With National HIV Testing Day right around the corner, there’s good news and bad news from the fight-to-end HIV front. The Center for Disease Control’s (CDC’s) latest HIV Surveillance Report, featuring 2022 data, shows that national prevention initiatives are slowly moving in the right direction, with the estimated number of new infections down 12% over the last survey.
However, a closer look at those numbers highlights that this progress is still stymied by significant disparities in health equity for underserved patients, particularly the Black and Latinx communities. The U.S. Department of Health and Human Services’ (HHS’) goal for the Ending the HIV Epidemic in the U.S. initiative (EHE) initiative—to reduce the number of new HIV infections in the United States by at least 90 percent by 2030—still seems largely aspirational, according to many experts. An estimated 1.2 million people in the U.S. are currently living with HIV, and only 87% percent of these individuals are aware of their positive status (the EHE includes a goal of increasing knowledge of HIV status to 95% by 2025).
In the face of unpredictable federal funding and constantly changing 340B drug discount program reimbursement, Avita’s covered entity partners are valiantly leading the charge to boost HIV testing, education, and care linkage across the United States. They know that helping community members understand their HIV status by offering convenient, fast, and comfortable community testing opportunities is key: Studies show that patients who learn they are HIV positive modify their behavior to reduce transmission, while individuals who are not aware they are living with HIV account for nearly 40% of new HIV infections.
At the forefront of innovating a multifaceted HIV testing program is longtime Avita partner CrescentCare, a New Orleans-based federally qualified health center (FQHC) committed to strengthening the wellness of the entire community through whole-person healthcare and education rooted in inclusivity, representation, and dignity. Read on to learn how its team has leveraged inclusion, patient choice, and compassion to successfully encourage community members to empower their health by knowing their HIV status.
Studies show that patients who learn they are HIV positive modify their behavior to reduce transmission, while individuals who are not aware they are living with HIV account for nearly 40% of new HIV infections.
An integrated HIV testing program built on patient choice
When HHS launched the EHE initiative in February 2019, it began by focusing resources, expertise, and technology on 57 prioritized jurisdictions across the United States. Louisiana’s Orleans Parish (home of New Orleans) was on the list. In 2022, Louisiana ranked 4th in the nation for HIV diagnosis rates, and the New Orleans Metropolitan Statistical Area (MSA) ranked 11th for HIV diagnosis rates among large metropolitan areas in the country.
CrescentCare has been on the ground in New Orleans (it was founded in 1983 as NO/AIDS Task Force and has since expanded its service and catchment areas as an FQHC), providing HIV/AIDS health services to the community since the beginning of the epidemic. Its team has addressed the dual challenge of increasing HIV testing and prevention in a city that is both a tourist hub and includes a largely underserved patient population by making HIV testing core to its care philosophy. “We’ve been able to integrate HIV testing into almost every aspect of the work we do in one way or another,” says the organization’s Prevention Manager of STI Testing and Treatment Programs, Blayke D’Ambrosio.
This includes offering rapid HIV testing with follow-up pre-exposure prophylaxis (PrEP) or HIV treatment care linkage:
- At CrescentCare’s clinic during walk-in hours
- During clinical appointments at multiple locations
- In coordination with local community partner events (think universities, non-profits, and city-organized events)
- Via the CrescentCare mobile testing van
As well as take-home HIV testing kits with follow-up PrEP or HIV treatment linkage, which are available:
- At CrescentCare’s clinic
- At select community outreach events
- Via CrescentCare telehealth partner Q Care Plus (with linkage to care through CrescentCare)
Offering a variety of HIV testing options incorporated into almost every part of CrescentCare’s services “helps normalize it from a stigma standpoint,” D’Ambrosio says. “This helps lower the transmission of HIV by engaging people who otherwise may not have gotten tested via one of our more traditional methods.”
Offering a variety of HIV testing options incorporated into almost every part of CrescentCare’s services “helps normalize it from a stigma standpoint. This helps lower the transmission of HIV by engaging people who otherwise may not have gotten tested via one of our more traditional methods.”
Fighting HIV stigma with compassion, one patient and one test at a time
When it comes to successfully encouraging patients to get tested for HIV, giving them a choice of testing methods tailored to their personalized needs is key, CrescentCare’s D’Ambrosio explains. That’s because, in addition to health equity issues that may prevent access to care, the organization’s testing team is constantly battling HIV stigma. “The work that we do is and should be focused on the patients and the people in the communities we’re serving,” she says. “We need to meet them where they’re at versus inherently wanting them to meet us where we’re at.
“Despite it being 2024, there’s still a lot of stigma around HIV and HIV testing,” she continues. “And that includes any location that’s associated with HIV. By going out into the community and offering testing via community events and our mobile van, we don’t require someone to come to a building where they might be afraid they’ll run into a neighbor or a family member.”
Training testing staff about compassionate care, cultural competency, and effective communication is also crucial, D’Ambrosio says. “A big part of overcoming HIV stigma is when the person who is testing you has a great attitude,” she explains. “Out testing staff has all completed training with the state in addition to undertaking continuous education we conduct in the office. This includes best practices in motivational interviewing, reading the patient in front of you and figuring out what they need, and avoiding using stigmatizing language.”
While the CrescentCare testing team wants to screen as many people as possible, the quality of the patient interaction is more important than just funneling people through testing, she adds. “We generally go into a testing session knowing that we’ll have 20 minutes with a patient at a bare minimum while their test results process,” she says. “But we’ll spend 40 minutes or longer talking to someone with many questions after a result. We want to give people the space they need to get as much information as possible.”
The work that we do is and should be focused on the patients and the people in the communities we're serving. We need to meet them where they're at versus inherently wanting them to meet us where we're at.
Tips for covered entities ramping up their HIV testing programs
When it comes to covered entities building out their HIV testing programs, D’Ambrosio has a key piece of advice: Be strategic. While CrescentCare now tests over 4,000 people annually for HIV via a variety of methods, they’ve crafted their services over time while paying particular attention to the following:
- Targeting audience needs and location: Who are you trying to engage? Where are they living and working? How has this shifted over time? For example, “We’ve seen a shift where testing in bars all the time isn’t as effective as testing at a college, city health event, or low-barrier shelter,” D’Ambrosio says. “It’s all about how we meet the needs of individuals.” For more tips on driving attendance to your HIV testing event, click here.
- Funding: “As we built our testing program, the first thing we asked ourselves was, ‘Can we fund this ourselves? If we can’t, can we get assistance with a grant from the state or another organization?’” D’Ambrosio says. If your organization is not already conducting rapid testing, she recommends researching if your state is looking for new testing partners first and going from there. Review your target audience and funding needs regularly. For example, “When we came out of the pandemic, we had to determine which testing strategies were still working or not,” she says.
- Workflow, follow-up, and considering your testing team: Figuring out your audience needs and funding are just the tip of the iceberg, D’Ambrosio says. You’ll also want to thoroughly document your testing workflows and follow-up processes for each method to ensure you’re offering a great patient experience, getting tests back on time, and linking patients to prevention or treatment services without snafus. Your testing team is at the heart of your entire operation, so “make sure your staff are taken care of before you expand too large,” she says. “You don’t want to overwhelm them. Be mindful of how you can diversify testing sustainably.”
Make sure your staff are taken care of before you expand too large. You don’t want to overwhelm them. Be mindful of how you can diversify testing sustainably.
