At-A-Glance: CDC Recommendations for Correctional and Detention Settings

Testing, Vaccination, and Treatment for HIV, Viral Hepatitis, TB, and STIs

This document consolidates in summary form current CDC guidelines and recommendations for testing, vaccination, and treatment of HIV, viral hepatitis, TB, and STIs for persons who are detained or incarcerated (as of December 2021), and highlights critical public health actions applicable at intake, during incarceration/ detention, and at release. The document also summarizes public health actions related to pregnant persons. Links to full-text recommendations for each disease area are listed at the end of the document; this “At-A-Glance” does not replace those detailed recommendations.

CDC recognizes that the ability of facilities to put these recommendations into practice will vary based on resources, onsite healthcare capacity, population turnover, and other factors. Facilities may need additional funds, and/or direct partnerships with state or local public health departments to provide these public health prevention services.

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Recommended Actions at Intake

The screening, vaccination, and treatment recommendations below are actions recommended at intake for persons who are detained or incarcerated. Depending on facility intake procedures and health care capacity, some of these actions might occur after intake or booking process at the initial health care provider encounter.

Recommended Actions at Intake
Screening Human immunodeficiency virus (HIV): All persons based on institutional prevalence of undiagnosed HIV infection1

Hepatitis B virus (HBV)2: All persons

Hepatitis C virus (HCV)3: All persons

Tuberculosis (TB) and Latent Tuberculosis Infection (LTBI):
  • All persons should be immediately screened for symptoms of pulmonary TB4
  • In facilities with nonminimal TB risk5, all persons should be further screened with a TST, a QFT-G, or a chest radiograph within 7 days of arrival
  • In facilities with minimal TB risk5, persons who have one or more clinical condition or other factor that increases their risk for infection or the risk for progressing to TB disease should be further screened with a TST, a QFT-G, or a chest radiograph within 7 days of arrival
Gonorrhea & Chlamydia: All women ≤35 years and all men <30 years 6

Syphilis: All persons based on local area and institutional prevalence7

Trichomonas: Women aged ≤35
Vaccination Hepatitis A virus (HAV): Begin hepatitis A vaccine series for8
  • All juveniles (≤18 years)
  • All adults at risk for HAV infection (e.g., MSM, PWID, persons experiencing homelessness)9
  • All persons at risk for severe adverse outcomes of HAV infection10
  • Consider vaccination for all persons during a community HAV outbreak propagated by person-to-person transmission11
HBV: Begin hepatitis B vaccine series for all juveniles and adults12

Human papillomavirus (HPV): Routine vaccination at age 11 or 12 years; vaccination can be given starting at age 9 years. Catch-up HPV vaccination for all persons through age 26 years who are not adequately vaccinated13
Treatment Persons with diagnosed infections should be treated in accordance with established clinical guidelines:

HIV: HHS Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIVexternal icon

HBV14: Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidanceexternal icon

HCV14: AASLD/IDSA Recommendations for Testing, Managing, and Treating Hepatitis Cexternal icon

TB15: Treatment for TB Disease (CDC website)

LTBI: Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from NTCA and CDC, 2020 (short-course, rifamycin-based regimens are preferred)

Syphilis/Gonorrhea/Chlamydia/Trichomonas: CDC 2021 STI Treatment Guidelines


1.Screening should be offered as opt-out screening. Facilities should initiate screening unless prevalence of undiagnosed HIV infection in their facility population has been documented to be <0.1%. In the absence of existing data for HIV prevalence, facilities should initiate voluntary HIV screening. Such screening is no longer warranted in facilities able to establish that the diagnostic yield is <1 per 1,000 persons screened.

2.Test for HBsAg, total anti-HBs, and total anti-HBc. For a chart outlining interpretations and recommended actions based on HBV serology findings, see Hepatitis B Vaccination, Screening, and Linkage to Care: Best Practice Advice from the American College of Physicians and the Centers for Disease Control and Preventionexternal icon.

3.Anti-HCV followed by HCV RNA if positive.

4.Persons should be screening for symptoms of pulmonary TB by being asked if they have had a prolonged cough (i.e., >3 weeks), hemoptysis (i.e., bloody sputum), or chest pain.

