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Evaluation of Large Jail STD Screening 

Programs, 2008-2009

Completed by CDC/NCHHSTP/DSTDP/HSREB

26 January 2011
1/26/2011 Page 2 of 29

Table of Contents

PURPOSE...............................................................................................................................................3

BACKGROUND ....................................................................................................................................3

METHODS .............................................................................................................................................4

KEY FINDINGS.....................................................................................................................................5

SUMMARY OF INDIVIDUAL JAIL VISITS ......................................................................................9

REFERENCES .....................................................................................................................................10

APPENDIX I: Facilities visited...........................................................................................................11

APPENDIX II: Jurisdiction: Maricopa County (Phoenix), AZ...........................................................12

APPENDIX III: Jurisdiction: Alameda County, California .................................................................14

APPENDIX IV: Jurisdiction: Los Angeles, CA...................................................................................15

APPENDIX V: Jurisdiction: San Francisco, CA..................................................................................17

APPENDIX VI: Jurisdiction: DeKalb County (Georgia).....................................................................19

APPENDIX VII: Jurisdiction: Baton Rouge, LA.................................................................................20

APPENDIX VIII: Jurisdiction: Wayne County (Detroit), MI.............................................................21

APPENDIX IX: Jurisdiction: Las Vegas, NV ......................................................................................23

APPENDIX X: Jurisdiction: New York City, NY................................................................................24

APPENDIX XI: Jurisdiction: Philadelphia, PA....................................................................................26

APPENDIX XII: Jurisdiction: Dallas, TX............................................................................................28

APPENDIX XIII: Jurisdiction: Harris County (Houston), TX.............................................................29
1/26/2011 Page 3 of 29

PURPOSE

To examine existing sexually transmitted disease (STD) screening programs in large jails to learn 

lessons that can benefit other health departments that want to establish or expand chlamydia (CT) and 

gonorrhea (GC) screening programs in their local jails.

BACKGROUND

Even with advances in prevention programs for sexually transmitted diseases, there is still a high 

burden of Chlamydia trachomatis infection among Americans. This disease was reported in over 1.2

million Americans in 2008,

1 making it the most commonly reported infectious disease. In addition, 

Neisseria gonorrhoeae infections were reported in over 335,000 Americans in 2008.1 However, 

many more cases of chlamydia and gonorrhea go undiagnosed and unreported because often, 

especially in women, the infections are asymptomatic. Untreated infections can have major 

consequences in women, namely pelvic inflammatory disease with its serious sequelae of chronic 

pelvic pain, ectopic pregnancies and infertility.2 In both men and women, untreated infection can 

promote both the acquisition and the transmission of HIV.3 Furthermore, both chlamydia and 

gonorrhea disproportionately affect persons in their young adult years.1 

Entrants to adult jails have been shown to have high prevalence of both chlamydial and gonococcal 

infections.1,4-6The average prevalence of chlamydial infection nationally among women in jails is 

8.5%, higher than the 6% prevalence observed nationally among sexually experience persons 

younger than 20 years. In jurisdictions with comprehensive, targeted jail screening, more chlamydial 

infections among females (and males if males are screened) are detected in the jails, and subsequently 

treated, than at any other single reporting source in these jurisdictions.1

Among detained adults greater than 18 years of age, women have higher CT prevalence rates than 

men, though the rates by sex decline with increasing age. Figure 1 below shows that in 2008 the CT 

prevalence among detainees from jails was 7.0 and 8.5 percent for men and women respectively, and 

that infection was more prevalent in younger inmates, than in older ones.1

Figure 1: Chlamydia positivity by age group and gender, adult corrections facilities, United 

States, 2008

1

A small number of large jails hold the majority of all jail inmates,7and young adults in jails are at 

high risk for STDs as they are often individuals who engage in unprotected sex, have multiple sex 
1/26/2011 Page 4 of 29

partners, and use drugs. In 2005, 5.5% of jurisdictions (159 jurisdictions) had average daily jail 

populations of 1,000 or more inmates.8 According to 2008 estimates, jurisdictions with 1,000 or 

more inmates held 52% of the total US jail population and that the 50 largest jail jurisdictions held 

29% of all jail inmates. California had 10 of the 50 largest jails, Florida had 9, Texas had 6, and 

Georgia had 4. Pennsylvania and Tennessee each had 2 of the largest jails. Sixteen other states each 

had one, and these included New York, Illinois, and Arizona, jurisdictions with 3 of the top 10 largest 

jails in the country. 9

Since these are jails, and not prisons, the majority of inmates are released back into the community

from where they came and lived prior to incarceration. Therefore, STD screening and treatment of 

adults in jails might be an important way to affect STD rates in their communities. Because of the 

increased efficiency of working with large jails and the large proportion of the US jail population 

they hold, it is logical to focus on expanding CT and GC screening in large jails (those with an 

average of 1,000 inmates) with particular concentration on the 75 largest jails in the United States.

Some jurisdictions already have chlamydia screening programs in place. In 2008, CDC received CT

screening data for women from 41 jail facilities in 22 different states, and screening data for men 

from 62 jail facilities from 24 states. However, it is believed that much of this is testing due to 

presence of symptoms or at inmate request and not routine asymptomatic screening. All seven 

CDC/DSTDP directly funded cities/counties (through the Comprehensive STD Prevention Services 

(CSPS) Cooperative Agreement) all have large jails and four currently implement CT screening of at 

least one gender: Los Angeles, New York City, Philadelphia and San Francisco. Chicago has made 

drastic cuts to its jail screening program, and Washington, D.C. and Baltimore have never had jail 

screening programs. Most of the other states that submit correctional screening data, screen from 

large jails, but the screening reaches only a fraction of the target population because it is usually 

based on inmate-initiated requests for screening or diagnostic testing only. 

