Background: Integration of HIV/STD/HCV testing at the client level in non-clinical outreach venues is challenging, but has the potential to reach high-risk individuals who may not otherwise seek out testing services.
Objectives: To describe the implementation/outcomes of an integrated community-based, bio-behavioral testing program model reaching high risk MSM.
Methods: Since 2007 ACNENY, a community-based organization (CBO) serving 15 counties in upstate New York, has trained outreach workers to directly provide HIV/STD/HCV screening with individualized risk reduction counseling in multiple community settings frequented by high-risk MSM. Federal/state STD and HIV prevention funding streams are blended to cover costs (rapid HIV tests; urine-based screening for Chlamydia/gonorrhea; venipuncture for syphilis). Integrated testing in field settings required new protocols (e.g., training outreach workers in phlebotomy, procedures for notifying clients of results and facilitated access to treatment). Availability of testing is publicized through innovative use of social networking sites/flyers/website and in-person outreach.
Results: In 2008, uptake was highest for urine screening (483 tested – 2.1% positivity for Chlamydia / 0.4% for gonorrhea), followed by HIV (365 tested -1.6% positivity) and syphilis (174 tested -2.3% positivity). The four new early syphilis cases were identified through bathhouse testing in a typically low morbidity geographic area.
Conclusions: Providing HIV/STD/HCV testing in locations where the target population congregates is an effective method for identifying new infections and reaching high-risk individuals who may not otherwise seek out testing services. Detailed protocols developed for the project could be adapted by other CBOs seeking to expand existing HIV testing activities to integrated HIV/STD/HCV screening.
Implications for Programs, Policy, and/or Research: The integration of syphilis testing into existing testing services is cost-effective. Provision of these services by community-based organizations that have existing relationships within the community increases access and effectiveness of the intervention. Additionally, early identification reduces negative health outcomes and increased transmission.