title: Undiagnosed HIV infection among New York City jail entrants, 2006: results of a blinded serosurvey.
abstract: 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.
authors.affiliation: New York City Department of Health and Mental Hygiene, 346 Broadway, Room 707, New York, NY 10013, USA. ebegier@health.nyc.gov
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Begier
authors.forename: Yussef
authors.initials: Y
authors.lastname: Bennani
authors.forename: Lisa
authors.initials: L
authors.lastname: Forgione
authors.forename: Amado
authors.initials: A
authors.lastname: Punsalang
authors.forename: David B
authors.initials: DB
authors.lastname: Hanna
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Herrera
authors.forename: Lucia
authors.initials: L
authors.lastname: Torian
authors.forename: Maria
authors.initials: M
authors.lastname: Gbur
authors.forename: Kent A
authors.initials: KA
authors.lastname: Sepkowitz
authors.forename: Farah
authors.initials: F
authors.lastname: Parvez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D011329:Prisoners; D016036:Seroepidemiologic Studies; D055815:Young Adult