METHODS

Scope: 

This evaluation reviewed 14 STD screening programs in large jails that have over 1000 inmates. 

Twelve sites were chosen based on size, geographic location, screening program, and the 

convenience in arranging site visits during the four-mouths initially allotted for travel (JuneSeptember 2008). We visited four locations where there is screening of at least one gender for CT: 

Los Angeles, New York City, Philadelphia, and San Francisco; and eight locations that screen for 

syphilis in the jails, but offer limited, if any, screening for CT: Alameda County CA, Baton Rouge 

LA, Dallas TX, DeKalb County GA, Houston TX, Las Vegas NV* (two sites), and Phoenix AZ. 

Then, in 2009 we visited two more programs that had jail screening programs (Detroit MI and 

Indianapolis IN), and a third site (Milwaukee WI*) who had once had a jail screening program, but 

had terminated it due to budget cuts. 

*Through the help of CDC, two facilities in Las Vegas and the Milwaukee County Jail plan to initiate 

a CT/GC screening pilot in 2010.

Data Collection: 

A literature review was conducted for background information. Additional data collected included

site visit reports, observations, and interviews with key stakeholders, such as health department staff, 

corrections staff, and jail health staff. 
1/26/2011 Page 5 of 29

We obtained similar data for each location and conducted telephone interviews as needed to 

supplement and clarify the information collected. The information about each screening program was 

then shared with the respective sites for accuracy.

Definitions:

For purposes of this evaluation and report, the following definitions will be used:

Jails: Facilities holding detainees awaiting trial or sentenced to short stays, usually one year 

or less. 

Screening: Administering a diagnostic test to individuals who have no symptoms of the 

infection (asymptomatic).

Testing: Administering a diagnostic test to individuals who have symptoms of the infection.

Comprehensive Screening: The screening and, if positive, treatment of a majority of a jail’s

specified target population(s).

Opt-in screening: This is when screening is offered to the individual who then decides 

whether to get tested or not. This also would include inmate initiated screening/testing.

Opt-out screening: This is when an individual is notified that a screening test is conducted 

as part of routine procedure unless they decline.

KEY FINDINGS

Although Chlamydia prevalence in jails is high, few jails have chlamydia screening programs 

Chlamydial infections among women in jails has been shown to be higher than that observed 

nationally, yet only 5

*

of the 14 jails visited provided comprehensive chlamydia screening. One 

facility, Philadelphia, screened all inmates, and the other 4 conducted targeted screening, based on 

age, gender, and/or criminal charges. One other facility

†

conducted some limited chlamydia 

screening. All of the jails visited provided chlamydia testing upon the request of an inmate or 

diagnostic (symptomatic) testing. 

Sites with comprehensive screening programs are able to treat most of the inmates who test 

positive for chlamydia infection

The objective of screening for chlamydia in jails is to identify individuals with infection, and get 

them treated. Figure 2 illustrates the percentage of positive inmates treated during and after

incarceration at the 5 facilities that have comprehensive screening programs. We were not able to 

obtain data for the proportion of inmates who were treated while incarcerated in the facilities that did 

not provide comprehensive screening.

Treatment provided to positive inmates at these facilities was provided by jail medical staff, although 

in Wayne County, San Francisco, and Los Angeles (after release from jail) the health department paid 

for the medication. For inmates that tested chlamydia positive and were released prior to treatment, 

all the facilities visited except Rikers Island in New York City refer these individuals to the local 

health department for follow-up and treatment. For inmates released from Rikers Island jail, there is 

no standardized follow-up process in place for treatment post-release; these inmates are given a 

brochure (at time of testing) of the list of health department STD clinics and instructed to follow-up 

for treatment for themselves and partners upon release.

 

*

Philadelphia Prison, Rikers Island, Los Angeles County, San Francisco County, and Wayne County, 

†

Indianapolis 
1/26/2011 Page 6 of 29

Figure 2: Percentage of chlamydia positive inmates treated during and after incarceration in 

jails with comprehensive screening programs

The rapid release of some jail inmates can cause significant difficulties in the treatment of those who 

are infected. The San Francisco facility had a treatment rate of 80% for STDs diagnosed among jail 

entrants. Some of the strategies that they have used to obtain such high treatment rates are 1) offering 

treatment by nursing protocol (this does not require MD exam or order specific to a patient), and 2) 

flagging the jail medical and public STD clinic records of persons unable to be treated while 

incarcerated so they can be treated if they are ever arrested again or if they go to the public STD 

clinic in the future. Philadelphia has very high treatment rates at approximately 95% with almost 

75% being treated while incarcerated and the remainder being treated through Philadelphia health 

department follow-up (health department staff found infected persons and brought them to clinics for 

treatment).

Short turnaround of lab results increases the likelihood of treating positive individuals while 

they are still in jail

A key factor in the ability to treat positive inmates while incarcerated is the time it takes to get lab 

results back. In both Los Angeles and Wayne County (see Figure 2), where the lowest proportion are 

treated, lab results take 5-7 days to be returned to the jail; whereas in the other locations, where more 

inmates were treated, the turnaround time was only 2-3 days. The shorter turnaround time is 

important as many jail inmates are released after a few days, and treating individuals after their 

release is more labor intensive, costly, and often unsuccessful as inmates do not always give the jail 

accurate information about where they live. 

