1. STD Services in Detention in Los Angeles County Melina R. Boudov, MA Project Director LA County Infertility Prevention Project mboudov@ladhs.org

2. Detention: excellent opportunity for STD Control and Prevention High risk population – “core transmitters” “Screening” vs. “testing” Always some form of medical intake Technological advances Non-invasive and minimally invasive tests (urine and blood) Rapid TAT Single dose treatment “Captive” population for follow-up and Rx

3. Detention: challenges for STD Control and Prevention “Total” institution Dynamic competing priorities confidentiality Staff Security training Clients Complex issues Follow-up

4. Juvenile Detention: CDC recommends CT and GC screening for all females in juvenile detention Targeted CT screening for high risk women in non-traditional settings Need to maximize use of limited resources – evidence-based programs

5. Challenges in STD Care in Juvenile Detention Confidentiality Staff Probation Health Clients Complex needs –adolescence, high risk Highly transient

6. STD Screening at LAC Juvenile Hall: Background LAC screening females in Juvenile Hall since 1996 as part of CDC’s STD Jail Prevalence Monitoring Project Males and females tested at medical intake Consistently high rates of CT and GC

7. STD Screening at LAC Juvenile Hall: Background Excellent treatment rates Enhanced follow-up for females testing positive through Project YES! STD case management Partner services Intensive individualized health education Referral Nationally recognized model

8. Setting: LAC Juvenile Hall Approximately 23,000 youth per year incarcerated ~20% female Three facilities – Central, Los Padrinos and Barry J. Nidorf Juvenile Halls

9. Setting: Delivery of Care LAC Juvenile Court Health Services provides all medical care at LAC Juvenile Halls LAC Department of Probation LAC STD Program and LACIPP

10. Chlamydia Testing and Prevalence at LAC Juvenile Halls by Gender, 2003 (4.7%)(13.8%) #

11. JH CT PREVALENCE AMONG MALES, BY RACE/ETHNICITY, 2003 n=817

12. JH CT PREVALENCE AMONG FEMALES, BY RACE/ETHNICITY, 2003 n=583

13. CHLAMYDIA PREVALENCE AMONG PREGNANT JH CLIENTS, 2003 Number of clients

14. Chlamydia Prevalence by Age Among Females, LAC Juvenile Hall, 2003 number screened=4,232 number cases=583 Age (2) 1 (24)(133)(420) * * Percent positive 1 Total number screened (810) (1,060)(1,077)(636)(57)

15. Adult Detention: LAC Twin Towers Jail Background 1999 prevalence study indicated high CT rates among new female bookings Data informed screening guidelines More than 6,000 screened annually

16. Screening Guidelines: Twin Towers All new bookings age 30 and younger And women over 30 if: Pregnant Arrested for prostitution or sex-related charge

17. Screening Results: Twin Towers, 2003 6,241 new female admittees were tested for CT and GC CT prevalence of 14%, GC prevalence of 4% Of the 874 women with CT, 108 (12.4%) also had GC Of the 247 women with GC, 108 (43.7%) also had CT

18. Chlamydia Prevalence Among Women Screened at Twin Towers by Race/Ethnicity, 2003, n=874 293 360 177 29 18 8

19. Chlamydia Prevalence by Age Among Female Inmates at Twin Towers, 2003 n umber screened=6,241 number cases=874 Age (692)(2,387)(2,126)(448)(254)(180)(90)(53)

20. Chlamydia Prevalence By Age Among Female Inmates at Twin Towers, 2003 number screened=5,523 number cases=829 (324)(366)(502)(469)(458) (513) (439)(462)(431)(429)(407)(398)(325)(462) Age

21. Juvenile Hall and Twin Towers Chlamydia Prevalence, 2003

22. CHLAMYDIA PREVALENCE AMONG PREGNANT TWIN TOWERS CLIENTS, 2003 Number of clients

23. CHLAMYDIA PREVALENCE AMONG POSSIBLY PREGNANT TWIN TOWERS CLIENTS, 2003 Number of clients

24. Gonorrhea Screening at LAC Twin Towers and LAC Juvenile Hall, 2003 Females screened at intake to Juvenile Hall Until the last quarter of 2002, all CT positives from Twin Towers were reflexively tested for GC In 2003, all new female bookings were screened for both CT and GC (adopted GenProbe Aptima2)

