A cross-sectional evaluation of opt-in testing for sexually transmitted and blood-borne infections in three Canadian provincial correctional facilities: a missed opportunity for public health?

• Published date: 29 August 2019
• Pages: 273-281
• Date: 29 August 2019
• DOI: https://doi.org/10.1108/IJPH-07-2018-0043
• Author: Jennifer Gratrix,Petra Smyczek,Lindsay Bertholet,M.C. Lee,Diane Pyne,Dan Woods,Keith Courtney,Rabia Ahmed
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice

A cross-sectional evaluation of opt-in

testing for sexually transmitted and

blood-borne infections in three Canadian

provincial correctional facilities: a missed

opportunity for public health?

Jennifer Gratrix, Petra Smyczek, Lindsay Bertholet, M.C. Lee, Diane Pyne, Dan Woods,

Keith Courtney and Rabia Ahmed

Abstract

Purpose –Incarceration provides an opportunity for screening and treatment of sexually transmitted and blood-

borne infections (STBBIs) in high-risk groups. The purpose of this paper is to determine positivity rates of STBBI

screening within correctional facilities using opt-in strategies and estimate the proportion of admissions tested.

Design/methodology/approach –A cross-sectional, retrospective review of testing data from January

2012 to August 2015 from three provincial correctional facilities located in Alberta, Canada was completed.

Analysis variables included STBBI, gender, facility, collection year and age. STBBI-stratified analysis was

performed to identify correlates for positivity using univariate and logistic regressions.

Findings –Overall prevalence of chlamydia was 11.2 percent and gonorrhea was 3.5 percent; correlates for

both were younger age and facility type. The syphilis prevalence rate was 3.2 percent; correlates included

being female, older age, adult facilities, with later years being protective. In total, 14 (0.3 percent) newly

diagnosed HIV cases were found, prevalence increased with age. HBV prevalence was 1.7 percent with no

significant correlations. Nearly one-tenth (n ¼422) of those screened for HCV antibody were positive; all

variables were significantly correlated. Overall estimates of the proportion of admissions tested by STBBI

were low and ranged from 4.8 to 16.1 percent.

Originality/value –This study found high rates of STBBI in correctional facilities and showed that only a

small proportion of the population was tested using an opt-in strategy. Shifting to an “opt-out”strategy may

be warranted.

Keywords Incarceration, Blood-borne viral infections, Sexual health, Infectious disease, Opt-in,

Sexually transmitted infections

Paper type Research paper

Introduction

It has been widely documented that youths and adults entering correctional facilities have high

rates of sexually transmitted and blood-borne infections (STBBIs) including chlamydia (CT),

gonorrhea (NG), syphilis, HIV and hepatitis B and C virus (HBV and HCV) (Zakaria et al., 2010;

Trubnikov et al., 2014; Public Health Agency of Canada, 2012). However, limited STBBI

screening within the correctional system makes estimating the overall burden in this population

difficult. Therefore, the vast majority of individuals cycling through the correctional system are not

screened and thus reported rates are likely underestimated.

The high prevalence of STBBIs among prisoners passing through the correctional system

provides an important opportunity for prevention, screening and treatment. Prisoners represent

Received 23 July 2018

Revised 4 February 2019

16 February 2019

Accepted 18 February 2019

The authors would like to

acknowledge the support of Leah

Feist to this study and the work of

the correctional healthcare staff

and the provincial STI nurses.

Jennifer Gratrix, Petra Smyczek

and Lindsay Bertholet are all

based at the Department of STI

Services, Alberta Health

Services, Edmonton, Canada.

M.C. Lee is based at

Microbiology Department,

DynaLIFE Dx,

Edmonton, Canada.

Diane Pyne, Dan Woods and

Keith Courtney are all based at

the Department of Corrections

Health, Alberta Health

Services, Edmonton, Canada.

Rabia Ahmed is based at the

Department of Medicine,

University of Alberta,

Edmonton, Canada.

DOI 10.1108/IJPH-07-2018-0043 VOL. 15 NO. 3 2019, pp. 273-281, © Emerald Publishing Limited, ISSN 1744-9200

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