71%

80%

62%

95%

63%

0%

20%

40%

60%

80%

100%

NYC SF LA PHL WC

New York City (NYC) San Francisco (SF) Los Angeles (LA)

Philadelphia (PHL) Wayne County (WC) 
1/26/2011 Page 7 of 29

Although respondents reported challenges to establishing or expanding routine screening, some 

solutions had been found

Various challenges to the establishment and/or expansion of routine STD screening programs were 

mentioned during stakeholder interviews and discussions with key staff. The two most significant 

challenges mentioned by all of the facility stakeholders were 1) competing priorities of security 

versus public health and 2) funding. Many of the sites also mentioned the following concerns: 

difficulty in accessing medical records at the jail, difficulty in timely treatment of infected inmates 

prior to release from jail, lack of staffing (screening and correctional staff), space availability for 

screening process, and other ancillary costs.

Despite some of the aforementioned barriers, a number of facilities have successfully established

some elements of a jail screening program. Some of the factors that have been central to the 

development, implementation, and sustainability of a successful screening program are the following: 

having an open line of communication between health and security staff, the development of

innovative techniques to incorporate screening and testing into an existing jail health program so as to

decrease the potential burden it may have on a facility, and building collaborative partnerships 

between potential stakeholders. A number of strategies to address these particular challenges were 

provided by the interviewed stakeholders and are discussed below. We do understand that all 

facilities are unique and therefore each option/idea should be considered independently and in the 

context of each particular facility. 

Security vs. Public Health

Health departments need to be cognizant of the jail’s focus on security, and be very flexible in their 

screening arrangements. If testing is provided by off-site personnel, such as health department staff, it 

will require additional clearance or escorts for staff. This can be addressed by employing only people 

who are able to obtain jail clearance (be able to pass a criminal background check by the local police 

department) to administer tests or by providing additional compensation to the jail for security that 

will be dedicated to escorting those staff administering tests. Even if testing is provided by existing 

medical staff, there might be increased demands for security staff involvement.

Flexibility around the physical arrangement of screening also is critical. For example, in Los Angeles, 

the health department screeners put their supplies on a cart that can be pushed from one holding cell 

to another enabling the security staff to perform their normal duties while the health department 

testing staff is mobile and their presence does not impede on the limited space available in the 

holding area of the jail. In Philadelphia, inmates pick up a urine cup as they go into the holding cells

and therefore don’t require transfer by the security staff to medical or other testing areas. (In both of 

these locations, the holding cells had commodes.) Screening in the housing units is another strategy 

that prevents corrections staff from having to escort inmates to another location for testing. 

Key Collaborations

When developing and implementing a jail screening program, it is essential that the health 

department form collaborations with the jail staff (both corrections and medical staff), i.e., set regular 

meetings, involve the staff members in program planning, and provide updates on progress. It is also 

important to identify ―champions‖ in each organization who understand and will promote the 

importance of STD screening within the facility. On the corrections side, the ―champion‖ is often a 

member of the jail medical team. It is also necessary to foster positive relationships between the 

corrections and medical staff (jail medical or health department) who are doing the work.
1/26/2011 Page 8 of 29

Funding

Several comprehensive jail STD screening programs were able to justify the expense of screening 

after they performed a pilot study to demonstrate the high burden of disease in their setting. For 

example, New York City was able to obtain city and state funding after a two-week pilot at Rikers 

Island found a positivity rate of 6.7% among the male population, with 87% of infections being 

asymptomatic. Pilot data were also used to determine screening criteria to better target limited 

resources. Other sites that successfully conducted pilot studies to gather data for the financial support 

of jail screening were Los Angeles and Wayne County.

A jail’s collaboration with a local public health department can help procure discounts for screening 

supplies, laboratory testing, and treatment. For example, the Philadelphia jail facility uses the local 

public health laboratory for chlamydia/gonorrhea nucleic acid amplification testing which brought the 

price down from $125/test to $15/test. 

Partnering with the Infertility Prevention Project (IPP) also may provide funding, as is the case in 

Wayne County.

Screening Facilitators

While visiting the jail screening programs, we observed several practices that seemed to aid the 

screening process, and thereby increase the number of inmates screened.

 

STD Screening at Intake/Medical Process

Incorporate STD screening into the medical intake process, by conducting STD screening at 

intake or booking where feasible. If screening is not feasible at intake or booking, then look for 

another appropriate opportunity (e.g., the 14-day medical exam). Screening at these times reduces 

the time that corrections staff have to move inmates, which is time consuming for them, and 

poses an additional security risk.

STD Screening Added to Previously Established Screening Programs

Introduce STD screening as part of an integrated screening service package, e.g., combine STD 

screening with TB, HIV, and Hepatitis screening. Acceptability of STD screening improves when 

linked with other tests, like HIV and TB that inmates are interested in. Because screening women 

in large jails for syphilis is currently a CDC Performance Measure in communities with high 

prevalence of infection among women, many places already have a relationship with their jails, 

and could add chlamydia/gonorrhea screening to the syphilis screening they are already doing. 

Also, urine collected for pregnancy testing in the jails could be aliquotted so that 

chlamydia/gonorrhea screening can be done using the same sample.

Opt-out vs. Opt-in Screening Process

Having STD screening as part of the overall medical process, unless an inmate opts out, has been 

more effective than the more commonly used opt-in mechanism (i.e., asking inmates if they want 

a test).