5.A facility has minimal TB risk if a) no cases of infectious TB have occurred in the facility in the last year, b) the facility does not house substantial numbers of persons with risk factors for TB (e.g., HIV infection, injection drug use), c) the facility does not house substantial numbers of persons who have arrived in the U.S. within the previous 5 years from areas of the world with high rates of TB, or d) employees in the facility are not otherwise at risk for TB. All other facilities should be categorized as a nonminimal TB risk facility.

6.Gonorrhea, chlamydia, and trichomonas screening should be offered as opt-out screening.

7.Opt-out syphilis screening should be conducted on the basis of local area and institutional prevalence of early (primary, secondary, and early latent) infectious syphilis. Correctional facilities should stay apprised of syphilis prevalence as it changes over time see https://www.cdc.gov/ std/treatment-guidelines/correctional.htm.

8.Unless documentation is available showing completion of the vaccine series.

9.For a full list of risk factors for HAV infection, see full HAV guidance document https://www.cdc.gov/mmwr/volumes/69/rr/rr6905a1.htm

10.Persons at risk for severe outcomes from hepatitis A infection include those with chronic liver disease or HIV infection.

11,Pre-exposure vaccination in populations at risk for hepatitis A infection is an effective outbreak control strategy. Because correctional facilities house individuals from high-risk populations (e.g., persons experiencing homelessness and persons who use drugs), vaccination in correctional settings can help to control community outbreaks of hepatitis A. Vaccination can also help control transmission inside facilities.

12.Unless documentation is available showing completion of the vaccine series, or the individual tests negative for HBsAg, total anti-HBs, and total anti-HBc.

13.See Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices | MMWR (cdc.gov)

14.All persons diagnosed with chronic HBV or HCV infection should be evaluated to determine the presence and extent of liver disease and candidacy for antiviral therapy.

15.Persons who have pulmonary TB symptoms or an abnormal chest radiograph should be evaluated to rule out TB disease; if TB disease is excluded as a diagnosis, LTBI treatment should be considered if the TST or QFT-G result is positive.

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Recommended Actions during Period of Incarceration/Detention

The testing, vaccination, and treatment recommendations below are in addition to actions recommended at intake (above). If individuals do not receive recommended testing, vaccination, or treatment at intake, facilities should ensure that it occurs as soon as possible during the period of incarceration/detention.

Recommended Actions during Period of Incarceration/Detention
Screening and Testing HIV:
  • Persons reporting ongoing risk factors (e.g., PWID, MSM)16
  • Persons with signs/symptoms of risk factors (e.g., STIs)
  • Persons potentially exposed to HIV
HBV2:
  • Persons reporting ongoing risk factors (e.g., PWID, MSM)16
  • Persons potentially exposed to HBV
  • Routine testing for persons serving long-term sentences
HCV3:
  • Persons reporting ongoing risk factors (e.g., PWID, hemodialysis patients)16, 17
  • Persons potentially exposed to HCV
TB and LTBI:
  • Persons serving long-term sentences who have a history of a negative TB test result should have follow-up testing annually at facilities with nonminimal TB risk5
  • Persons serving long-term sentences who have a history of a positive TB test result should be screened for symptoms of TB disease annually at facilities with nonminimal TB risk5
  • Any person with an exposure to a person with infectious TB should receive a test for TB infection if no history of a positive TB test result, or symptom screening for TB disease if history of a positive TB test result
Syphilis/Gonorrhea/Chlamydia:
  • Persons reporting/presenting with genitourinary, oropharyngeal, anorectal symptoms or rash
  • Persons potentially exposed to an STI or HIV
Trichomonas: Persons reporting/presenting with vaginal discharge
Vaccination HAV:
  • Begin/complete hepatitis A vaccine series for8, 18:
    • All juveniles
    • All adults at risk for HAV infection (e.g., MSM, PWID)9
    • All adults at risk for severe adverse outcomes of HAV infection10
  • Consider vaccinating all persons during a community HAV outbreak propagated by person-to-person transmission11
  • As post-exposure prophylaxis19
HBV:
  • Begin/complete hepatitis B vaccine series for all juveniles and adults12, 18
  • As post-exposure prophylaxis20
HPV: Routine vaccination at age 11 or 12 years; vaccination can be given starting at age 9 years. Catch-up HPV vaccination for all persons through age 26 years who are not adequately vaccinated13
Treatment Persons with diagnosed infections should be treated in accordance with established clinical guidelines:

