A Cost and Qualitative Comparison between Rapid and Conventional HIV Testing - Offered at Jail Entrance

Sep 22, 2026

A cost analysis and qualitative assessment compare rapid HIV testing (RHT) and conventional HIV testing (CHT) during jail medical intake at the Rhode Island Department of Corrections. A pilot in 2008–2009 evaluated OraQuick Advance HIV 1/2 using oral fluid specimens, with costs estimated per detainee for negative and positive results and confirmation using established laboratory protocols. Interviews with jail nurses, social workers, and correctional officers assessed feasibility and acceptability, with perceived benefits including earlier identification, reduced staff workload, and lower needle-sticking risk. RHT showed minimal cost differences overall but higher costs for confirmatory positives, with increased annual expenditure estimated for replacement.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Background

Objectives

Methods

Results

Discussion

Next Steps

Acknowledgments

Contact Information

hltisetsreasrse…’s fi.tteeYddo.uThaevogruryesctoantsaoisalentdofteesdaesetes’oennj. nugseanehtyh’rlsdattete’sd,d, trhieo’ esueanhtuty. ’re going to have a security issue. A Cost and Qualitative Comparison between Rapid and Conventional HIV Testing Offered at Jail Entrance CG Beckwith 1,2 , E Patry2 , L Bazerman2 , A Nunn 1,2 , A Cornwall2 , H Gray2 , MD Schleinitz 1,3 1Alpert Medical School of Brown University; 2The Miriam Hospital; 3 Rhode Island Hospital Providence, Rhode Island Background • The CDC has recommended routine HIV testing as part of the medical evaluation in correctional facilities since 2006. • Correctional facilities provide access to populations with increased prevalence of HIV and increased risk of becoming infected due to substance abuse and other risky behaviors. • The Rhode Island Department of Corrections (RIDOC) has offered routine opt-out HIV testing during the intake medical evaluation since the early 1990’s using a conventional HIV test (venipuncture), with results available approximately 7-10 days after testing. • In a retrospective review of new HIV diagnoses at the RIDOC from 2000-2007, it was determined that 43% of those newly diagnosed were released within seven days of incarceration (MMWR June 25, 2010) . • Rapid HIV testing (RHT) may be preferable to conventional HIV testing to facilitate result delivery and linkage to HIV care in this transient population but the cost implications of rapid HIV testing are unknown. Objectives • Conduct a cost analysis from the RIDOC perspective comparing rapid and conventional HIV testing (CHT) conducted during the jail medical intake at the RIDOC. • Assess perceived barriers and facilitatorsto RHT among RIDOC staff. Methods • In 2008-2009, a pilot program of RHT was conducted in the RIDOC jail using the OraQuick® Advance HIV 1/2 test with an oral fluid specimen. • To conduct the cost analysis, data was collected during five separate sessions each of RHT and CHT. Data was collected regarding: 1) Staff time related to preparation, specimen acquisition, and processing 2) Supplies consumed 3) Costs of supplies and staff • The cost of HIV testing per detainee for RHT and CHT was estimated for negative and positive results (including confirmation with repeat enzyme immunoassay, immunofluorescent antibody, and western blot as per RI Dept of Health protocol) . • Qualitative interviews were conducted with key stakeholders to determine feasibility and acceptability of RHT in the RIDOC jail facility. Results Cost Analysis Results: • The average total cost of a negative rapid test conducted in the RIDOC jail was $0.34 more expensive than a negative EIA per detainee. • Confirming a positive rapid test was $16.29 more expensive than a positive EIA per detainee. • In a jail facility that conducts approximately 13,000 negative and 150 positive HIV tests per year, this translates into an increased annual expenditure of $6863.59 if RHT was to replace CHT. Rapid HIV Test* Conventional HIV Test** Estimated cost per detainee of RHT andCHT Negative Positive $0.00 $50.00 $100.00 $150.00 *OraQuick ® Advance Rapid HIV 1/2 Test: Cost of kit $12.50 . All supplies are included. Staff time: $3.79. **Supplies calculated into CHT cost: Tape, Vacutainer, 21.5 needle, tube, butterfly, tourniquet, gauze and gloves; prices obtained from general supply catalogue. Cost of conventional EIA to the RIDOC $11.00 . Staff time: $4.95 . Qualitative interview results: • Key informants (nurses, social workers, correctional officers) from the jail overwhelmingly reported positive experiences with RHT and preferred the rapid testing model to the conventional testing program. Perceived benefits included: • Earlier identification of HIV infection before inmate released into the community • Use of oral specimens increased the cooperation of detainees, decreased staff workload and facilitated the process of taking medical histories.

FAQs

What was the main purpose of comparing rapid and conventional HIV testing in this jail setting?

The study compared costs from the RIDOC perspective and evaluated staff-perceived barriers and facilitators to rapid HIV testing during jail intake.

How were rapid HIV tests and confirmatory testing handled in the analysis?

Rapid testing used the OraQuick Advance HIV 1/2 oral fluid test, and positive results were confirmed using the established RI Department of Health confirmation approach (repeat EIA, immunofluorescent antibody, and western blot).

What qualitative benefits did staff report for rapid HIV testing?

Key informants reported earlier identification of HIV before release, better detainee cooperation due to oral specimens, reduced staff workload, and a perceived reduction in needle-stick injury and exposure to blood-borne pathogens.

Sep 22, 2026

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