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Overview
The demonstration projects for Implementation of
Rapid HIV Testing in Historically Black Colleges and Universities and
Alternative Venues and Populations address strategies 1 and 2 of the
Advancing HIV Prevention initiative. Strategy 1 is to make voluntary HIV
testing a routine part of medical care. Strategy 2 is to implement new
models for diagnosing HIV infections outside medical settings.
These projects will demonstrate new models for
diagnosing HIV infection through greater access to rapid HIV testing along
with prevention and care services for persons diagnosed with HIV. The
projects will look at the feasibility, impact, and best methods of
integrating routine rapid HIV testing programs in a variety of
nontraditional testing venues targeting high-risk and hard-to-reach
populations. The individuals targeted by these demonstration projects are
among those less often reached by health promotion initiatives and more
often disproportionately impacted by the HIV epidemic. In addition, these
projects will help determine whether offering rapid HIV testing reduces
potential loss to follow-up by increasing the percentage of people who
actually receive their test result and are linked to care (because initial
results are available within 20 to 40 minutes, rather than days or weeks).
Further, these projects will help examine whether offering HIV testing to
every client, rather than just those deemed high risk, can address the
stigma associated with getting tested.
These demonstration projects will take place in a
range of settings including Historically Black Colleges and Universities (HBCUs);
community-based organizations (CBOs) serving migrants, transgender persons,
and American Indians; and primary care settings serving high HIV prevalence
communities. The sites offering testing as part of this set of demonstration
projects will use a range of non-traditional approaches and settings. For
example, at HBCUs, testing will be offered not only at the campus health
center but also at nearby off-campus locations and campus health promotions
and social and academic events.
Persons delivering testing and counseling for this
demonstration project will range from trained CBO personnel providing
testing in the field to clinical staff at primary care clinics. CBOs will
provide full counseling, testing, and referral services.The project sites
will develop plans for linking newly diagnosed HIV-positive persons to
appropriate medical and social services and for contacting clients who are
lost to follow-up.
The project sites will provide CDC with information
that will help develop models to better understand how to reduce the
barriers that make it difficult for communities to access HIV testing and
services.
Goals
The goals of this program are to
- build new models for providing HIV testing and linkage to care.
- integrate routine rapid HIV testing programs into a variety of
non-traditional testing venues.
- demonstrate the value of rapid testing for accessing hard-to-reach
populations and ensuring they receive their test results and are linked
to care and treatment.
Collaborator Sites
Historically Black Colleges and Universities (HBCUs)
Albany, Georgia, Albany State University will
collaborate with Fort Valley State University to conduct routine testing for
students at both schools and for people in the community. This collaborator
site will partner with CBOs including a local faith-based organization to
offer off-campus testing. The student health centers at the 2 universities
will be used for most of the testing. Collaborating groups will use other
non-clinical campus sites to host events throughout the year. There will be
focus groups to better understand barriers confronting testing of students
in these small southern communities.
Washington, District of Columbia, Howard University
will conduct routine testing of undergraduate and graduate students ages 18
to 49. They will use student peer leaders for recruitment and marketing of
the testing promotion. Daily testing will take place at the student health
center on the main campus and bi-weekly testing will occur on more remote
campuses. Recruitment for testing will also occur at a variety of
non-clinical campus locations and during some major campus social events.
Initially, focus groups will be used to assess barriers to students getting
tested and to help determine marketing strategies.
Jackson, Mississippi, Jackson State University
will perform routine testing of students and people in the community using
CBOs and student peer leaders from campus. Rapid testing will take place in
a campus counseling center. Testing will also occur at a
university-sponsored community health program office about 5 miles from
campus. Additional outreach activities will include a major kick-off event
to publicize and normalize the idea of routine testing. Initially, focus
groups will be conducted to determine and plan outreach events and ensure
acceptability of suggested testing venues.
Pine Bluff, Arkansas, Jefferson Comprehensive Care System,
Inc. is a non-profit CBO serving a 10- county area in Pine
Bluff, Arkansas. It will manage testing at 4 HBCUs including: Arkansas
Baptist College, Philander Smith College, Shorter College, and University of
Arkansas at Pine Bluff. Routine testing will be offered to students from all
4 campuses at health clinics on 2 of the campuses. The more rural campuses
do not have ongoing clinical services. Student peer leaders as well as
faculty liaisons will collaborate across campuses to recruit and inform
students about the project. Educational and outreach activities at the 4
schools will incorporate the testing project into student orientation
activities, academic courses, and inter-campus social activities. This will
include a major kick-off event to publicize and help normalize the idea of
routine testing. Focus groups will be used to identify and assess barriers
to testing.
Migrant and Seasonal Farm Workers
Lawrenceville, Georgia, AID Gwinnett will
partner with the North Georgia AIDS Alliance to implement a rapid HIV
testing and education program focused on migrant workers in northern
Georgia, including Hall, Gwinnett, Newton, and Rockdale Counties. These
organizations will conduct outreach and rapid HIV testing in non-traditional
venues serving migrant worker populations (e.g., churches, beauty salons,
markets, and poultry plants) and create a network of community agencies and
clinical settings routinely offering rapid HIV testing. They will also
pursue an extensive media outreach component including radio and print
announcements to encourage testing.
Hartford, Connecticut, Hispanic Health Council
will provide outreach and testing in a range of settings to reach the
migrant communities of the Connecticut River Valley. These will include use
of a mobile testing minivan at gathering places of migrant farm workers
after typical daytime working hours. Locations will include businesses,
markets, restaurants, bars, and sporting events. Hispanic Health Council
will also integrate HIV testing into other services they offer to the
Hispanic community, including counseling and referral services at their
offices.
