Implementing a Rapid HIV Testing/Linkage to Care Project Among Homeless Individuals in Los Angeles County: A Collaborative Effort between Federal, County, and City Government

BACKGROUND The homeless population, though vulnerable to HIV infection, traditionally lacks access to HIV testing diagnostics and linkage to care (LOC). This project, an ongoing collaborative effort involving Gilead Sciences, the US Department of Veterans Affairs (VA); County of Los Angeles, Department of Public Health, Office of AIDS Programs and Policy; and City of Los Angeles AIDS Coordinator's Office, is evaluating barriers and facilitators to: providing HIV rapid testing to homeless shelter clients; linking HIV-positive individuals to care through the VA or Los Angeles County Department of Health Services, depending on veteran status.

METHODS HIV oral rapid tests are offered by HIV counselors. In cases with (preliminary) positive test findings, confirmatory test and clinic appointment is arranged, and taxi voucher is provided. Summary sheets are kept including tests conducted and client's veteran status. Data analysis is ongoing to review performance.

RESULTS A year of data indicates significant progress in testing — 552 clients tested (28 veterans), 5 preliminary positives (4 confirmed positive; 1 did not receive confirmation). LOC confirmed for 3; county affirms the 4th client's LOC — pending proper support documentation. Challenges included development of confirmatory test procedures, gap between confirmation and LOC, and LOC follow-up.

CONCLUSION This collaboration between governmental agencies has been successful, and can be used as a model for future collaborative efforts of this type. Efforts are ongoing to better track clients using a new linkage to care model. We hope that this new model of linking immediately upon preliminary reading will expedite LOC.