Screenings in prison and after release

The first health check on arrival

NICE says that at first reception into prison, a healthcare professional (or a trained healthcare assistant supervised by a registered nurse) should carry out a health assessment for every person before they are allocated to a cell. (NICE NG57) It should cover physical health, alcohol use, substance misuse, mental health, and self-harm and suicide risk, and its questions ask about conditions such as diabetes, heart disease, tuberculosis, hepatitis B or C, HIV and other sexually transmitted infections. (NICE NG57)

The second health check within 7 days

NICE says a healthcare professional should carry out a second health assessment for every person within 7 days of the first. As a minimum it includes asking about past alcohol and drug use, head injury, smoking history, the date of their last sexual health screen, serious illness in the family (for example heart disease, diabetes or cancer), whether they have ever had a screening test such as a cervical screening test or mammogram, and their expected release date. It also includes measuring height, weight, pulse, blood pressure and temperature, and a urine test. (NICE NG57) See blood pressure screening.

TB and latent TB

NICE says people coming into prison should be screened for TB within 48 hours of arrival, (NICE NG57) and that prisons with static digital X-ray facilities for TB screening should X-ray all new arrivals, including people transferred from other prisons, who have not had a chest X-ray in the past 6 months. (NICE NG33) In high incidence areas, and at prisons that receive people from them, NICE says prison health services should offer a blood test for latent TB (an interferon-gamma release assay) to people younger than 65 who are in regular contact with substance misuse or other support services, combined with hepatitis B and C and HIV testing. (NICE NG33) The USPSTF recommends latent TB screening for adults at increased risk, which includes people who live in, or have lived in, high-risk congregate settings such as correctional facilities. (USPSTF latent TB) See latent tuberculosis screening and latent TB test results.

Hepatitis B and C

NICE lists people in prison, including young offenders, among the groups at increased risk of both hepatitis B and hepatitis C. (NICE PH43) It says prison healthcare services should make sure everyone is offered confidential testing for hepatitis B and C when entering prison and during their stay, that people get their results wherever they are when the results come back, and that results go to their community GP if they consent. (NICE NG57)(NICE PH43) The Chief Medical Officer for England reports that blood-borne virus screening on entering prison, mainly for hepatitis B, hepatitis C and HIV, has improved. (CMO for England 2025) In the US, the USPSTF recommends hepatitis C screening for all adults aged 18 to 79 (USPSTF hepatitis C) and hepatitis B screening for adolescents and adults at increased risk; its page notes that the CDC, the American College of Physicians and the American Association for the Study of Liver Diseases include people in correctional facilities in their hepatitis B screening groups. (USPSTF hepatitis B) See hepatitis C screening, hepatitis C test results, hepatitis B screening and hepatitis B test results.

HIV and sexual health

NICE says everyone should be offered HIV testing when entering prison, with information on why it is recommended, including for people who say they may wish to decline. (NICE NG57) The second health check asks about the date of the last sexual health screen. (NICE NG57) The USPSTF recommends HIV screening for adolescents and adults aged 15 to 65, and says repeat screening is reasonable for people who live or receive medical care in a high-prevalence setting such as a correctional facility. (USPSTF HIV) See HIV screening and HIV test results.

Mental health, alcohol and drug use questions

NICE says the reception check should ask about alcohol and drug use, past contact with mental health services, and thoughts of self-harm or suicide. (NICE NG57) It says staff should consider using the Correctional Mental Health Screen for Men (CMHS-M) or Women (CMHS-W) when a person's history, answers or behaviour suggest a mental health problem, and that a score of 6 or more for men, or 4 or more for women, should lead to a further assessment by a trained practitioner. (NICE NG57) The USPSTF recommends depression screening in all adults (USPSTF depression) and anxiety screening in adults 64 or younger, (USPSTF anxiety) and recommends asking adults 18 or older about unhealthy alcohol use (USPSTF alcohol use) and unhealthy drug use. (USPSTF drug use) See mental health screenings by age, alcohol screening (AUDIT-C) and drug use screening questions.

Usual screening on schedule

NICE says people in prison should be offered health checks equivalent to those in the community, for example the NHS Health Check, the learning disabilities annual health check, and NHS screening programmes such as those for abdominal aortic aneurysm and bowel, breast and cervical cancer. (NICE NG57) The Chief Medical Officer for England says prison healthcare providers are responsible for making sure adult cancer and non-cancer screening programmes are offered and accessible, and notes that people may be released or transferred before they are screened, and that breast screening relies on mobile units visiting or on escorted trips out. (CMO for England 2025) In the US, the USPSTF recommends blood pressure screening in adults 18 or older (USPSTF blood pressure) and screening for prediabetes and type 2 diabetes in adults aged 35 to 70 who have overweight or obesity. (USPSTF diabetes) See cancer screenings by age and diabetes screening.

Before and after release

NICE says people with complex needs should have a pre-release health assessment at least 1 month before their expected release date; for people who may be in prison for less than 1 month, it should be planned at the second health check. (NICE NG57) Everyone should get a copy of a care summary and post-release plan that lists new diagnoses and future appointments, and people who were not registered with a community GP should be helped to find and register with one. (NICE NG57) The Chief Medical Officer for England says that after release a person must register with a community GP for the full care record, including care in prison, to move back to the community practice. (CMO for England 2025) Someone who has missed screenings can start from catching up on screenings and take questions to ask your doctor to the first appointment.

Where they differ:

TB. NICE asks for active TB screening of everyone within 48 hours of arrival, with a latent TB blood test for some people in high incidence areas; (NICE NG57)(NICE NG33) the USPSTF recommends latent TB screening for adults who live or have lived in correctional facilities. (USPSTF latent TB)
Hepatitis. NICE names people in prison as a group to offer hepatitis B and C testing on entry and during their stay; (NICE PH43) the USPSTF screens all adults aged 18 to 79 for hepatitis C with no separate prison criterion, (USPSTF hepatitis C) and its own hepatitis B risk description does not name prison, while the CDC, ACP and AASLD lists it cites do. (USPSTF hepatitis B)
HIV. NICE says to offer everyone an HIV test on entering prison; (NICE NG57) the USPSTF screens everyone aged 15 to 65 and calls repeat screening reasonable in correctional facilities. (USPSTF HIV)

Your doctor decides what your result means for you.

Questions people ask

What health checks happen when someone arrives in prison?

NICE says a first health assessment should happen at reception, before the person is given a cell, covering physical health, alcohol use, substance misuse, mental health and self-harm and suicide risk. A second health assessment should follow within 7 days, including blood pressure, pulse, height, weight, temperature and a urine test. (NICE NG57)

Are TB, hepatitis and HIV tests offered in prison?

NICE says people coming into prison should be screened for TB within 48 hours of arrival, should be offered confidential hepatitis B and C testing when they enter prison and during their stay, and should be offered HIV testing when they enter prison. (NICE NG57) (NICE NG33) (NICE PH43)

Do cancer screening and NHS Health Checks continue in prison?

NICE says people in prison should be offered health checks equivalent to those in the community, including the NHS Health Check and NHS screening programmes such as those for abdominal aortic aneurysm and bowel, breast and cervical cancer. The Chief Medical Officer for England says prison healthcare providers are responsible for making sure adult screening programmes are offered and accessible. (NICE NG57) (CMO for England 2025)

What health checks happen before and after release?

NICE says people with complex needs should have a pre-release health assessment at least 1 month before their expected release date, that everyone should get a copy of a care summary and post-release plan listing future appointments, and that people should be helped to register with a community GP if they were not registered before. (NICE NG57)