HIV: HHS Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIVexternal icon

HBV14: Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidanceexternal icon

HCV14: Recommendations for Testing, Managing, and Treating Hepatitis Cexternal icon

TB15: Treatment for TB Disease (CDC website)

LTBI: Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from NTCA and CDC, 2020 (short-course, rifamycin-based regimens are preferred)

Syphilis/Gonorrhea/Chlamydia/Trichomonas: CDC 2021 STI Treatment Guidelines


5.A facility has minimal TB risk if a) no cases of infectious TB have occurred in the facility in the last year, b) the facility does not house substantial numbers of persons with risk factors for TB (e.g., HIV infection, injection drug use), c) the facility does not house substantial numbers of persons who have arrived in the U.S. within the previous 5 years from areas of the world with high rates of TB, or d) employees in the facility are not otherwise at risk for TB. All other facilities should be categorized as a nonminimal TB risk facility.

8.Unless documentation is available showing completion of the vaccine series.

9.For a full list of risk factors for HAV infection, see full HAV guidance document https://www.cdc.gov/mmwr/volumes/69/rr/rr6905a1.htm

10.Persons at risk for severe outcomes from hepatitis A infection include those with chronic liver disease or HIV infection.

11.Pre-exposure vaccination in populations at risk for hepatitis A infection is an effective outbreak control strategy. Because correctional facilities house individuals from high-risk populations (e.g., persons experiencing homelessness and persons who use drugs), vaccination in correctional settings can help to control community outbreaks of hepatitis A. Vaccination can also help control transmission inside facilities.

12.Unless documentation is available showing completion of the vaccine series, or the individual tests negative for HBsAg, total anti-HBs, and total anti-HBc.

13.See Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices | MMWR (cdc.gov)

14.All persons diagnosed with chronic HBV or HCV infection should be evaluated to determine the presence and extent of liver disease and candidacy for antiviral therapy.

15.Persons who have pulmonary TB symptoms or an abnormal chest radiograph should be evaluated to rule out TB disease; if TB disease is excluded as a diagnosis, LTBI treatment should be considered if the TST or QFT-G result is positive.

16.Although risk behaviors including drug use and sexual activity are prohibited in correctional and detention environments, they may still occur. Clinicians should note that individuals may be hesitant to report these behaviors due to fear of reprisal.

17.For a full list of persons at risk for chronic HCV infection, see full guidance, https://www.cdc.gov/hepatitis/hcv/guidelinesc.htm

18.Complete vaccine series while in custody if the individual has not been released prior to the minimum time required between doses.

19.See Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020 for guidance on administering vaccine and/or immune globulin as postexposure prophylaxis for HAV infection.

20.See Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices for guidance on testing and administering vaccine and/or immune globulin as postexposure prophylaxis for HBV infection. Recommendations depend upon vaccination status.

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Recommended Actions for Pregnant Persons

These recommendations for pregnant persons are in addition to applicable recommendations in previous sections of this document.

Recommended Actions for Pregnant Persons
Testing HIV: Test during each pregnancy and repeat testing may be warranted.

HBV: Test during each pregnancy

HCV: Test during each pregnancy

Syphilis: Test during each pregnancy
  • at intake (treat as first prenatal visit)
  • at 28 weeks
  • at delivery
Chlamydia & Gonorrhea: Test all pregnant persons <24 years of age, and pregnant persons ≥25 years of age who are at increased risk21
Vaccination HAV: Vaccinate pregnant persons who are8,18:

  • At risk for HAV infection9
  • At risk for severe outcomes from HAV infection10
HBV: Vaccinate all juveniles and adults (including pregnant persons)12,18
Treatment HIV: For treatment recommendations, see HHS Recommendations for the Use of Antiretroviral Drugs During Pregnancyexternal icon

HBV: For treatment recommendations, see CDC Screening and Referral Algorithm for HBV Infection among Pregnant Peoplepdf icon

HCV: Direct-acting antiviral drugs for HCV infection are not approved for use during pregnancy; treatment should be considered after delivery

TB and LTBI:
  • Begin treatment for TB disease as soon as TB is detected22
  • For most pregnant women, treatment for LTBI can be delayed until 2–3 months post-partum to avoid administering unnecessary medication during pregnancy
  • For women who are at high risk for progression from LTBI to TB disease, especially those who are a recent contact of someone with infectious TB, treatment for LTBI should not be delayed on the basis of pregnancy alone, even during the first trimester
  • For treatment recommendations, see CDC Treatment for TB Disease & Pregnancy
Syphilis/Chlamydia/Gonorrhea: For treatment recommendations, see CDC Sexually Transmitted Infections Treatment Guidelines: Pregnant Women


8.Unless documentation is available showing completion of the vaccine series.