Screening and Treatment Requirements in Medical Provider Contracts

Medical care provided to inmates in seven

‡

of the local jails we visited was provided by private 

contractors. Philadelphia and New York City stipulated in their contracts with these medical care 

 

‡ Alameda County, Dallas, DeKalb County, Indianapolis, Las Vegas, New York City, and Philadelphia
1/26/2011 Page 9 of 29

providers that they will conduct STD screening services as standard operating procedures. This 

has resulted in no extra outlay of expenses from the health department for screening the inmates

and has resulted in the most comprehensive screening programs.

Screening and Treatment Requirements in State Laws

The Pennsylvania state laws regarding reporting of communicable diseases (Pennsylvania 

Bulletin, Vol. 32, No. 4, January 26, 2002, Section 27.84. ―A person convicted of a crime or 

pending trial, who is confined in or committed to a State of local penal institution, reformatory, or 

other house of detention, may be examined for a sexually transmitted disease ...‖.) states that 

every person who is in custody of penal (adult and juvenile) authorities may be examined for 

STDs and will be offered treatment if found infected. The Philadelphia STD program works with 

state authorities to get this legislation passed and present jail/prison contractors must abide by 

these regulations for offering STD screening and treatment to jail inmates. This has enabled the 

Philadelphia prison to screen and treat close to 95% of inmates entering their facilities.

SUMMARY OF INDIVIDUAL JAIL VISITS

Please refer to Appendices for summaries of each jail visit. Contact information is also provided 

from each jail visit for further information.
1/26/2011 Page 10 of 29

REFERENCES

1. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 

2008. Atlanta, GA: U.S. Department of Health and Human Services, November 2009.

2. Eng TR, Butler WT, eds. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. 

Washington, D.C.: National Academy Press, 1997.

3. Wasserheit JN. Epidemiological synergy. Interrelationships between human 

immunodeficiency virus infection and other sexually transmitted diseases. Sexually 

Transmitted Diseases 1992;19(2):61-77.

4. Mertz KJ, Voigt RA, Hutchins K, Levine WC. and the Jail STD monitoring group. Findings 

from STD screening of adolescents and adults entering corrections facilities: implications for 

STD control strategies. Sexually Transmitted Diseases 2002;29(12):834-9.

5. Joesoef MR, Weinstock HS, Kent CK, Chow JM, Boudov MR, Parvez FM, Cox T, Lincoln T, 

Miller JL, Sternberg M. and the Corrections STD Prevalence Monitoring Group. Sex and age 

correlates of Chlamydia prevalence in adolescents and adults entering correctional facilities, 

2005: implications for screening policy. . Sexually Transmitted Diseases 2009;36(2 

Supplement):S67-S71.

6. Skolnick AA. Look Behind Bars for Key to Control of STDs. JAMA 1998;279(2):97-98.

7. Sabol WJ, Minton TD, Harrison PM. Prison and jail inmates at midyear 2006. Bureau of 

Justice Statistics, U.S. Department of Justice. NCJ 217675. Bureau of Justice Statistics 

Bulletin. 2007.

8. Sabol WJ and Minton TD. Jail inmates at midyear 2007. Bureau of Justice Statistics, U.S. 

Department of Justice. NCJ 221945. Bureau of Justice Statistics Bulletin. 2008.

9. Minton TD and Sabol WJ. Jail inmates at midyear 2008-statistical tables. Bureau of Justice 

Statistics, U.S. Department of Justice. NCJ 225709. Bureau of Justice Statistics Bulletin. 

2009.
1/26/2011 Page 11 of 29

APPENDIX I: Facilities visited

ARIZONA

Maricopa County - 4

th Avenue and Lower Buckeye Jails

Phoenix, AZ

CALIFORNIA

Alameda County - Santa Rita Jail 

Dublin, CA

Los Angeles County – Central Regional Detention Facility and Men’s Central Jail

Los Angeles, CA

San Francisco County Jail

San Francisco, CA

GEORGIA

DeKalb County Jail

Decatur, GA

INDIANA

Marion County Jail – Arrestee Processing Center and Liberty Hall*

Indianapolis, IN

LOUSIANA

East Baton Rouge Parish Prison

Baton Rouge, LA

MICHIGAN

Wayne County Jail – Andrew C. Baird Detention Facility

Detroit, MI

NEVADA

Clark County – Clark County Detention Center and Stewart Mojave Jail

Las Vegas, NV

NEW YORK 

Rikers Island Jail

New York City, NY

PENNSYLVANIA

Philadelphia Prison

Philadelphia, PA

TEXAS

Dallas County Jail

Dallas, TX

Harris County Jail

Houston, TX

WISCONSIN

Milwaukee County Jail* 

Milwaukee, WI 

*Summary report unavailable at this time, contact authors for more information
1/26/2011 Page 12 of 29

APPENDIX II: Jurisdiction: Maricopa County (Phoenix), AZ

Facilities Visited: 

4th Avenue Jail 

Lower Buckeye Jail

Dates: September 23 and 24, 2008

Screening/Testing Program Summary:

Who is screened/tested and for what infections and when

o All eligible

What sexually transmitted diseases: 

o CT/GC and syphilis

When are inmates screened/tested:

o UPON REQUEST ONLY

Where are inmates screened/tested: 

o Intake

o Jail Clinic

Who conducts the screening/testing: 

o Maricopa County Correctional Health Services

Opt-in or opt-out testing:

o N/A

Other Highlights:

Medical care in the jail is provided by Maricopa Department of Correctional Health 

(Separate from the Sherriff’s Department and Public Health 

If a non-prostitution arrestee requests an STD test at Intake, an electronic appointment is 

made for him/her to be brought to the clinic for testing, which follows him/her to the housing 

unit. 

