Medicine and Health, Article Critique Example

Abstract

The work of Begier, et al (2006) entitled “Undiagnosed HIV Infection Among New York City Jail Entrants, 2006: Results of a Blinded Serosurvey” is reviewed in this study. Three other studies are also cited.

 Background/Introduction

The work of Begier, et al (2006) entitled “Undiagnosed HIV Infection Among New York City Jail Entrants, 2006: Results of a Blinded Serosurvey” is reviewed in this study. Begier, et al reports a study that tested 6411 entrants into jail and states that of those admitted to jail among the 6411 participants in this study that HIV prevalence was 5.2% overall among males and females. The study reports that 28.1% of HIV infections identified in the serosurvey “were undiagnosed at jail entry” and only 11.5% of these “were diagnosed during routine jail testing.” (2009) Begier et al states that identification of individuals who are undiagnosed with HIV infection “is a cornerstone of the Centers for Disease Control and Prevention’s (CDD) approach to controlling the HIV epidemic in the United States.” (Begier, 2009 )   The objective of the study reported by Begier et al was to determine the prevalence of HIV among jail entrants, including the undiagnosed proportion.

Study Hypothesis

This study did not state a hypothesis but instead is a comparison study in which the distribution of demographic and HIV status variables between inmates who did or did not have specimens available for serosurvey testing using X2 analyses. HIV prevalence and 95% CIs were calculated both overall and for all demographic and risk strata following weighting by sex to account for female inmate oversampling.

Experimental Design/Methodology

The method used was HIV data and electronic clinical data to ascertain previously undiagnosed HIV infections before permanently removing identifiers. It is reported that DOHMH’s Bureau of Correctional Health Services (CHS) “…coordinates all medical, mental health, and dental services for New York City jail inmates, including routine, voluntary health screening at intake. During the health screening referred to as ‘‘medical intake’’, which a part of the processing before housing inmates, nursing staff verbally offers HIV testing at the beginning of intake process.” (Begier, et al, 2009) This is all documented in the electronic medical record with or without the consent of the patient. Testing is reported to have been conducted by nursing staff or a patient care associated and results provided during medical intake prior to the inmate being moved into the housing area. Negative results are provided by nursing staff and positive results are provided by physicians. The serosurvey is reported to have been conducted through use of remnant serum specimens drawn for this routine universal syphilis testing. All new admissions to NYC jails starting 1 May 2006 were eligible for inclusion in the sample. The study reports that sample size calculations were performed separately for male and female participants to ensure adequate power for assessing predictors within each sex. (Begier, et al, 2009, paraphrased)

Results

Results of the study report that of the 389 individuals identified as being infected by HIV by serosurvey testing, 104 appeared to have not been diagnosed at the time they were admitted to the jail. In addition, it is reported that 13 or 11.1% of the 104 undiagnosed reported the “well-established HIV risk factors of MSM or IDU activity and only an additional 41 or 39.2% reported a sexually transmitted disease history, unprotected sex, and/or multiple sex partners.” (Begier, et al, 2009)

Conclusions

HIV prevalence among NYC jail entrants is stated to be “markedly elevated above the general population”. (Begier, et al, 2009) This is stated in another study reported by Beckwith et al (2011) which found an “increased prevalence of HIV among incarcerated populations.” Begier, et al however reports that the HIV population in the NYC jail “appears to have decreased nearly by half since the last serosurvey in 1998.” (Begier, et al, 2009) Jurgens, Nowak and Day (2011) in the work entitled “HIV and Incarceration: Prisons and Detention” report that the “high prevalence of HIV infection among prisoners and pre-trial detainees, combined with overcrowding and sub-standard living conditions sometimes amounting to inhuman or degrading treatment in violation of international law, make prisons and other detention centers a high risk environment for the transmission of HIV.”  This is stated to contribute to the epidemics of the communities that prisoners return to when released. Also stated by Jurgens, Nowak and Day (2011) is that there is a need for programs to be introduced into prisons to address HIV in the prisons, which includes education, voluntary HIV testing and counseling and treatment for prisoners who are HIV positive. According to Flanigan, et al (2010) jails make provision of “an underutilized public health opportunity for screening for HIV” as well as for screening for other sexually transmitted infections and viral hepatitis and for other infectious diseases such as tuberculosis. It is critically important that the prison and jail population be tested for HIV infection so that these individuals can be treated, educated, and the spread of HIV prevented.

References

Beckwith CG, et al (2011) An Evaluation of a Routine OPT-Out Rapid HIV Testing Program in a Rhode Island Jail. AIDS Educ Prev. 2011 Jun;23(3 Suppl):96-109. PubMed PMID: 21689040.

Begier, EM, et al (2009) Undiagnosed HIV Infection Among New York City Jail Entrants, 2006: Results of a Blinded Serosurvey. J Acquir Immune Defic Syndr 2009;00-000-000.

Flanigan TP, et al (2010) Testing for HIV, sexually transmitted infections, and viral hepatitis in jails: still a missed opportunity for public health and HIV prevention. J Acquir Immune Defic Syndr. 2010 Dec 15;55 Suppl 2:S78-83. PubMed PMID: 21406992.

Jürgens R, Nowak M, Day M. (2011) HIV and incarceration: prisons and detention. J Int AIDS Soc. 2011 May 19;14:26. PubMed PMID: 21595957.