Enhanced HIV Prevention and Testing by Aligning Risk and Recency https://grants.dudleytdoughertyfoundation.org/proposals-2015/enhanced-hiv-prevention-and-testing-by-aligning-risk-and-recency-2 https://grants.dudleytdoughertyfoundation.org/@@site-logo/sitelogo-75x75.png

Enhanced HIV Prevention and Testing by Aligning Risk and Recency

Additional Information
Used for	1) Purchase Clearview and Alere Determine rapid HIV testing kits to enable earlier detection of HIV by matching rapid test to the recency of risky behavior occurrence. 2) Support staff time of Registered Nurse and Medical Assistant to implement enhanced risk assessment and testing protocol and coordinate bi-weekly HIV Prevention discussion groups. 3) RAIN (Regional AIDS Interfaith Network) collaboration fee for prevention education and HIV+ consultation and client counseling.
Benefits	Clients will know their status sooner. HIV counseling and primary care via RAIN can be put into place earlier for HIV+ clinic clients. Armed with awareness, knowledge and medication and behavioral compliance, HIV/AIDS multiplier effect can be mitigated, and possibly blunted.
Proposal Description	The beneficiaries of the Program are women who are inherently at high risk of exposure to HIV. By virtue of wanting to know their status (testing), they self-identify and prioritize as being at high-risk. They are women who are homeless, uninsured, living in poverty and staying in the homeless shelter. The majority are African-American. The need for testing in this population is growing as the population grows. In Mecklenburg County, NC, homeless women without children living in shelters increased 37%. Homeless women with children (families)increased 15%. Our clinic is located within the shelter where they live, the Salvation Army Center of Hope, which is the largest homeless shelter for women and children in the county. All shelter residents can access the clinic's free services, including HIV testing, simply by showing their shelter ID. The availability of HIV prevention information and testing at the clinic increases the likelihood of being tested as compared to a referral to another agency/location. The grant will support the outcomes of: 150 women will attend the discussion groups on HIV Prevention and 150 women will be tested. An estimated 2% to 3% may be HIV+. Outcomes achievement will be facilitated by the following: 1) testing protocol will be enhanced to take into consideration type of risky behavior and recency of occurrence. Clinic staff will assess these factors and select the most relevant rapid test to be administered. Both Clearview and Alere Determine rapid tests will be used to incorporate a greater sensitivity to detecting HIV for more recent exposures (program process/protocol map attached). Clinic staff will be trained on the assessment tool and how to administer both brands of rapid tests: 2) Bi-weekly discussion groups will focus on prevention and promote the new capabilities of testing for more recent occurrences. With the new testing capabilities, more discussion group participants may decide to be tested at the group, especially if they had a recent risky occurrence; 3) RAIN remains the collaborative resource for HIV+ counseling, primary care and support. All clients that test HIV+ are referred to RAIN. When clients come to the clinic already HIV+, they are not retested by are immediately referred to RAIN. Program budget is $13,775 (budget attached). Grant funds of $7,500 will be used for program out-of-pocket expenses of $5,548 including : 1) purchase of 150 Clearview and Alere Determine rapid testing kits ($4,650); 2) testing supplies and materials, education material and clinic cleaning/sanitizing ($650); and 3) bus passes used as incentives to attend the discussion groups ($248). The balance of $1,953 will support clinic staff and RAIN collaboration fee. History: Nearly five years ago, our HIV Prevention and Testing Program was initiated. In 2012, The Dudley T. Dougherty Foundation awarded a grant of $16,355 to support program start-up. In 2014, The Dudley T. Dougherty Foundation granted another $5,000 to support offering more testing opportunities, increasing the frequency of the HIV prevention discussion groups and to explore ways to involve adolescents. Involving adolescents requires parental/guardian permission. Gaining permission met with virtually universal resistance from the parents/guardians. Since inception, 848 tests have been administered to the high-risk population of homeless women living in the homeless shelter. Last year, 138 were tested. 142 attended the discussion groups. The OraQuick rapid test was first used in the program. After a couple of years, a change to Clearview rapid test was made to benefit from modest cost savings. Both brands are easy to administer, show results in 15 to 20 minutes and are highly effective (i.e. low incidence of false-positive results). The Clearview window of detection starts at around four weeks after exposure. Lost to potential detection are more recent high-risk behaviors and exposures (one to four weeks). Program: Our enhanced HIV Prevention and Testing Program will align risk (unprotected sex, intravenous drug use and sharing needles) and recency (when behavior occurred). Aligning risk and recency and matching the appropriate rapid test will provide a more responsive HIV testing protocol. Bothe Clearview and Alere Determine will be used in the enhanced program as determined by the risk and recency assessment. Alere Determine has the benefit of a narrower two-week detection window after exposure. Clearview window is four weeks and more. The process/protocol map is attached. The process starts with asking clients what kind of risky behavior was engaged in and when it occurred. * of less than two weeks, both Clearview and Alere Determine rapid tests are ineffective. However, with the higher accuracy of Clearview, the Clearview rapid test will be administered. If results are positive, the client is considered positive. A confirmatory WesternBlot test is run and the client is referred to RAIN. If rapid tests are negative, a WesternBlot test is run as it may be too soon for rapid testing. * If two to four weeks, Alere Determine rapid test in administered. If negative, client is negative. If positive, client is considered positive. A confirmatory WesternBlot test is run and they are referred to RAIN. * If more than four weeks, Clearview is administered. If negative, client is negative. If positive, client is considered positive. A confirmatory WesternBlot test is run and they are referred to RAIN. Note: USDHHS recognizes the accuracy of rapid HIV tests and considers two positive "rapid" tests as accurate. No WesternBLot confirmatory tests are required. North Carolina does not accept this view and requires WesternBlot confirmatory tests for all positive rapid tests. When North Carolina accepts this view, the Program will be changed to administer another rapid test immediately after positive results of the first rapid test appear, and eliminate the WesternBlot test.