Choosing HIV Counseling and Testing Strategies for Outreach Settings

Despite ongoing risks, many people are not regularly tested for HIV. In qualitative and survey studies, clients cited as testing barriers to traditional testing and counseling: the need for a clinic appointment; venipuncture; face-to-face counseling; the wait for test results; and a return visit to the clinic. In the current study, researchers hoped to determine which HIV testing and counseling methods ensured that clients received test results.

Clients of a needle-exchange site and two bathhouses for men who have sex with men (MSM) were offered on randomly determined days one of four testing strategies: traditional testing with standard counseling (TS), rapid test with standard counseling (RS), oral fluid test with standard counseling (OS), and traditional test with the option of written pretest materials or standard counseling (TO).

Of 10,058 needle-exchange clients and 6,952 bathhouse clients offered testing, 4,165 declined (27 percent of needle-exchange; 21 percent of bathhouse), 5,831 were ineligible, and 7,014 (41 percent) were eligible, of whom 761 (11 percent) were tested: 324 at the needle exchange and 437 at the bathhouses.

The proportion of clients accepting HIV testing differed significantly by strategy. More needle-exchange clients accepted OS and received results compared with the traditional tests (11.9 percent accepted TS; 14.1 percent accepted RS). Of those offered TO, 56 (77 percent) chose written materials rather than face-to-face counseling. More bathhouse clients accepted OS (22.8 percent vs. 21.2 percent RS and 15.8 percent TS), but more clients overall received results on RS days. Offered TO, 82 (81 percent) bathhouse clients chose written materials rather than face-to-face counseling, though acceptance rates for TS and TO did not significantly differ. At both sites, more clients who completed testing received their results under RS compared with TS.

Among those who accepted testing, completion rates (61 percent needle exchange; 78 percent bathhouse) correlated well with shorter waiting times, which depended on the testing strategy used and number of testing acceptors. Per-client time was longer for RS because the counselor also performed the test. Per-client time was shorter when clients opted for written pretest materials.

All testers but those in RS were given the option of receiving results via telephone. Of all testers, 17 were HIV-positive. At the bathhouse, all 3 RS testers received their results; 2 were Western-blot confirmed HIV-positive and 1 was negative. Among the 13 HIV-positive in non-RS testing, 4 received their results. At the needle exchange, both the clients testing positive (1 OS; 1 TO) received their results.

"Oral fluid testing and rapid blood testing at both outreach venues resulted in significantly more people receiving test results compared with traditional HIV testing," researchers concluded. "Making counseling optional increased testing at the needle exchange but not at the bathhouses."