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Reach at-risk youth with rapid HIV tests
When it comes to HIV in the United States, young people are disproportionately at risk: An estimated 50% of new HIV infections occur among those under age 25.1 Among youth infected with HIV, 55% are African American, and 24% are Latino.2
How can clinicians reach these at-risk youth with a prevention message? The Rapid HIV Testing Program offered through St. Christopher's Hospital for Children in Philadelphia provides sexual health education and counseling, rapid HIV testing, and additional intensive counseling to those who test positive. Conducted in a variety of community-based settings that are easily accessible to youth, post-implementation data indicate the program has been successful in identifying HIV-positive, minority youth and facilitating access to care.
The program, which has been in existence since 2002, has tested as many as 500 at-risk individuals in a year. Over one 10-month period, 450 individuals were tested, including 248 at-risk youth between ages 14 and 24. Within the group of 248, seven tested positive for HIV.3
St. Christopher's is a nonsectarian, 161-bed hospital, with more than 270 pediatric specialists offering services exclusively to children. The physicians also serve at the Pediatrics Department at the Drexel University College of Medicine, also in Philadelphia.
The Rapid HIV Testing Program began as a pilot designed to increase access to HIV testing by offering services in the neighborhoods where young people live, rather than requiring them to travel to clinic locations in downtown Philadelphia, to receive HIV testing.
The program provides consistent testing at community locations, including family homeless shelters, homeless youth shelters, charter schools, and local college health centers, says Theresa Parrino, LCSW, assistant director of the Drexel University College of Medicine/St. Christopher's Pediatric/Adolescent HIV/AIDS Program. Additionally, the program offers the rapid test during the year at various events throughout the city, such as health fairs, social events for teens, and church functions, she notes.
Within each location, the program generally operates during set hours in two private rooms to maintain confidentiality, with one room used for initial testing and one for follow-up testing and counseling to those who initially test positive. For example, a location may provide services on the first Tuesday of the month between 4 p.m and 7 p.m.; during this time period, counselors come to the site to offer program services.
How does the program get the word out about offsite testing? According to Parrino, the program normally partners with established community agencies to provide space for testing and outreach support, with program staff using neighborhood flier postings, radio announcements, group presentations, and e-mails to promote attendance.
The program includes two full-time coordinators, three full-time social workers, a full-time outreach worker/tester, and five contracted outreach workers/testers. Generally, two to three testers can serve 12-17 youth during a three-hour period. Outreach workers/testers typically have at least some college education.
The annual operating budget is about $1.5 million. Costs include staffing, materials, and the costs related to testing. The program is funded through a combination of federal funds and grants, including monies from the Ryan White Comprehensive AIDS Resources Emergency Act, St. Christopher's Foundation, Johnson & Johnson, and the Elizabeth Glaser Pediatric AIDS Foundation.
Different formats target prevention
A key element of the program lies in its sexual health curriculum and counseling. Using a variety of formats, such as group activities, games, and movies, program officials offer youth ages 14-24 prevention information.
All youth also have individual sessions with counselors, which normally last about 20 minutes. Counselors assess the individual's STD risks and provide additional information on HIV/AIDS, including specific information on exposure, and testing and retesting options. Counselors use calendars to help youth pinpoint when they may have been exposed to HIV infection and determine the date that they should return for testing or retesting, if needed.
Youth who are interested in taking a rapid HIV test then are asked to sign two consent forms: one for testing and one for care outreach. Counselors obtain information on how to contact youth if needed. Those who are interested in testing also are screened for their readiness to test. Youth who are intoxicated, at risk for suicide, or who exhibit serious mental health symptoms are not tested. Once tested, youth take part in additional educational activities until the results are available, which usually is a 20-minute period.
Youth who initially test positive are immediately retested, with results not typically known for another week. A master's-level social worker counsels those who test positive with the rapid test, as well as provides a more thorough screening for risk of suicide. A pager number is provided in case those who test positive with the rapid test need support while waiting for the results of the second test. Results of the second test are given at a neighborhood clinic, where individuals who test HIV-positive are immediately linked to youth-specific, comprehensive HIV care.
Why is off-site testing so important in reaching adolescent populations?
"We developed our program based on the premise that the most at-risk youth do not often present to large medical facilities or anonymous test sites that in Philadelphia are located in the Center City district, which is quite a distance from some of the hardest-hit communities by HIV standards," says Jill Foster, MD, section chief of the Drexel University College of Medicine/St. Christopher's Pediatric/Adolescent HIV/AIDS Program. "These kids also do not access primary care physicians and thus slip through most of the prevention cracks in Philadelphia."