A Mobile HIV Education and Testing Program: Bringing Services to Hard-to-Reach Populations

Abstract

Few programs exist that offer a range of human immunodeficiency virus (HIV) services to multiple populations (i.e., substance abusers, individuals on probation, sex workers and their clients, court-mandated perpetrators of domestic violence) in multiple settings (i.e., courts, methadone maintenance clinics, residential and outpatient substance abuse treatment programs). The purpose of this article is to describe a model mobile HIV program, highlighting its flexibility in providing services to clients who infrequently present to traditional clinic-based testing sites. This mobile HIV program was developed to provide on-site HIV testing and counseling, education, and linkages to primary care services. The implementation of the program begins with training of agency staff, who then provide preliminary orientation with clients regarding HIV testing. Approximately 3 weeks later, the mobile program staff (HIV nurse specialist and HIV counselors) provide standardized group pretest counseling and education. Clients who decide to be tested meet with mobile program staff for individualized risk assessment and specimen collection. Two weeks later, clients meet with mobile program staff to obtain results and receive posttest counseling; risk reduction strategies are reemphasized at that time. Unique to this program is the provision of referrals for a wide range of primary care services for both seropositive and seronegative clients. Since 1994, the mobile program has been implemented at six sites, and over 1100 clients have been served. Two major outcomes from the program have been observed: 1. With adequate preparation and psychological support, 40% of hard-to-reach populations will elect to be HIV tested. 2. Through social networks of program participants, HIV-positive individuals not previously engaged in care have been referred to a comprehensive HIV primary care program.

Towards Universal Voluntary HIV Testing and Counselling: A Systematic Review and Meta-Analysis of Community-Based Approaches

“…19 studies reported uptake among 41,110 participants in key populations, including 16,725 MSM [90]–[97], 4,681 PWID [92],[98]–[100], 81 FSW [101], 13,240 adolescents [102],[103], and 6,383 individuals from combinations of key populations. The percentage accepting HTC was 99.7% among FSW, ranged from 13.7% to 94.5% among PWID, ranged from 9.4% to 95.0% among MSM, and ranged from 33.9% to 96.6% among adolescents (Figure 10).…”

HIV testing in community settings in resource‐rich countries: a systematic review of the evidence

“…Five studies provided nontargeted testing to the general population, while the rest addressed HIV testing in one or more high‐risk populations. Eleven studies investigated HIV testing in multiple high‐risk groups . The most commonly targeted group for testing was MSM (17 studies, including two that specifically targeted BME MSM) .…”

“…HIV testing was offered at a wide range of sites. Stand‐alone HIV testing sites (14 studies ) and mobile clinics (11 studies ) were the most frequently selected sites for community testing. Several studies conducted testing in venues known to be frequented by the target population, for example drug treatment centres for IDUs or gay bars and sex on premises venues for MSM.…”

Validation of a single-platform, volumetric, flow cytometry for CD4 T cell count monitoring in therapeutic mobile unit

“…In order to increase the number of individuals tested for HIV, in keeping with our target of universal access, we recently developed a strategy based on bringing the healthcare package much closer to the people, through mobile HIV testing units [15], conceived to bring education and testing services to hard-to-reach population [16]. This pilot study, the first in the Central African region, clearly demonstrated the acceptability, feasibility and effectiveness of using mobile units as a tool for mass HIV testing in individuals with limited access to voluntary counseling and testing [15].…”