Rapid HIV testing experience at Veterans Affairs North Texas Health Care System's Homeless Stand Downs

Abstract

In the USA, 21% of the estimated 1.1 million people living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) are unaware they are HIV-infected. In 2011, Veterans Health Administration (VHA)'s Office of Public Health in conjunction with VHA's Health Care for Homeless Veterans Program funded grants to support rapid HIV testing at homeless outreach events because homeless populations are more likely to obtain emergent rather than preventive care and have a higher HIV seroprevalence as compared to the general population. Because of a Veterans Affairs North Texas Health Care System (VANTHCS)'s laboratory testing requirement, VANTHCS partnered with community agencies to offer rapid HIV testing for the first time at VANTHCS' 2011 Homeless Stand Downs in Dallas, Fort Worth, and Texoma, Texas. Homeless Stand Downs are outreach events that connect Veterans with services. Veterans who declined testing were asked their reasons for declining. Comparisons by Homeless Stand Down site used Pearson χ², substituting Fisher's Exact tests for expected cell sizes <5. Of the 910 Veterans attending the Homeless Stand Downs, 261 Veterans reported reasons for declining HIV testing, and 133 Veterans were tested, where 92% of the tested Veterans obtained their test results at the events – all tested negative. Veterans' reported reasons for declining HIV testing included previous negative result (n=168), no time to test (n=49), no risk factors (n=36), testing is not a priority (n=11), uninterested in knowing serostatus (n=6), and HIV-infected (n=3). Only “no time to test” differed significantly by Homeless Stand Down site. Nonresponse rate was 54%. Offering rapid HIV testing at Homeless Stand Downs is a promising testing venue since 15% of Veterans attending VANTHCS' Homeless Stand Downs were tested for HIV, and majority obtained their HIV test results at point-of-care while further research is needed to determine how to improve these rates.

Keywords:

• HIV
• screening
• homeless persons
• Veterans
• community outreach

Acknowledgments

The points of view in this document are those of the authors and do not necessarily represent the official position of the Department of Veterans Affairs, the US Government, or the University of Texas Southwestern Medical Center. None of the manuscript authors have any conflict of interests. Dr. North discloses research support from NIAAA, NIDDK, the Department of Veterans Affairs, the American Psychiatric Association, and the Orthopaedic Trauma Association, and consultant fees from the Tarrant County, Texas Department of Health, the Texas Department of State Health Services, and the Pueblo, Colorado City/County Department of Health. Dr. Surís currently receives research support for the following activities: She serves as an expert consultant in a UT Dallas Center for Brain Health study sponsored by the Department of the Army: award number W81XWH-11-2-0132: Novel Treatment of Emotional Dysfunction in PTSD (principal investigator: John Hart Jr., M.D). She is site principal investigator for Department of Defense study Developing Memory Reconsolidation Blockers as Novel PTSD Treatments (subcontract between Massachusetts General Hospital and Dallas VA Research Corp). She is principal investigator for VA RR&D Merit Review sponsored study, Extinction of Fear Memories with Glucocorticoids in Veterans with PTSD. Dr. Bedimo discloses research support from Merck & Company and Tibotec Therapeutics and consultant fees from AIDS Arms, Inc. Dr. LePage discloses research support from the Department of Veterans Affairs.

We would like to thank AIDS Arms, Inc., MHMR of Tarrant County, and Callie Clinic for providing Veterans who attended the 2011 VANTHCS Homeless Stand Downs with HIV testing and counseling, VHA's Office of Public Health along with Health Care for Homeless Veterans Program for supporting HIV testing, and Four Rivers and Resources Connection for providing testing and counseling space. We greatly appreciate the support and assistance of all the Stand Down volunteers and VANTHCS staff, in particular, Robin Amirkhan, Vania Brown-Small, Pushpi Chaudhary, Teresa House-Hatfield, Don Hubbard, Joanne Hurtekant, Cheryl Johnson, Gwendolyn Johnson, Helen Lacy, Valetta Morrow, Catherine Orsak, Sheryl Poyer, Linda Saucedo, Marye Shellito, and Tammra Wood. We would also like to thank the Veterans for their service and time.

Notes

1. Please note that the word “Veteran” was capitalized in this manuscript in accordance to VA Secretary Eric Shinseki's guidance.