Rapid HCV Testing as an HIV Testing Strategy in Rural Areas
Need: To provide HIV testing in rural areas while navigating around HIV stigma.
Intervention: A pilot study to provide HCV (Hepatitis C Virus) rapid tests and then offer an HIV rapid test as well.
Results: An increase in the number of people tested for HCV and HIV.
According to the
Missouri Department of Health and Senior Services, in
2020 there were 13,389 people living with HIV in the
state. Since HIV testing still carries stigma in rural
Butler County Health Department in southeast Missouri
uses an approach that meets another health need in the
region while navigating around the HIV stigma. The
department provides HCV (Hepatitis C Virus) rapid tests
and then offers an HIV rapid test.
The project serves a 20-county area. Sites where the
service is provided include:
Local health departments
Domestic violence shelters
Affordable housing organizations
Juvenile offices and group homes
Probation and parole offices
Senior citizen centers
Other locations by request
Patients with a presumptive positive are provided with a
materials packet that includes general information,
resources, and a letter to give to their healthcare
provider or clinic. The letter is to be returned to the
project staff, allowing tracking of patients'
Rapid HCV test, followed by offer of an HIV rapid
HIV antigen/antibody test for high-risk patients
Rapid syphilis antibody tests
Prevention education for high school students and
Pre-exposure prophylaxis (PrEP) information
PrEP clinic (starting December 2022), offered on a
sliding scale or free
The project began in October 2012. By August 2013:
458 rapid HCV tests were conducted, finding 64
Of those persons who were
offered an HIV test at the time, 407 accepted the offer.
There were no positive HIV test results in the first year
of the program. However, this project allowed people who
may not have gotten an HIV test to get risk reduction
messages, affirmations for reducing their risks, and a
chance to find out their current status. It allowed 64
people to find out their positive HCV status and get
referrals for services.
In the 9 months prior to the pilot, when only an HIV
rapid test was offered, just 21 persons were tested.
The project saw continued success in the following years:
In 2014, 646 rapid HCV tests were conducted, finding
94 positives (14.5%), and 734 HIV tests were conducted,
finding 1 positive.
In 2015, 900 rapid HCV tests were conducted.
In 2016, 525 rapid HCV tests were conducted, finding
55 positives (10.5%), and 595 HIV tests were conducted,
finding 1 positive.
In 2017, 475 rapid HCV tests have been conducted,
finding 25 positives (5.3%), and 331 HIV tests were
conducted, finding 0 positives.
Transportation remains a huge barrier for rural
residents. Butler County Health Department is training
other areas in southeast Missouri so that these community
partners can also provide rapid testing and decrease
clients' travel time. In addition, traveling to clients
and providing education in multiple settings help reduce
Project coordinators in the southeast region meet four
times each year to discuss topics such as transmission
The pilot revealed where this approach was most
successful. More people opted to get the rapid HCV test
in community settings and were less likely to accept the
offer at a local county health department. Outdoor
settings saw more traffic when organizers offered free
items like gift cards, T-shirts, sunglasses, and hygiene
letter (available for use and adaptation) is given to
patients with a presumptive positive, to share with their
healthcare provider or clinic.
The department used to advertise mainly through flyers
but is relying more so on social media channels like
Facebook. Project coordinators also created a website to
help people in southeast Missouri find testing sites in
their counties and learn whether those sites charge a fee
Please contact the models and innovations contact directly for the most complete and current information
about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.