County lab does most of the lab work, but Maricopa County funds a STAT lab technician, for 

syphilis testing, in the Intake Clinic a few hours a day in the afternoon – 20 hours a week 

Specimens are taken by courier to county lab daily (M-F), and syphilis results are returned in 

24 hours via a phone call with a written report to follow. Any CT or GC tests done take 

about a week due to the large volume of tests the public health lab handles. 

About 70% of the positives are treated in jail, and the others are referred to the Health 

Department, who are able to find 15-20% of those referred.

Suggestions/lessons learned (stated by staff at visit):

Need help in funding – for example, the STD program providing test kits, PH lab performing 

tests, etc.

Takeaways: 

The IPP program is funding some CT/GC testing of women in Maricopa County jail, though 

not a lot of information about who, when, and if testing or screening is based on any criteria. 
1/26/2011 Page 13 of 29

Appendix II: Jurisdiction: Maricopa County (Phoenix), AZ (cont.)

Contact Person: Kerry Kenney 

Senior PHA, Arizona STD Program,

kenneyk@azdhs.gov
1/26/2011 Page 14 of 29

APPENDIX III: Jurisdiction: Alameda County, California

Physical Facilities Visited: 

Santa Rita Jail

Dates: August 29, 2008

Screening/testing Program Summary:

Who is screened/tested: 

o All eligible

What sexually transmitted diseases: UPON REQUEST ONLY

o CT/GC

o Syphilis

o HIV

When are inmates screened/tested: 

o Everyday 24/7 (Request only)

Where are inmates screened/tested:

o Intake

Who conducts the screening/testing: 

o Contracted medical provider – Prison Health Services at time of visit

Opt-in or opt-out testing:

o N/A

Suggestions/lessons learned (stated by staff at visit): 

N/A

Takeaways:

Title 15 of the California Minimum Standards for Local Detention Facilities sets the 

requirements for all services for inmates, including medical services. The California 

Department of Corrections and Rehabilitation (CDCR) through the Corrections Standards 

Authority has oversight of all juvenile (local juvenile detention facilities and state youth 

authority) and adult (local jails and state prisons) correctional facilities throughout California.

Urine samples are taken from all females at intake for pregnancy testing – is an opportunity 

to do CT/GC testing and assess facility morbidity. 

If resources were available to support the testing, Prison Health Services is very willing to 

obtain the specimens for expanded screening.

Contact Person: Robert Benjamin, MD, MPH

Deputy Health Officer, TB Controller

 Robert.Benjamin@acgov.org
1/26/2011 Page 15 of 29

APPENDIX IV: Jurisdiction: Los Angeles, CA

Facilities Visited: 

Los Angeles County Jails 

o Century Regional Detention Facility (CRDF)

o Men’s Central Jail (K6G unit)

Dates: September 2 and 3, 2008

Screening/testing Program Summary:

Who is screened/tested (by STD): 

o Women (CRDF)

 Under 30 

 Pregnant or possibly pregnant

 Prostitution or other sex-related charges

 Other women are eligible for syphilis and HIV tests

o Men (K6G unit (MSM specific unit) at Men’s Central Jail)-screened/tested at exposed 

anatomic sites 

What sexually transmitted diseases: 

o CT/GC

o Syphilis 

o HIV

When are the inmates screened/tested: 

o Women

 CRDF – screening is from approx 7pm – 3 am Monday through Friday. 

o Men 

 K6G – screening is from approx 7:30 am – 12 noon Monday through Friday 

Where are the inmates screened/tested:

o Women

 Intake facility- after women are brought in from sub-stations.

o Men

 Intake-after they’ve been interviewed and accepted into the K6G unit.

Who conducts the screening/testing: 

o LA County STD Program Staff

Opt-in or opt-out testing:

o opt-out testing – verbal consent is given

Suggestions/lessons learned (stated by staff at visit):

Make sure that at the start that everyone has looked at ways to ensure that the program will 

be sustainable.

Have open and constant communication with all parties involved – especially corrections and 

custody staff/administration

Try to make this a routine part of what is done at the jail – harder to dissolve then.

Find a champion or person at the Sheriff’s Dept. who will support the endeavor/project.
1/26/2011 Page 16 of 29

Appendix IV: Jurisdiction: Los Angeles, CA (continued)

Takeaways:

Title 15 of the California Minimum Standards for Local Detention Facilities sets the 

requirements for all services for inmates, including medical services. The California 

Department of Corrections and Rehabilitation (CDCR) through the Corrections Standards 

Authority has oversight of all juvenile (local juvenile detention facilities and state youth 

authority) and adult (local jails and state prisons) correctional facilities throughout California.

By doing pilots and showing the amount of disease found in the jail, the STD program has 

offered staff and payment for the testing that is done. The LA County Sheriff’s Department 

only has to pay for treatment for those still incarcerated if found positive.

STD program funded testing in the beginning and still funds testing.

IPP funds the screening of women, and CSPS and SE funds screening of men.

IPP money supports 2 staff who screen at CRDF, and there are STD program funds for the 

screening at K6G.

