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Correctional facilities provide health care to large numbers of medically underserved people. As such, preventive health in correctional settings is an important yet underused investment in public health. Because they often have histories of poor access to health care, the justice-involved population is more likely than the general population to be diagnosed with advanced-stage cancers. We report on the first 2 years of an ongoing collaboration between a state correctional system and state health department to implement annual colorectal cancer screening for sentenced people using fecal immunochemical testing (FIT). Preparation for the annual iterations begins in January, and patient engagement begins in March. In the first year of implementation (2018), 1396 of 1856 (75.2%) sentenced people completed an eligibility screen, and 254 of 321 (79.1%) eligible patients completed a FIT (eligible patients were aged ≥50 [≥45 if Black] in year 1 [lowered to ≥45 in year 2] and reported no previous relevant medical or family history of colorectal cancer); 54 (21.3%) completed FITs were positive. Of the 54 patients with positive FITS, 33 (61.1%) completed follow-up colonoscopies resulting in the identification of polyps in 26 (48.1%) patients with a positive FIT. We found invasive adenocarcinoma for 2 (3.7%) of the positive FITs (6.1% of colonoscopies performed). In the second year (2019), after a conversion from paper to tablet-based eligibility screening, 1707 of 2059 (82.9%) sentenced people completed an eligibility screen, and 200 of 285 (70.2%) eligible patients completed a FIT, 27 (13.5%) of whom had a positive result. We share lessons learned about implementing mass screening to encourage further communication among departments of health and corrections to advance preventive health.

Preventing coronavirus disease 2019 (COVID-19) in correctional and detention facilities* can be challenging because of population-dense housing, varied access to hygiene facilities and supplies, and limited space for isolation and quarantine (1). Incarcerated and detained populations have a high prevalence of chronic diseases, increasing their risk for severe COVID-19-associated illness and making early detection critical (2,3). Correctional and detention facilities are not closed systems; SARS-CoV-2, the virus that causes COVID-19, can be transmitted to and from the surrounding community through staff member and visitor movements as well as entry, transfer, and release of incarcerated and detained persons (1). To better understand SARS-CoV-2 prevalence in these settings, CDC requested data from 15 jurisdictions describing results of mass testing events among incarcerated and detained persons and cases identified through earlier symptom-based testing. Six jurisdictions reported SARS-CoV-2 prevalence of 0%-86.8% (median = 29.3%) from mass testing events in 16 adult facilities. Before mass testing, 15 of the 16 facilities had identified at least one COVID-19 case among incarcerated or detained persons using symptom-based testing, and mass testing increased the total number of known cases from 642 to 8,239. Case surveillance from symptom-based testing has likely underestimated SARS-CoV-2 prevalence in correctional and detention facilities. Broad-based testing can provide a more accurate assessment of prevalence and generate data to help control transmission (4).

Some of the most vulnerable and most affected individuals have the least access to effective addiction treatment: prisoners. Of the 2.2 million individuals currently incarcerated in the United States, an estimated 50% at least have one substance use disorder. Given the high prevalence of addiction and its effects on recidivism and reentry, correctional health must include evidence-based treatment of substance use disorders.

In the midst of the opioid epidemic, some of the most vulnerable and most affected individuals have the least access to treatment: prisoners. The United States has 5% of the world's population, and 25% of the world's prisoners. Of the 2.2 million individuals currently incarcerated in the United States, over half have a substance use disorder. In addition to a staggering prevalence of substance use disorders, the rate of HIV is 5–7 times greater for justice-involved individuals compared with the general population, and the rate of hepatitis C virus is an estimated 10 times greater. Healthcare providers who work in the correctional health setting have not just an opportunity but a moral obligation to address the health needs of incarcerated individuals, which include treatment of infectious diseases (ID) and treatment of substance use disorders. Multiple studies have demonstrated the synergistic benefits of concomitant treatment of bloodborne infections and opioid use disorders, especially when continued through release from incarceration. As justice-involved individuals are far more likely than the general population to be affected by these health conditions, ID specialists are in a unique position to treat such diseases in tandem both in and out of correctional facilities, thus greatly improving the health of these individuals and of the general population.

Criminal justice involvement is increasingly recognized as a powerful social determinant of health in urban populations, especially among low income and minority populations. Those who have experienced incarceration have higher rates of infectious and chronic diseases and are at risk of worsened health post-release: mostly due to lack of resources in the community and increased engagement in risk behavior.