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Routine or targeted HIV screening of Indonesian prisoners

Erni Juwita Nelwan (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)
Ahmad Isa (Medical Faculty, Padjadjaran University, Hasan Sadikin Hospital, Health Research Unit, Bandung, Indonesia)
Bachti Alisjahbana (Medical Faculty, Padjadjaran University, Hasan Sadikin Hospital, Health Research Unit, Bandung, Indonesia)
Nurlita Triani (Banceuy Narcotic Prison, Bandung, Indonesia)
Iqbal Djamaris (Banceuy Narcotic Prison, Bandung, Indonesia)
Ilham Djaja (Banceuy Narcotic Prison, Bandung, Indonesia)
Herdiman T Pohan (Division of Tropical and Infectious Disease, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia)
Prisca Zwanikken (Department of Policy and Practice, Royal Tropical Institute, Vrije Universiteit, Amsterdam, Netherlands)
Reinout van Crevel (Department of Internal Medicine, Nijmegen Medical Centre, Radboud University, Nijmegen, Netherlands)
Andre van der Ven (Department of Internal Medicine, Nijmegen Medical Centre, Radboud University, Nijmegen, Netherlands)
Andre Meheus (Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium)

International Journal of Prisoner Health

ISSN: 1744-9200

Article publication date: 14 March 2016

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Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Originality/value

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.

Keywords

Acknowledgements

Competing interests: none of the authors have declared any conflict of interest, all authors have seen and approved the manuscript, which is not being considered for publication elsewhere.

Citation

Nelwan, E.J., Isa, A., Alisjahbana, B., Triani, N., Djamaris, I., Djaja, I., Pohan, H.T., Zwanikken, P., Crevel, R.v., van der Ven, A. and Meheus, A. (2016), "Routine or targeted HIV screening of Indonesian prisoners", International Journal of Prisoner Health, Vol. 12 No. 1, pp. 17-26. https://doi.org/10.1108/IJPH-04-2015-0012

Publisher

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Emerald Group Publishing Limited

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