Women:

o Because of physical layout of intake facility, screening is able to occur without 

deputies pulling inmates individually. STD Staff have deputy open holding tank and 

then staff make announcement that they are offering screening to women 30 years 

and younger and pitch the screening. They then hand out urine cups and women 

urinate in the toilet in the holding cell. It is possible to leave holding cell open and 

have women come out into the large hallway to do paperwork. When crowded, the 

senior deputy will process women 30 years and younger first so that they can be 

screened more efficiently. Then staff will pass out urine cups while women are lined 

up after being dressed in. STD and deputy staff have successfully worked out 

flexible ways to structure screening based on number of women available and which 

holding cells they are in.

o For alloquotting of specimen for Aptima, staff usually have woman open urine cup 

over biologic waste bag and staff takes out specimen. Woman then closes urine cup 

and throws in bag. Reduces amount of screwing and unscrewing of caps for staff 

(reduces risk of repetitive motion injury), and is efficient. 

o Staff can work off small Rubbermaid cart to do screening when working with women 

in holding cells where there is limited space. If working with women on other end of 

intake area where there is more open space, STD staff work off both a table and cart. 

It has been found to be feasible to do screening in limited spaces. 

Contact Person: Melina Boudov

IPP Coordinator

 mboudov@ph.lacounty.gov
1/26/2011 Page 17 of 29

APPENDIX V: Jurisdiction: San Francisco, CA

Facilities Visited: 

San Francisco STD Program – Administrative Offices and STD Clinic

San Francisco City Lab

San Francisco City Jail

Dates: August 20-21, 2008

Screening/Testing Program Summary: 

Who is screened/tested: Based on priority for screening

o Commercial Sex Workers

o Females 35 and under

o Males 30 and under

What sexually transmitted diseases: 

o CT/GC 

When are the inmates screened: 

o Intake - 9:00 a.m. – 9:30 p.m.

o Monday -Friday

o Intake

o Housing - evenings

Where are the inmates screened: 

o Intake

o Housing

Who conducts the screening/testing: 

o Health Department (2 screeners: 9 a.m. – 6 p.m.; 6:30 p.m. - 9:30 p.m.; and a 3rd who 

overlaps these hours). 

o Jail Medical Staff screens persons missed by health department

Opt-in or Opt-out: 

o Opt-out

Other Highlights:

Medical care in the jail is provided by San Francisco Department of Health, Jail Health 

Services 

STD screeners are funded by the STD Program, but the jail medical staff picks up those 

missed.

Specimens are taken to public health laboratory daily (M-F), and results returned in two days 

via electronic download to jail database

Standardized orders allow nurses to provide treatment.

Electronic records facilitate treatment. The lab sends test results electronically to jail and 

STD program. A list of positives is generated. If a person is unable to be treated while 

incarcerated or after release, an electronic flag is placed on his/her jail record to ensure 

treatment if arrested again. Flag is also placed on STD clinic record should the person go 

there.

80% of inmates are treated, either while in jail or by the Health Department after leaving jail
1/26/2011 Page 18 of 29

Appendix V: Jurisdiction: San Francisco, CA (cont.)

Suggestions/lessons learned (stated by staff at visit)

To be effective, all parties need to be flexible and open to change

Be cognizant and respectful of jail staff and their systems

Suggestions/lessons learned (stated by staff at visit)

Look at the prevalence to know who to screen

Health workers can do the screening; it doesn’t have to be a nurse

Establish, maintain, and foster good relationships with partners. Try to see things their way.

Takeaways:

Both STD Program management and the Jail Medical Director are champions of jail 

screening and treatment. 

STD Program is about to pilot-test two new procedures: test female visitors to jail and use 

vaginal swabs with female inmates, instead of urine. 

Contact Person: Jacque McCright

jacque.mccright@sfdph.org
1/26/2011 Page 19 of 29

APPENDIX VI: Jurisdiction: DeKalb County (Georgia)

Facilities Visited: 

DeKalb County Jail

Dates: September 18, 2008

Screening/Testing Program Summary:

Who is screened/tested:

o All eligible (upon request and 14 day exam only) 

What sexually transmitted diseases:

o CT/GC

When are the inmates screened/tested: 

o Monday and Friday (Request only)

o Friday (14 Day Exam)

Where are the inmates screened/tested:

o Intake

o Jail Clinic

Who conducts the screening/testing: 

o Jail medical staff (vendor – Correct Health at time of visit) performs testing

o Quest labs runs the lab tests

Opt-in or opt-out testing: 

o Opt-out testing, arrestee must sign a refusal form

Suggestions/lessons learned (stated by staff at visit)

Have open and constant communication with all parties involved – especially corrections and 

custody staff/administration

Takeaways: N/A

Contact Person: Frank Coye 

Outreach Director, DeKalb County Board of Health

 fxcoye@dhr.state.ga.us
1/26/2011 Page 20 of 29

APPENDIX VII: Jurisdiction: Baton Rouge, LA

Facilities Visited: 

East Baton Rouge Parish Prison

Metro Health (CBO)

Dates: July 17-18, 2008

Screening/Testing Program Summary:

Who is screened/tested:

o Women

What sexually transmitted disease: 

o Syphilis

When are the inmates tested:

o Offered M-F to women who entered the jail since phlebotomist was last there (usually 

within 1-3 days of entering the jail)

Where are the inmates tested: 

o In the medical area of the jail

Who conducts the screening/testing: 

o Metro Health funded by the Louisiana State STD Program 

Opt-in or Opt-out: 

o Opt-in

Other Highlights:

Medical care in the jail is provided by the city’s Emergency Medical Services 

State STD program contracts with a CBO (Metro Health) to do the screening in the jail. 

Suggestions/lessons learned (stated by staff at visit):N/A

Takeaways:

If contracting for screening services, contract needs to be very specific. Cannot hold CBO 

accountable if you have not been specific about what you expect them to do. 

