Cost- Effectiveness of Routine Opt-Out Screening for HIV, HCV, and STIs in U.S. Jails within "Hotspots"
Main Article Content
Abstract
Background: Incarcerated populations experience disproportionately high rates of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and sexually transmitted infections (STIs), particularly in geographic "hotspot" areas. Despite Center of Disease Control (CDC) recommendations for routine opt-out screening, most U.S. jails rely on risk-based approaches that miss a substantial proportion of infections. Missing opportunities to treat for these infectious diseases in jails represents a significant issue; reducing the prevalence of communicable diseases on a national level requires addressing carceral hotspot areas.
Objective: To compare the cost-effectiveness of routine opt-out versus risk-based screening for HIV, HCV, chlamydia, syphilis, and gonorrhea in jails located within infection hotspots.
Methods: We created Markov state transition models using parameters derived from existing literature for five major infections – HIV, HCV, chlamydia, syphilis, and gonorrhea. With these models, we ran simulations that showcase the predicted number of infected incarcerated individuals who receive treatment with opt-out screening versus risk-based screening. Using health utility values and treatment costs, we calculated the Incremental Cost Effectiveness Ratio (ICER) for all infection models that we compared to a Willingness to Pay Threshold (WTP) to assess the relative cost effectiveness of opt-out screening and risk-based screening.
Results: For STI models, opt-out screening shows high cost-effectiveness relative to the WTP, with ICER values being far below the $100,000 WTP (ranging from $727 to $4,941 additional cost for opt-out screening per QALY gained). The HCV model showed moderate cost effectiveness with opt-out screening, with an ICER of $85,760 per QALY gained, whereas the HIV model was not cost-effective. Additionally, a higher proportion of infected individuals are estimated to be able to complete full treatment course while incarcerated with opt-out screening. Considerable gains were seen with the chlamydia and syphilis models with 20.5% and 22.8% more infection positive cases estimated to be fully treatable during incarceration respectively.
Conclusions: Routine opt-out screening for most infectious diseases examined is highly cost-effective in hotspot jails. Our findings support prioritizing opt-out screening implementation in high-burden correctional facilities as a strategy to improve individual health outcomes and reduce community transmission.
Article Details
How to Cite
WOLFER-JENKINS, Claire et al.
Cost- Effectiveness of Routine Opt-Out Screening for HIV, HCV, and STIs in U.S. Jails within "Hotspots".
Medical Research Archives, [S.l.], v. 14, n. 1, jan. 2026.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/7188>. Date accessed: 03 feb. 2026.
doi: https://doi.org/10.18103/mra.v14i1.7188.
Keywords
Infectious disease, HIV, HCV, STIs, Cost effectiveness, Carceral Health Care
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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