Community HIV Testing and Screening
Community HIV screening occurs in non-clinical settings. Community HIV screening programs are generally combined with education and outreach events such as health fairs. Some clinical settings may partner with community-based organizations to provide testing resources, including test kits and trained staff members.
Conducting screening in a community setting can help reach a broad set of people who are at risk and may be less likely to visit a clinic for a test. It can also be used to target screening efforts by going directly to places where people live and work.
Tearing Down Fences, sponsored by the Rural Center for AIDS/STD Prevention at Indiana University, presents many useful strategies for implementing HIV testing among hard-to-reach and high-risk populations in rural America. Innovative strategies include interventions targeting migrant farmworkers, where HIV tests are conducted directly in the field during work hours, as well as providing truck drivers with HIV tests at truck stops and rest stops.
Other non-clinical, community settings for testing can include places like:
- Health fairs
- Substance use disorder treatment programs
- Drug stores and pharmacies
- Correctional facilities
- Employment centers and workplaces
- Social services organizations
- College campuses
- Community events
- Places where people socialize, like bars
- Community-based residential facilities
Another option to make HIV screening more available and accessible is mobile testing units. In rural communities, trucks or vans are used to provide a safe space to conduct rapid HIV testing in a variety of locations. One advantage of mobile testing is the flexibility to travel to more remote areas where clinics may not offer free or low-cost HIV testing. Mobile testing can also reach people who are unable or unwilling to visit a clinic for a test because of concerns about confidentiality or their health insurance status. Mobile testing units can also offer a more private space for community-based organizations without a dedicated location for HIV screening. Further, mobile testing units reduce transportation barriers.
Another method of targeting high risk HIV/AIDS populations for testing in rural areas is by working with community-based organizations that support and treat people with substance use disorders. These organizations provide an ideal setting for HIV testing, since people with substance use disorders, especially injection drug users, are at a higher risk for acquiring HIV.
The Centers for Disease Control and Prevention (CDC) reports that cost-effectiveness studies of HIV screening programs conducted by community-based organizations have found that the cost per diagnosis ranges from $10,334 to $20,413. The cost for testing in corrections facilities or jails may vary significantly, depending on the prevalence of HIV and other implementation considerations.
Examples of Community HIV Testing and Screening Programs in Rural Communities:
- The Nebraska AIDS Project (NAP) is a nonprofit advocacy and HIV prevention organization that also provides free rapid HIV testing and counseling both in-office and at other community locations. The program operates in Nebraska, eastern Wyoming, and southern Iowa.
- AIDS Alabama owns a mobile testing unit that can be used for HIV prevention education activities as well as HIV screening. The mobile unit includes two private rooms for HIV testing and counseling, as well as a refrigerator for HIV tests and a comfortable waiting area. It is driven to a number of events and sites where high-risk populations may be present. Event organizers can also invite the mobile unit to attend their health fairs, neighborhood festivals, or other community events.
- The Montana Department of Public Health and Human Services contracts with community-based organizations to implement HIV testing around the state. One testing intervention developed specifically to meet the needs of populations in Montana is called “Taking it to the System.” This intervention is designed for populations living in correctional facilities as well as corrections staff. The intervention has been successful in educating people about HIV and hepatitis C virus risks and implements testing in additional settings including youth detention centers and job training centers.
- Ursuline Sisters HIV/AIDS Ministry is a faith-based organization in Ohio that works with adults and children impacted by HIV/AIDS by providing health and social support services at three different locations in the Mahoning Valley region. Ursuline Sisters has been successful at increasing HIV testing rates in a tri-county rural region by using state-certified peer navigators. In order to conduct testing in Ohio, peer navigators participate in a multi-day HIV counseling and testing certification course. Peer navigators travel to health departments, correctional facilities, substance abuse facilities, college campuses, health fairs, local stores, and other locations to conduct testing.
Considerations for Implementation
There are several considerations for implementing HIV testing in community settings outside of a clinical environment. For instance, to ensure accuracy of screening tests, non-healthcare providers who wish to conduct screenings outside of a healthcare setting need to have adequate training and are also required to obtain a Clinical Laboratory Improvement Amendment (CLIA) Certificate of Waiver by the Food and Drug Administration or to work with another agency who has a lab already CLIA-certified. Interested parties can find information on how to obtain this certification on the CDC's website.
Appropriate training for people who will deliver the tests is essential to make sure that clients who test positive are linked to appropriate care and services as soon as possible. The Centers for Disease Control and Prevention offers extensive resources and training materials to help non-clinical settings implement HIV testing.
In addition, stigma associated with HIV is a major barrier to screening. As such, confidentiality in testing is of the upmost importance. Mobile vans or screening programs may choose to address this by offering screening for other conditions as well, such as high blood pressure or cholesterol. Organizations implementing HIV screening interventions outside of a clinical setting will need strong partnerships and relationships within the community.
Another challenge is that it may be difficult to locate people who test positive during community HIV screenings. This issue can be resolved by only conducting rapid HIV testing at a single site. Providing a private and comfortable waiting area can also encourage people to stay at the site until their results are ready. Structural barriers, such as limited space to provide confidential HIV testing, may limit the feasibility of testing in some non-clinical settings such as correctional facilities. The CDC issued guidance for ensuring privacy and confidentiality in correctional facilities for HIV testing.
Resources to Learn More
for HIV Counseling, Testing, and Referral Services in Non-Clinical Settings
Detailed guide for HIV providers and counselors interested in conducting a non-clinical testing program. While there is some discussion of Maine-specific policies and programs, it also includes resources like workflow charts, testing algorithms, certification opportunities, and best practices.
Organization(s): Maine Center for Disease Control and Prevention
HIV among Incarcerated Populations
Provides facts and resources about HIV in the incarcerated population in the U.S. Includes information about prevention challenges experienced in correctional facilities, as well as key strategies and efforts that the CDC is undertaking to overcome these challenges. The site also lists current CDC recommendations for HIV testing and screening in jails and prisons.
Organization(s): Centers for Disease Control and Prevention
HIV Testing in Nonclinical Settings: A Guide for HIV Testing Providers
Guidance for HIV providers who are interested in implementing rapid or non-rapid HIV training in a community-based (non-clinical) setting. Includes suggestions about how to approach targeting and recruitment of potential clients. Also outlines protocols and scripts to use during testing and counseling sessions.
Organization(s): Centers for Disease Control and Prevention: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
HIV Testing Training Course
Online training course for staff working in non-clinical settings who will be administering rapid HIV tests. Covers topics including specimen handling, quality assurance and quality control, and recommendations for prevention counseling and delivering test results.
Organization(s): Centers for Disease Control and Prevention