Contact Person: Lisa Longfellow, State STD Manager

llongfe@dhh.la.gov
1/26/2011 Page 21 of 29

APPENDIX VIII: Jurisdiction: Wayne County (Detroit), MI

Facilities Visited: 

Wayne County Jail

Dates: August 19, 2009

Screening/Testing Program Summary: 

Who is screened/tested: 

o CT/GC:

 All females 30 and younger

 Females 31-40 who met at least one of the following criteria: symptoms, 

known exposure to an STD, multiple sex partners, diagnosed with an STD in 

previous 3 years, or pregnant.

 All males 29 and younger

 Males 30-35 who met at least one of the following criteria: symptoms, recent 

(90 days) known exposure to an STD, infected partner.

o Syphilis: 

 Women

o HIV

 Inmates aged 13-64

What sexually transmitted diseases: 

o CT/GC

o Syphilis

o HIV

When are the inmates screened/tested: 

o At time of inmate’s medical exam, which could be 2 days to 2 weeks after intake.

Where are the inmates screened/tested: 

o Usually in the medical area, but sometimes in the housing unit.

Who conducts the screening/testing: 

o Medical Assistants who are part of the jail medical staff. 

Opt-in or Opt-out: 

o Opt-in, but strongly encouraged

Other Highlights:

Jail health care is provided by Wayne County Jail Health Services, a division of the Wayne 

County Department of Health and Human Services.

Jail screening started as a pilot in 2007, and was initiated by the jail. Categories of inmates 

tested are based on monitoring prevalence.

Jail Health Services and the STD program (both State and local) have a very good working 

relationship.

State STD and IPP programs have a very good working relationship. 

STD screening and treatment is paid for by the State STD program—most CT/GC testing has 

been funded with IPP money, and monitored to assure prudent use of resources. Other 

funding from HIV grants.
1/26/2011 Page 22 of 29

Appendix VIII: Jurisdiction: Wayne County (Detroit), MI (cont.)

Other Highlights (continued):

About 50% of eligible females screened for CT/GC

60-65% of positives are treated prior to release

Suggestions/lessons learned (stated by staff at visit)

All players must have a collaborative, respectful relationship at the personal level. This 

applies not only to the managers, but to the staff doing the work.

Begin with a pilot project to allow for screening protocol to be reflective of population 

prevalence. All inmates are not at high risk for GC and CT, and based on limited time and 

financial resources, inclusion criteria for screening is appropriate and necessary.

Takeaways:

Because this program is supported by IPP resources, positivity must be high enough to justify 

the diversion of screening resources from other high prevalence sites such as adolescent 

health clinics and juvenile detention facilities.

Contact Person: Amy Peterson

STD Program Specialist, Michigan Dept. of Community Health

PetersonAm@michigan.gov
1/26/2011 Page 23 of 29

APPENDIX IX: Jurisdiction: Las Vegas, NV

Facilities Visited: 

Clark County Detention Center (CCDC)

Stewart-Mojave Jail 

Dates: September 25, 2008

Screening/testing Program Summary: 

Who is screened/tested: 

o Screening is very limited at these facilities 

What sexually transmitted disease: 

o Syphilis

o HIV

When are the inmates screened/tested: 

o By appointment – Inmates are asked at the 14-day medical if they want to be tested

Who conducts the screening/testing: 

o Health Department 

Opt-in or Opt-out: Opt-in

Other Highlights:

Medical care in both jails are provided by private contractors: CCDC --NaphCare and 

Stewart-Mojave – Prison Health Services

Contracts for medical care are written by the Sheriff’s Office

New Captain who oversees the medical care at CCDC has limited the health department’s 

access to the housing units for screening/testing purposes

Suggestions/lessons learned (stated by staff at visit)

Be patient, and give in to what the jail wants before you starting asking for permission to 

expand 

Foster good relationships with jail partners. Try to see thing their way.

Takeaways: N/A

Contact Person: Marlo Tonge

Tonge@snhdmail.org
1/26/2011 Page 24 of 29

APPENDIX X: Jurisdiction: New York City, NY

Facilities Visited: 

Rikers Island Jail

Date: May 7, 2008

Screening/testing Program: 

Who is screened/tested: 

o All females 

o CT/GC

o Syphilis

o HIV is offered

o Males 

o All males

 Syphilis and HIV

o <= 35 yrs

 CT/GC

What sexually transmitted diseases:

o CT/GC

o Syphilis

o HIV

When are the inmates screened/tested: 

o At Intake – within 24 hours of admission

Where are the inmates screened/tested: 

o Medical Intake Area

Who conducts the screening/testing: 

o Jail medical provider

Opt-in or Opt-out: 

o Opt-in, but strongly encouraged

Other Highlights:

Jail health care is provided by a private contractor – Prison Health Services (PHS)

Jail health care is overseen by the Bureau of Correctional Health Services within the NYC

Department of Health and Mental Hygiene

Urine-based screening of males started as a pilot in 2003, based on a study that showed high 

prevalence of CT and GC in incarcerated males

o Results of pilot showed that 6.7% were positive, and 87% of those testing positive 

had been asymptomatic

o Pilot results helped secure funding for permanent screening program

Requirement to screen is part of the contract PHS has with the city

Lab results take 2-3 days, and jail medical staff provide the treatment 

Suggestions/lessons learned (stated by staff at visit):

When initiating a screening program, show corrections staff that the screening will not slow 

down the intake process and that extra infrastructure is not needed.

Doing a pilot can help secure funding for a screening program
1/26/2011 Page 25 of 29

Appendix X: Jurisdiction: New York City, NY (cont.)

