Strategy in Action: HIV Testing Innovations Contribute to NHAS Goal.

Strategy in Action: HIV Testing Innovations Contribute to NHAS Goal

With an estimated 20 percent of people living with HIV in the United States unaware of their status, strengthening our HIV testing efforts will be key to achieving the goals of the National HIV/AIDS Strategy (NHAS). Fortunately, many innovative HIV testing efforts are underway in communities across the country.

HIV testing is integral to HIV prevention, treatment, and care. Knowledge of one’s HIV status is important for preventing the spread of disease. Studies show that individuals who learn they are infected with HIV take active steps to reduce the likelihood of transmitting the virus to their partners. Early diagnosis of HIV helps to ensure that people living with the virus are linked into care and receive life-saving treatment. And recently we’ve learned that antiretroviral treatment can also help to prevent the further spread of HIV. Therefore, the NHAS aims to increase, by 2015, from 79 percent to 90 percent the percentage of people living with HIV who know their serostatus (from 948,000 to 1,080,000 people).

From Maine to California, health departments, community-based organizations, substance abuse and mental health programs, health care providers, hospitals, and others are implementing novel and effective approaches to HIV testing to help contribute to this important outcome. Examples we’ve heard about recently include:

• HIV Screening Offered at the Department of Motor Vehicles – An innovative example of the Strategy’s call for greater collaboration among government service providers is underway in Washington, DC, where HIV testing has been offered at the Department of Motor Vehicles for the past year. While waiting to get a driver’s license, temporary tags or other services, motorists visiting the Department of Motor Vehicles service center in the nation’s capital can get a free HIV test. This innovative collaboration between the DMV and the DC Department of Health (DOH) has tested more than 5,000 people since the program started in a single location in October 2010. According to Family and Medical Counseling Service Inc., the non-profit group that runs the program under a grant from DOH, between 25 and 35 people get tested every day, and anyone who is tested gets $7 off his or her DMV services. If someone tests positive, the nonprofit offers a ride to its office where staff can set up counseling and a doctor’s appointment. Building on the success of the DMV effort, officials expanded the program in late 2011 to offer testing at an office where Washington residents register for food stamps, Medicaid, and other government assistance. The same nonprofit will run the program there, offering as an incentive a $5 gift card to a local grocery store.

• Testing at Community Activities – In Pine Ridge, South Dakota, the Oglala Sioux  tribe partnered with its local Indian Health Service facility to increase the availability of HIV screening in nonclinical, community-based settings. An experienced and well-regarded public health nurse has taken HIV testing to events and venues where there may not normally be a health-related activity. Over the past year, this locally initiated program has offered confidential HIV testing at community potlucks, rodeos, basketball games and Pow Wows.  Bringing HIV testing to nonclinical settings has allowed them to reach community members who may not be in regular health care, including young people, and provide them with HIV education and the opportunity for confidential HIV testing.

• Promoting the HIV-STD Link and Encouraging Screening – Responding to a recent special surveillance report indicating a 23% increase in the number of primary and secondary syphilis cases in Chicago and a documented high rate of HIV-syphilis co-infection especially among MSM, the Chicago Department of Public Health  recently launched the “Get Tested Chicago ” campaign to encourage individuals to get tested for HIV and other Sexually Transmitted Infections (STI), including syphilis and, if diagnosed, to get into care. The public awareness campaign includes targeted billboards, radio public service announcements (PSAs), and bus advertisements aimed at early detection, testing and awareness.  The campaign makes the link between syphilis, as well as other sexually transmitted infections, and HIV. It notes that studies have repeatedly demonstrated that people are more likely to become infected with HIV when other STDs are present.  Moreover, it informs Chicagoans that if a person is HIV-positive, or if the immune system is weakened for any reason, syphilis (and other STIs) may progress faster and do more damage to the body.