25. Gonorrhea Prevalence by Age Among Females, LAC Juvenile Hall, 2003 number screened=4,175 number cases=154 (2)(24)(132)(411)(802)(1,041)(1,060)(634)(55)

26. Gonorrhea Prevalence by Age Among Females, LAC Twin Towers Jail, 2003 number screened=5,523 number cases=222 (324)(366)(502)(469)(458)(513)(439)(462)(431)(429)(407)(398)(325)

27. Adult Detention: LAC Twin Towers Jail: Challenges Time, space Clients – off streets, no privacy, multiple needs Short detention time Treatment and follow-up Field therapy project

28. Adult Detention: LAC Twin Towers Jail: Field Therapy More than half of CT+ clients released untreated One field worker for Rx and partner services In 2005, additional 7% of the clients received Rx Of those located, 85% received field Rx

29. Adult Detention: LAC Men’s Central Jail Background 2000 Syphilis outbreak led to partnership with LAC Sheriff's Dept for active STD surveillance Voluntary screening (until late 2005) Self-identified MSM inmates in K-11 unit Trustees (General Population inmates) About 1,200 screened annually

30. Demographics – 2003 { { { Inmate Type Age Race General Population Hispanic African-American White MSM 18-19 20-29 30-39 50+ 40-49 Other Unknown n = 1,101

31. Overview - 2003 1,101 Inmates Screened 864 CT/GC CT Positivity = 4.7% (n = 41) GC Positivity = 2.4% (n = 21) 844 Syphilis Early Syphilis = 1.2% (n = 10) 956 HIV HIV Prevalence = 7.2% (n = 69)

32. Overall MSM GP STD/HIV Morbidity by Inmate Type - 2003

33. Chlamydia by Age - 2003 Total positive = 41 (prevalence = 4.7%); MSM = 9 (prevalence = 1.8%); GP = 32 (prevalence = 8.9%)

34. Chlamydia by Race/Ethnicity - 2003 Total positive = 41 (prevalence = 4.7%); MSM = 9 (prevalence = 1.8%); GP = 32 (prevalence = 8.9%)

35. Gonorrhea by Age - 2003 Total positive = 21 (prevalence = 2.4%); MSM = 13 (prevalence = 2.6%); GP = 8 (prevalence = 2.2%)

36. Gonorrhea by Race/Ethnicity - 2003 Total positive = 21 (prevalence = 2.4%); MSM = 13 (prevalence = 2.6%); GP = 8 (prevalence = 2.2%)

37. Early Syphilis by Age - 2003 Total Early Syphilis = 10 (prevalence = 1.2%); MSM = 9 (prevalence = 1.9%); GP = 1 (prevalence = 0.3%)

38. Early Syphilis by Race/Ethnicity - 2003 Total Early Syphilis = 10 (prevalence = 1.2%); MSM = 9 (prevalence = 1.9%); GP = 1 (prevalence = 0.3%)

39. HIV by Age – 2003 Total positive = 69 (seroprevalence = 7.2%); MSM = 66 (seroprevalence = 12.1%) ; GP = 3 (seroprevalence = 0.7%) Based on HIV counseling session 7 newly identified cases; CI = 0.8 per 100 in 2003

40. HIV by Race/Ethnicity - 2003 Total positive = 69 (seroprevalence = 7.2%); MSM = 66 (seroprevalence = 12.1%) ; GP = 3 (seroprevalence = 0.7%) Based on HIV counseling session 7 newly identified cases; CI = 0.8 per 100 in 2003

41. Adult Detention: LAC Men’s Central Jail: Challenges Rise in Syphilis rates led to sexual network study Revealed a lot of sex (and infection) within K-11 Illegal AND public health risk Policy change re:condom access and Compulsory universal Syphilis screening Confidentiality and public health