9.For a full list of risk factors for HAV infection, see full HAV guidance document https://www.cdc.gov/mmwr/volumes/69/rr/rr6905a1.htm

10.Persons at risk for severe outcomes from hepatitis A infection include those with chronic liver disease or HIV infection.

12.Unless documentation is available showing completion of the vaccine series, or the individual tests negative for HBsAg, total anti-HBs, and total anti-HBc.

18.Complete vaccine series while in custody if the individual has not been released prior to the minimum time required between doses.

19.See Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020 for guidance on administering vaccine and/or immune globulin as postexposure prophylaxis for HAV infection.

20.See Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices for guidance on testing and administering vaccine and/or immune globulin as postexposure prophylaxis for HBV infection. Recommendations depend upon vaccination status.

21.Pregnant women at increased risk for chlamydia (e.g., those aged ≥25 years who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STI) and gonorrhea (e.g., those with other STIs during pregnancy or those with a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STI or is exchanging sex for money or drugs) should be screened at first prenatal visit. All persons diagnosed with chlamydia or gonorrhea should be rescreened 3 months after treatment (e.g., new sexual partner, unprotected sex, STI history). See CDC’s Pregnancy Screening Recommendations and Screening for Chlamydia and Gonorrhea: US Preventive Services Task Force Recommendation Statement | JAMA | JAMA Networkexternal icon for additional information.

22.Pregnant persons who are being treated for drug-resistant TB should receive counseling about the risk to the fetus.

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Recommended Actions for Release Planning and Linkage to Prevention and Care Services

It is best practice for correctional and detention facilities to ensure that discharge plans facilitate linkage with community-based providers for continued preventive and clinical services for existing health conditions.

Disease-specific Considerations for Release:
Recommended Actions for Release Planning and Linkage to Prevention and Care Services
HIV:
  • Provide persons with HIV with an adequate supply of antiretroviral medication upon release to bridge the gap until the patient can receive care from a community-based HIV provider.
  • Provide information on pre-exposure prophylaxis (PrEP) to all persons who are known to be at risk of HIV infection in their community.
Viral hepatitis and HIV:
  • Refer persons with HBV infection, HCV infection, or HIV to community-based medical and social services as needed to support continued medical care, risk-reduction, and treatment for substance use disorder.
TB and LTBI:
  • Communicate with state/local public health and community healthcare providers to facilitate treatment completion after release for persons under treatment for TB/LTBI.
  • Provide persons being treated for TB or LTBI counseling on the importance of completing a full course of TB or LTBI treatment.
HIV, viral hepatitis, and STIs:
  • Provide persons with HIV, viral hepatitis, or any STI with counseling on how to prevent transmission to household, sexual, and drug-use contacts as applicable (including risk reduction and condom use).
Provide all persons or their identified health care provider with a personal immunization record upon release.


Public Health Reporting

If an incarcerated person or staff member is diagnosed with HIV, viral hepatitis, TB/LTBI, or any reportable STI, the case should be reported to the appropriate public health jurisdiction or authority, especially in those states where reporting is required by law. Note that HIV, TB, viral hepatitis, syphilis, gonorrhea, and chlamydia are all nationally notifiable conditions; states voluntarily report notifiable disease cases to CDC (without personal identifying information) to facilitate nationwide aggregation and monitoring of disease trends.

Health Education Materials

For HIV, viral hepatitis, TB/LTBI, and STI health education materials that facilities can provide to persons who are incarcerated or detained, see CDC Correctional Health: Health Education Materials.

Full Guidance Documents by Disease Area

Acronyms

HAV – hepatitis A virus
HBV – hepatitis B virus
HCV – hepatitis C virus
HIV – human immunodeficiency virus
HPV – Human papillomavirus
LTBI – latent tuberculosis infection
MSM – men who have sex with men
PWID – people who inject drugs
QFT-G – QuantiFERON-TB Gold
STI – sexually transmitted infections
TB – tuberculosis
TST – tuberculin skin test

Footnotes

1Screening should be offered as opt-out screening. Facilities should initiate screening unless prevalence of undiagnosed HIV infection in their facility population has been documented to be <0.1%. In the absence of existing data for HIV prevalence, facilities should initiate voluntary HIV screening. Such screening is no longer warranted in facilities able to establish that the diagnostic yield is <1 per 1,000 persons screened.

