HIV seropositivity rates in outreach-based counseling and testing services: program evaluation
DiFranceisco, W.; Holtgrave, D.R.; Hoxie, N.; Reiser, W.J.; Resenhoeft, R.; Pinkerton, S.D.; Vergeront, J.
Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology Official Publication of the International Retrovirology Association 19(3): 282-288
1998
ISSN/ISBN: 1077-9450 PMID: 9803971 DOI: 10.1097/00042560-199811010-00011Document Number: 278292
The assumption that outreach-based HIV counseling and testing services reach a clientele with a higher HIV seroprevalence than similar clinic-based services was investigated as part of a comprehensive evaluation of the state of Wisconsin's (US) HIV counseling and testing program in 1992-95. Client records were available for 62,299 anonymous outreach- and clinic-based testing episodes. 0.9% of outreach and 0.8% of clinic clients tested HIV-positive. Although contacts in the high-exposure risk group were 13.7 times more likely to be HIV-infected than those in lower risk categories, they were only 1.9 times more likely to have been served in an outreach setting. Among non-White counseling and testing clients, the odds of selection through outreach (odds ratio (OR), 3.34; 95% confidence interval (CI), 3.2-3.5) was similar to the overall seropositivity risk (OR, 3.01; 95% CI, 2.5-3.6). An inverted relation between service setting and seropositivity (OR, 0.65; 95% CI, 0.5-0.8) indicated that, within some subpopulations, outreach contacts were significantly less likely to test HIV-positive than clinic clients. In fact, multivariate analysis revealed a negative association between HIV positivity and outreach when demographic and contextual factors were controlled. 22% of HIV-positive White male clients who reported sex with men were identified through outreach, but this was the only risk exposure category for Whites in which the proportion of outreach among seropositive cases exceeded the overall success rate for outreach (20.5%). Men reporting sex with men represented 41.5% of all seropositive cases among non-Whites. These findings indicate a need to re-target outreach services, especially toward non-Whites and gay/bisexual men, to enhance their overall effectiveness.