• “Would you or wouldn’t you take an HIV test?” – In San Diego, the “Lead the Way ” campaign reflects the Strategy’s call to intensify HIV prevention efforts in communities where HIV is most heavily concentrated. The campaign aims to have all adults in the city’s 92103 and 92104 ZIP codes answer the question, “Would you or wouldn’t you take an HIV test?”  Researchers at the University of California, San Diego (UCSD), designed and are implementing “Lead the Way,” with support from the National Institutes of Health. “UCSD researchers want to show that we can reduce the spread of HIV now, even without a vaccine. HIV testing is easy, confidential and is the simplest way to help our local community fight the spread of HIV/AIDS,” observed Susan Little, MD, professor of medicine in UCSD’s Division of Infectious Diseases and lead researcher of  “Lead the Way.” The campaign operates a drop-in testing center and sets up mobile testing sites at a variety of community events and venues. In addition, trained HIV testers from UCSD’s Antiviral Research Center are visiting residential locations in randomly selected areas throughout the two ZIP codes to offer free rapid HIV tests that will provide results in minutes. Those that do not wish to participate in the finger-prick test will have the option of completing a brief survey. “Volunteering to take the quick finger-prick test or filling out the survey will help us understand why people will or will not take an HIV test.  If we can understand the psychology, we can create more effective campaigns to promote testing. The ultimate goal is that everyone gets tested and those who need treatment receive it, so we can significantly curb the spread of HIV,” Dr. Little said.

These are just some of the many significant steps taken over past year to help the nation reach the Strategy’s goals. What innovative approaches to HIV testing are underway in your community? Share your examples to inspire others in the Comments section below.

For more information, visit CDC’s HIV Testing page or read the Kaiser Family Foundation’s 2011 fact sheet “HIV Testing in the United States”.

By Ronald Valdiserri, M.D., M.P.H., 
Deputy Assistant Secretary for Health, Infectious Diseases, 
and Director, Office of HIV/AIDS Policy, U.S. Department of Health and Human Services

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About Office of HIV/AIDS Policy
U.S. Department of Health and Human Services

The Office of HIV/AIDS Policy, within the Office of the Assistant Secretary for Health (ASH), advises the Assistant Secretary for Health and senior U.S. Department of Health and Human Services (HHS) officials on: the appropriate and timely implementation and development of HIV/AIDS policy; the establishment of priorities; and the implementation of HIV/AIDS programs, activities, and initiatives across other HHS health agencies.

Reaching these goals will require that all of us—including our families, friends, schools, faith-based organizations, care providers and communities—take on the responsibility of fighting HIV/AIDS. In particular, our attitudes—about those most at-risk for HIV and those living with HIV—must be free of negative perceptions and stigma.

OHAP develops and supports  initiatives to promote HHS policies, programs, and resources, including:

• Implementation of the National HIV/AIDS Strategy—working to achieve a more coordinated national response to the HIV epidemic by reducing HIV transmission, increasing access to HIV care and improving health outcomes, and reducing HIV-related disparities and health inequities.
• Secretary’s Minority AIDS Initiative Fund (SMAIF)—targeting  resources appropriated by Congress to support HIV prevention, care and treatment, outreach and education, capacity building, and technical assistance activities for racial and ethnic minorities in the United States who are at high-risk for, or living with, HIV/AIDS.
• AIDS.gov—works to increase HIV testing and enhance care among people most at-risk for, or living with, HIV, by using emerging communication strategies to provide access to information on various aspects of HIV/AIDS prevention, treatment and care, including the National HIV/AIDS Strategy.
• Implementation of the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis—supporting the ongoing implementation of the action plan by  identifying opportunities for enhanced interagency collaboration, leveraging existing resources, and strengthening partnerships inside and outside of government.
• Presidential Advisory Council on HIV/AIDS (PACHA)—provides advice, information, and recommendations to the Secretary and to the President regarding programs, policies, and research priorities intended to promote effective prevention, care, and treatment of HIV disease.