People in correctional facilities
Overview
- Men, women and young people in correctional facilities are often marginalised groups, including homeless, itinerate, Aboriginal and Torres Strait Islander people, people who inject drugs and sex workers.
- Injecting drug use and unsafe tattooing occurs in correctional facilities.
- Therefore, there is a high prevalence of blood-borne viruses (BBVs) amongst people in correctional facilities.
Testing advice
| Infection | Consideration |
|---|---|
| Chlamydia | Consider Self-collection of samples for NAAT testingVaginal swab: instruct the patient to insert the swab into the vagina like a tampon and then remove and place into the transport tube. Rectal swab: instruct the patient to insert the swab into the anal canal 2-4cms and then remove and place into the transport tube. FPU (First pass urine): Collect approximately 20 ml (1/3 of the standard urine jar) of the first part of the urine stream in a specimen jar at the time you are consulting the patient. The patient does not need to have held their urine for more than 20 minutes prior to specimen collection. A midstream urine (MSU) or early morning specimen (i.e. first void urine) are not required for NAAT. Click here for information on how to describe self-collection technique to a patient. |
| Gonorrhoea | Consider Self-collection of samples for NAAT testingVaginal swab: instruct the patient to insert the swab into the vagina like a tampon and then remove and place into the transport tube. Rectal swab: instruct the patient to insert the swab into the anal canal 2-4cms and then remove and place into the transport tube. FPU (First pass urine): Collect approximately 20 ml (1/3 of the standard urine jar) of the first part of the urine stream in a specimen jar at the time you are consulting the patient. The patient does not need to have held their urine for more than 20 minutes prior to specimen collection. A midstream urine (MSU) or early morning specimen (i.e. first void urine) are not required for NAAT. Click here for information on how to describe self-collection technique to a patient. If NAAT test result is positive, take swab at relevant site(s) for culture, before treatment. Cultures are the preferred test for samples from non-genital sites. |
| HIV | Repeat test if patient exposed within previous 12 weeks (window period). |
| If clinical suspicion of syphilis, refer to the syphilis guideline. | |
| Hepatitis A | Vaccinate if not immune. |
| Hepatitis B |
Vaccinate if not immune. Serological testing after hepatitis B vaccination should be considered in correctional facilities. |
| Hepatitis C | If antibody positive, test for hepatitis C NAAT to determine if patient has chronic hepatitis C. |
| NAAT – Nucleic Acid Amplification Test | |
Specimen collection
Clinician collected for NAAT/culture/microscopy
Urethral swabs for microscopy should be collected when the patient has not urinated for at least 1 hour and only if the patient has frank urethral discharge. Squeeze the urethra to express the discharge and collect on urethral swab. It is not necessary to insert the swab into the urethra.
Rectal swabs should be collected by inserting a sterile swab 2-4cms into the anal canal and moving the swab gently side to side for 10-20 seconds.
Pharyngeal swabs should be collected from the tonsils and oropharynx.
High vaginal swab of vaginal discharge smeared onto a glass slide, air dried and sent for microscopy. Swab inserted into transport medium for culture.
Self-collection of samples for NAAT testing
Vaginal swab: instruct the patient to insert the swab into the vagina like a tampon and then remove and place into the transport tube.
Rectal swab: instruct the patient to insert the swab into the anal canal 2-4cms and then remove and place into the transport tube.
FPU (First pass urine): Collect approximately 20 ml (1/3 of the standard urine jar) of the first part of the urine stream in a specimen jar at the time you are consulting the patient. The patient does not need to have held their urine for more than 20 minutes prior to specimen collection. A midstream urine (MSU) or early morning specimen (i.e. first void urine) are not required for NAAT.
Click here for information on how to describe self-collection technique to a patient.
Clinical indicators for testing
- All people should have a risk assessment for sexual health and BBV infection on admission to prison by appropriately trained staff.
- All people should be able to access advice and screening for STIs and BBVs.
- It is not recommended to routinely test for herpes and genital warts with serology. Consider testing for herpes and genital warts only if there are clinical signs and symptoms.
Special considerations
Pregnancy test where appropriate.Follow up
- Educate about condom use and risk minimisation
- Vaccinate for hepatitis A and B, if susceptible
- Discuss and activate reminders for regular screening tests according to risk, especially if their behaviors indicate the need for more frequent testing.
Auditable outcomes
- 100% of individuals tested for STIs and blood-borne viruses in first week of admission to prison
- 100% of individuals positive for an STI are appropriately managed.