2Test for HBsAg, total anti-HBs, and total anti-HBc. For a chart outlining interpretations and recommended actions based on HBV serology findings, see Hepatitis B Vaccination, Screening, and Linkage to Care: Best Practice Advice from the American College of Physicians and the Centers for Disease Control and Preventionexternal icon.

3Anti-HCV followed by HCV RNA if positive.

4Persons should be screening for symptoms of pulmonary TB by being asked if they have had a prolonged cough (i.e., >3 weeks), hemoptysis (i.e., bloody sputum), or chest pain.

5A facility has minimal TB risk if a) no cases of infectious TB have occurred in the facility in the last year, b) the facility does not house substantial numbers of persons with risk factors for TB (e.g., HIV infection, injection drug use), c) the facility does not house substantial numbers of persons who have arrived in the U.S. within the previous 5 years from areas of the world with high rates of TB, or d) employees in the facility are not otherwise at risk for TB. All other facilities should be categorized as a nonminimal TB risk facility.

6Gonorrhea, chlamydia, and trichomonas screening should be offered as opt-out screening.

7Opt-out syphilis screening should be conducted on the basis of local area and institutional prevalence of early (primary, secondary, and early latent) infectious syphilis. Correctional facilities should stay apprised of syphilis prevalence as it changes over time see https://www.cdc.gov/ std/treatment-guidelines/correctional.htm.

8Unless documentation is available showing completion of the vaccine series.

9For a full list of risk factors for HAV infection, see full HAV guidance document https://www.cdc.gov/mmwr/volumes/69/rr/rr6905a1.htm

10Persons at risk for severe outcomes from hepatitis A infection include those with chronic liver disease or HIV infection.

11Pre-exposure vaccination in populations at risk for hepatitis A infection is an effective outbreak control strategy. Because correctional facilities house individuals from high-risk populations (e.g., persons experiencing homelessness and persons who use drugs), vaccination in correctional settings can help to control community outbreaks of hepatitis A. Vaccination can also help control transmission inside facilities.

12Unless documentation is available showing completion of the vaccine series, or the individual tests negative for HBsAg, total anti-HBs, and total anti-HBc.

13See Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices | MMWR (cdc.gov)

14All persons diagnosed with chronic HBV or HCV infection should be evaluated to determine the presence and extent of liver disease and candidacy for antiviral therapy.

15Persons who have pulmonary TB symptoms or an abnormal chest radiograph should be evaluated to rule out TB disease; if TB disease is excluded as a diagnosis, LTBI treatment should be considered if the TST or QFT-G result is positive.

16Although risk behaviors including drug use and sexual activity are prohibited in correctional and detention environments, they may still occur. Clinicians should note that individuals may be hesitant to report these behaviors due to fear of reprisal.

17For a full list of persons at risk for chronic HCV infection, see full guidance, https://www.cdc.gov/hepatitis/hcv/guidelinesc.htm

18Complete vaccine series while in custody if the individual has not been released prior to the minimum time required between doses.

19See Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020 for guidance on administering vaccine and/or immune globulin as postexposure prophylaxis for HAV infection.

20See Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices for guidance on testing and administering vaccine and/or immune globulin as postexposure prophylaxis for HBV infection. Recommendations depend upon vaccination status.

21Pregnant women at increased risk for chlamydia (e.g., those aged ≥25 years who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STI) and gonorrhea (e.g., those with other STIs during pregnancy or those with a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STI or is exchanging sex for money or drugs) should be screened at first prenatal visit. All persons diagnosed with chlamydia or gonorrhea should be rescreened 3 months after treatment (e.g., new sexual partner, unprotected sex, STI history). See CDC’s Pregnancy Screening Recommendations and Screening for Chlamydia and Gonorrhea: US Preventive Services Task Force Recommendation Statement | JAMA | JAMA Networkexternal icon for additional information.

22Pregnant persons who are being treated for drug-resistant TB should receive counseling about the risk to the fetus.

Page last reviewed: April 7, 2022