Purpose:

High rates of HIV have been documented among persons entering correctional systems. Currently, few jails routinely test for HIV upon entry.  People incarcerated for fewer than 30 days are unlikely to receive HIV counseling and testing and receive their test results before they are released.  CDC funded four voluntary rapid HIV counseling and testing (CT) demonstration projects in short-stay correctional facilities to increase the proportion of HIV-infected inmates who know their status.

Methods:

We assessed the costs of rapid HIV testing in jails and compared the costs with the number of inmates tested for HIV and inmates newly diagnosed with HIV.  Programs provided testing between March 1, 2004 and Feb. 28, 2005 in 23 county jails in Fort Lauderdale, FL, New Orleans, LA, upstate NY, and Milwaukee and Janesville, WI.  We obtained costs retrospectively from each program site including costs associated with CT staff time, training, travel, equipment, supplies, rapid HIV test kits, administration, and overhead.  Costs are expressed in US 2006 dollars.

Results:

Table 1. Costs and outcomes of voluntary rapid HIV CT in county jails (3/2004 – 2/2005).

	Ft. Lauderdale, FL	New Orleans, LA	Upstate, NY	Milwaukee, WI	Janesville, WI
Inmates tested for HIV	6,420	4,621	4,190	1,537	648
Inmates newly diagnosed with HIV (% of inmates tested)	61 (1.0%)	35 (0.8%)	21 (0.5%)	4 (0.3%)	0 (---)
Cost per inmate tested ($)	29	36	49	49	43
Cost per inmate newly diagnosed with HIV ($)	3,302	4,707	9,843	18,684	---
Total program cost ($)     (CT staff time)     (Travel)	189,298 (48%) (3%)	164,741 (45%) (0%)	206,705 (53%) (6%)	74,737 (43%) (21%)	27,478 (34%) (21%)

Conclusion:

The CT demonstration project successfully provided voluntary rapid HIV testing to inmates in jails and identified previously undiagnosed cases of HIV infection.  The cost of identifying a newly diagnosed HIV case varied across project sites due to differences in HIV sero-positivity among inmates tested, CT staff time, and staff travel to jails.  When using the cost of CT staff time alone, our estimates of the cost per newly diagnosed HIV cases are within the range reported in the literature.  Cross-site cost comparisons enable program managers to determine where program costs can be streamlined.