Key points
Access current CDC guidelines and recommendations for testing, vaccination, and treatment of HIV, viral hepatitis, and tuberculosis (TB)/latent TB infection (LTBI) for people who work in correctional or detention settings. Links to full-text recommendations for each disease area are listed at the end of the page.
Testing, Vaccination, and Treatment for HIV, Viral Hepatitis, and Tuberculosis/Latent TB Infection (TB/LTBI)
CDC provides a summary of recommended actions upon hire and in response to an occupational exposure for people who work in correctional or detention settings. The following prevention recommendations for staff should be implemented within the context of a facility's Occupational Health program. If testing, vaccination, or post-exposure prophylaxis for occupational exposures are unavailable through an Occupational Health program, staff should be instructed to seek these services from their personal healthcare provider or local public health department.
Access summary recommendations for persons who are incarcerated or detained:
Recommended actions for staff
Testing
HIV: Staff with an occupationalAexposure to HIVB
HBV: Staff with an occupationalA exposure to HBVC
HCV: Staff with an occupationalA exposure to HCVD
- Test with NAT for HCV RNA at 3 weeks postexposureD
TB and LTBI:
Upon hire:
- All staff should be screened for TB diseaseE
- Perform a blood test (interferon-gamma release assay [IGRA] for TB infection) for all healthcare staff without documented history of a previously positive test result; a tuberculin skin test (TST) is an acceptable alternativeF
Periodic screening:
- Annual testing of staff is not recommended unless there is a known exposure or ongoing transmissionF
- Healthcare staff members who have untreated LTBI should be screened for symptoms of TB disease annuallyF
If exposed:
- Any staff member with an exposure to a person with infectious TB should receive a TB symptom screen as soon as exposure is known. If no documented history of a prior positive TB test result, staff should be tested immediately and again 8–10 weeks after the last known exposure, preferably using the same test at time of hire
Vaccination
HAV:
- As post-exposure prophylaxis following an occupational exposure to HAVG
- Consider during an outbreak for persons at high risk for infection
- Consider in facilities where hygiene is difficult to maintain
HBV:
- All previously unvaccinated persons whose work duties may involve exposure to blood or other potentially infectious body fluids
- As post-exposure prophylaxis following an occupational exposure to HBVC
Treatment
HIV: Antiretrovirals as post-exposure prophylaxis for staff with an occupational exposure to HIVA. Start post-exposure prophylaxis treatment as soon as possible after occupational exposure to HIV and continue treatment for a 4-week duration
HBV: Advise staff to seek consultation from their personal healthcare provider if they have a positive test result.
HCV: Advise staff to seek consultation from their personal healthcare provider if they have a positive test result.
TB and LTBI:
Positive test result for TB infection:
- Staff should be evaluated to diagnose TB disease or LTBI.
TB disease:
- Staff should be excluded from work until determined to be non-infectious.
Once TB disease has been excluded, treatment for LTBI is recommended for most persons.
- Short-course rifamycin-based regimens are the preferred treatment for LTBIH.
Additional considerations for HIV, Hepatitis B, and Hepatitis C
Given the higher prevalence of these diseases among people incarcerated and the potential for occupational exposure, facilities with an Occupational Health program could consider including HIV, HBV, and HCV screening for all staff and HBV vaccination for staff who are identified as unvaccinated and susceptible to HBV infection upon hiring. All facilities could consider including education on screening and vaccination for these diseases for their staff and advise staff to follow up with their primary care provider to ensure they are up to date with CDC recommendations. CDC recommendations include:
HIV:
- Screening: everyone between the ages of 13 and 64 should get tested for HIV at least once as part of routine health care
HBV:
- Screening: all adults aged 18 years or older should be screened for HBV at least once in their lifetime
- During initial screening, test for HBsAg, anti-HBs, and total anti-HBc
- During initial screening, test for HBsAg, anti-HBs, and total anti-HBc
- Vaccination: HBV vaccine is recommended for all adults age 19 through 59 years and adults age 60 years or older with risk factors for hepatitis B infection
HCV:
- Screening: all adults aged 18 years or older should be screened for HCV at least once in their lifetime
- Complete HCV testing includes HCV antibody with reflex to NAT for HCV RNA when HCV antibody is reactive
- Complete HCV testing includes HCV antibody with reflex to NAT for HCV RNA when HCV antibody is reactive
Public health reporting
If a staff member is diagnosed with HIV, viral hepatitis, or TB, 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, and viral hepatitis are all nationally notifiable conditions; TB infection or LTBI is also reportable in some states. States voluntarily report notifiable disease cases to CDC (without personal identifying information) to facilitate nationwide aggregation and monitoring of disease trends.
Guidance documents
HIV:
Viral Hepatitis:
Hepatitis A:
Hepatitis B:
- Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations — United States, 2023 | MMWR
- Universal Hepatitis B Vaccination in Adults Aged 19-59 Years: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2022
Hepatitis C:
TB and LTBI:
- Prevention and Control of Tuberculosis in Correctional and Detention Facilities: Recommendations from CDC (2006)
- Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC (2020)
- Clinical Testing Guidance for Tuberculosis: Health Care Personnel
- Occupational Safety and Health Administration (OSHA) defines an Occupational Exposure as reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties.
- Refer to Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis for more information regarding testing and the use of antiretrovirals following an occupational exposure to HIV.
- See Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations — United States, 2023 | MMWR.
- Refer to Testing and Clinical Management of Health Care Personnel Potentially Exposed to Hepatitis C virus – CDC Guidance, United States, 2020 for more information regarding the testing algorithm.
- See Prevention and Control of Tuberculosis in Correctional and Detention Facilities: Recommendations from CDC, 2006.
- Refer to TB Screening and Testing of Health Care Personnel, 2022.
- 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.
- See Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC.