate total costs.

This protocol does not constitute research involving prisoners (as outlined by the U.S. Department of Health & Human Services Office for Human Research Protections - https://www.hhs.gov/ohrp/regulations-and-policy/guidance/faq/prisoner-research/index.html) since the investigators will not be:

1. Obtaining identifiable private data or information about prisoner subjects through intervention or interaction with them while incarcerated.
2. Seeking the informed consent of prisoners to be subjects in research;
3. Using, studying or analyzing, for research purposes, identifiable private information about prisoners, or identifiable specimens obtained from prisoners; or
4. Surveying prisoners for this research study.