Milwaukee, Wisconsin, United Migrant Opportunity Services
will serve the Hispanic and African-born migrant and immigrant communities
of Wisconsin, Minnesota, and South Dakota. Their trained community promotoras
(i.e., lay health workers) will provide outreach and their testing
coordinators will provide testing. They will further integrate HIV testing
into the direct migrant services they currently provide, including child
care, assistance with housing, vocational training, and other social
services.
Transgender Communities
San Francisco, California, AIDS Healthcare Foundation
and partner Ark of Refuge will provide rapid HIV testing to a primarily
African American, transgender population through a transgender-focused
program that includes a clinic treating pre- and postoperative transgender
persons at risk for or infected with HIV. They will offer rapid HIV testing
to transgender clients who access any service through this program,
including HIV prevention education and mentoring, weekend food bank, worship
services, and transitional housing. Potential clients will be offered
immediate HIV counseling and testing services on a walk-in, no-appointment
basis. Clients who test positive for HIV will immediately receive counseling
and referral into care.
New York, New York, Housing Works, Inc. (HW),
the nation’s largest minority-run HIV/AIDS service organization, serves
primarily minority populations disproportionately affected by HIV, including
transgender persons of color. HW will provide counseling and testing for 260
transgender people in New York City. They will recruit counseling and
testing participants through a social network approach and by using a mobile
van to target areas frequented by members of the transgender community. They
will compare the 2 approaches to recruitment and collect data on the
transgender population’s HIV exposure factors, knowledge of HIV/AIDS
status, and barriers to HIV/AIDS testing.
Miami, Florida, South Beach AIDS Project (SoBAP)
will provide routine off-site testing, field-based outreach, and Internet
outreach to the pre- and postoperative transgender community of about 1,000
persons in Broward and Dade Counties. Data show that this population, a
sizeable portion of which is involved in the sexwork industry, is at
significantly higher risk for HIV infection. SoBAP has built relationships
with gatekeepers in the transgender communities and learned valuable lessons
about perceived barriers and benefits to healthseeking behaviors. SoBAP will
stage off-site late night outreach and offer routine off-site counseling,
testing, and linkage to services. They plan to saturate the transgender
communities in Broward and Dade Counties with multi-tiered advertising and
promotion for their program.
Native American Communities
Salt Lake City, Utah, Intermountain Harm Reduction Project,
a CBO, will partner with the Indian Walk- In Center to offer routine testing
to Native Americans from 5 tribal entities and 11 reservations in the Salt
Lakemetropolitan area. Testing will be offered in conjunction with all
Indian Walk-In Center programs as well as at the main Intermountain Harm
Reduction Project facility, a training center, the reservations, and other
remote locations, as necessary. Much of the work will be operated by local
tribal organizations and tribe members.
Phoenix, Arizona, Native American Community Health Center,
a CBO working with Native Americans in Phoenix since 1978, will conduct
routine HIV testing through local outreach in the Phoenix metropolitan area.
Testing locations will be non-traditional and will include community venues,
health fairs, and pow wows. Additional testing will take place at local
tribal health facilities and with participants of in-house wellness
programs. This collaborator site will target Native Americans living in
Maricopa County including a transgender Native American population. Testing
will also target transient Native Americans who migrate to Phoenix from
reservations.
Sault Ste. Marie, MI, Saulte Ste. Marie Tribe/Chippewa
Indians Sault Tribe Health Center will conduct routine HIV
testing for clients ages 17 to 49. The majority of testing will occur on
reservation land at the main tribal health center and 4 satellite health
centers. Testing will also be offered at a local urgent care center that
serves many Native Americans. Outreach testing will be offered to specific
clients at residential treatment facilities as well.
Clinical Settings Serving High-Prevalence Communities
Chicago, Illinois, Access Community Health Network,
a network of 42 health centers, will incorporate routine rapid HIV testing
into services for clients who visit 1 of 2 Access health centers: Kling
Internal Medicine on the west side of Chicago or Ashland Family Health
Center on the south side of Chicago. Each of these sites serves about 3,000
clients annually in federally designated underserved areas of Chicago with
predominantly low-income and minority populations (more than 85% African
American or Hispanic).
Oakland, California, Alameda County Medical Center (ACMC)
is the primary county hospital in the eastern San Francisco Bay Area and
currently has about 600 new AIDS cases per year. The ACMC will collaborate
with the Highland Hospital Emergency Department and its HIV Testing Program
to establish routine, on-going rapid HIV testing through the emergency
department (ED), with HIV testing integrated into other routinely delivered
services such as taking patients’ vital signs. At full implementation, it
is projected that all ED staff will be involved with rapid HIV testing and
that ACMC will be testing an estimated 5,000 patients per year.
Project Milestones
- Funding announcement: June 2004
- Selection of project sites: September 1, 2004
- Initial site visits by CDC team: October 2004 through February 2005
Data Collection
Data collection methods are currently being developed in coordination
with the sites. At present, the sites are working with CDC to determine the
feasibility of linking project-specific data collection to the existing data
infrastructure at sites.
Data collection at each site will include quantitative data, such as the
number of people tested, the number of HIV infections diagnosed, the number
of people linked into care, and qualitative data from focus groups and
surveys. These data will help identify best practices such as the most
effective ways to motivate people to get tested and the characteristics of
counselors who are effective in convincing community members to get tested.
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