Takeaways: 

Success of the program is dependent on the front-line staff

Successful programs are collaborative

Contact Person: Farah Parvez, M.D., MPH

Office of Correctional Public Health

fparvez@health.nyc.gov
1/26/2011 Page 26 of 29

APPENDIX XI: Jurisdiction: Philadelphia, PA

Physical Facilities Visited: 

Philadelphia Prison

Dates: September 16 and 17, 2008

Screening/testing Program Summary:

Who is screened/tested and for what infections and when

o All eligible

What sexually transmitted diseases:

o CT/GC

o Syphilis

When are inmates screened/tested: 

o Within 4.5 hours of entering jail system at medical intake

Where are inmates screened/tested:

o Intake

Who conducts the screening/testing: 

o Contracted medical provider – Prison Health Services at time of visit

Opt-in or opt-out testing – N/A

o Mandatory testing (According to Pennsylvania Bulletin, Vol. 32, No. 4, January 26, 

2002, Section 27.84, ―A person convicted of a crime or pending trial, who is confined 

in or committed to a State of local penal institution, reformatory, or other house of 

detention, may be examined for a sexually transmitted disease ...‖.)

Other Highlights:

Medical care in the jail is provided by a contractor, Prison Health Services, and funded by the 

city

80-85% of all inmates get screened.

Specimens are taken to public health laboratory daily (M-F), and results returned in two-three 

days via fax. (RPRs same day when tech is on-site)

The contractor, Prison Health Services, pays the city for running the tests, so this is income 

to the Health Department

91-95% of the positives get treated, either in jail or by the Health Department

Doctor’s orders required for treatment in jail, but can be obtained by phone 

Jail keeps very good records of who is screened, positive, and treated; and shares with Health 

Department on a frequent basis.

Suggestions/lessons learned (stated by staff at visit):

Try to get put into State regulations for correctional health

Put it into contracts for correctional health

Develop data, with incidence, and approach the ―powers‖ to let them know that CT is 

affecting a particular age group, and they need to be identified to be treated to avoid 

complications and transmission. 
1/26/2011 Page 27 of 29

Appendix XI: Jurisdiction: Philadelphia, PA (cont.)

Takeaways:

STD program had input on the development of the law, and the wording of the contract with 

PHS. To get support they first defined the extent of the CT problem in the City, and then 

politicized it. Their first emphasis was on emphasizing the epidemic among young people 

(probably much more saleable than inmates). The STD program already had a relationship 

with the jail as they had been supplying GC supplies for the symptomatic testing. And then 

in 2004 when the medical contractor’s (PHS) lab wanted to charge $120 for a CT and GC 

testing, the STD program worked with PHS and negotiated with the city lab for $13.50/ 

CT/GC test. 

Contact Person: Melinda Salmon

Philadelphia STD Program Manager

 Melinda.e.salmon@phila.gov
1/26/2011 Page 28 of 29

APPENDIX XII: Jurisdiction: Dallas, TX

Physical Facilities Visited: 

Dallas County Jail

Dates: September 8-9, 2008

Screening/testing Program: 

Who is screened/tested: 

o All eligible

What sexually transmitted diseases: 

o Syphilis 

o HIV

When are the inmates screened: 

o Monday-Wednesday

o During the day

Where are the inmates screened:

o A health department phlebotomist is near the booking area, and testing is done in the 

housing area, when requested

Who conducts the screening/testing: 

o Health Department 

Opt-in or Opt-out: 

o Opt-in

Other Highlights:

Had been some recent changes in medical care providers in the jail, and had particular 

problems when a contractor provided the care, but at the time of our visit, care was being 

provided by the county hospital system, which improved care.

At the time of our visit, screening was offered by the correctional staff. If inmate accepted, 

they were escorted to the phlebotomist who was located on another floor. (They were trying 

to get the phlebotomist moved to the same floor as Intake.) Screening was also offered at 

Intake when the inmate was seen by an RN.

About 50% of those testing positive are released prior to getting treatment.

Suggestions/lessons learned (stated by staff at visit)

Need a close working relationship between the health department, jail medical staff, and 

correctional staff

Takeaways:

Few inmates accept the offer of syphilis and HIV testing, probably due to the needle stick 

(for syphilis) and the logistics – testing offered by the same correctional staff who will have 

to escort inmate to the testing area.

Contact Person: LaShonda Worthey. Program Manager

LWorthey@dallascounty.org
1/26/2011 Page 29 of 29

APPENDIX XIII: Jurisdiction: Harris County (Houston), TX

Physical Facilities Visited: 

No jail visited per hurricane IKE

Dates: September 10, 2008

Screening/testing Program:

Who is screened/tested:

o Pregnant females

What sexually transmitted diseases: 

o CT/GC

o HIV

o Syphilis

When are inmates screened/tested: 

o 14 day exam

Where are the inmates screened/tested: 

o Jail Clinic

Who conducts the screening/testing: 

o Medical Services Division of the Harris County Sherriff’s Office

Opt-in or opt-out testing: 

o Opt-in

Suggestions/lessons learned (stated by staff at visit)

Relationship with Sheriff’s Dept very important. Jail is like a city itself.

To get buy-in, stress that you don’t want to send someone back into the community with 

syphilis – want to get treated while in jail.

Need to work through the jail medical staff to get inmates brought to clinic 

Re-evaluate agreements with partners consistently and on a regular basis – is the process still 

appropriate?

Takeaways: N/A

Contact Person: Marlene McNeese-Ward 

 Chief, Houston Bureau of HIV/STD and Viral Hepatitis Prevention

Marlene.mcneese-ward@cityofhouston.net