title: Routine or targeted HIV screening of Indonesian prisoners.
abstract: OBJECTIVE
  Routine HIV screening of prisoners is generally recommended, but rarely implemented in low-resource settings. Targeted screening can be used as an alternative. Both strategies may provide an opportunity to start HIV treatment but no formal comparisons have been done of these two strategies. The paper aims to discuss these issues.
  
  
  METHODS
  The authors compared yield and costs of routine and targeted screening in a narcotic prison in Indonesia. Routine HIV screening was done for all incoming prisoners from August 2007-February 2009, after it was switched for budgetary reasons to targeted ("opt-out") HIV screening of inmates classified as people who inject drugs (PWIDs), and "opt-in" HIV testing for all non-PWIDs.
  
  
  RESULTS
  During routine screening 662 inmates were included. All 115 PWIDs and 93.2 percent of non-PWIDs agreed to be tested, 37.4 percent and 0.4 percent respectively were HIV-positive. During targeted screening (March 2009-October 2010), of 888 inmates who entered prison, 107 reported injecting drug use and were offered HIV testing, of whom 31 (29 percent) chose not to be tested and 25.0 percent of those tested were HIV-positive. Of 781 non-PWIDs, 187 (24 percent) came for testing (opt-in), and 2.1 percent were infected. During targeted screening fewer people admitted drug use (12.0 vs 17.4 percent). Routine screening yielded twice as many HIV-infected subjects (45 vs 23). The estimated cost per detected HIV infection was 338 USD for routine and 263 USD for targeted screening.
  
  
  CONCLUSIONS
  In a resource limited setting like Indonesia, routine HIV screening in prison is feasible and more effective than targeted screening, which may be stigmatizing. HIV infections that remain unrecognized can fuel ongoing transmission in prison and lead to unnecessary disease progression and deaths.
authors.affiliation: Division of Tropical and Infectious Disease, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia AND Medical Faculty, Padjadjaran University, Hasan Sadikin Hospital, Health Research Unit, Bandung, Indonesia.
authors.forename: Erni Juwita
authors.initials: EJ
authors.lastname: Nelwan
authors.forename: Ahmad
authors.initials: A
authors.lastname: Isa
authors.forename: Bachti
authors.initials: B
authors.lastname: Alisjahbana
authors.forename: Nurlita
authors.initials: N
authors.lastname: Triani
authors.forename: Iqbal
authors.initials: I
authors.lastname: Djamaris
authors.forename: Ilham
authors.initials: I
authors.lastname: Djaja
authors.forename: Herdiman T
authors.initials: HT
authors.lastname: Pohan
authors.forename: Prisca
authors.initials: P
authors.lastname: Zwanikken
authors.forename: Reinout
authors.initials: R
authors.lastname: van Crevel
authors.forename: Andre
authors.initials: A
authors.lastname: van der Ven
authors.forename: Andre
authors.initials: A
authors.lastname: Meheus
mesh_terms: D000328:Adult; D003955:Diagnostic Tests, Routine / Q000191:economics; D015658:HIV Infections / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007214:Indonesia; D008297:Male; D008403:Mass Screening; D011329:Prisoners; D057566:Self Report; D055815:Young Adult
keywords: Effectiveness; HIV; Indonesia; Prevention; Prison; Screening