Online Program

Dissemination of Αt-home HIV testing to high-risk urban African American youth: Barriers and solutions

Wednesday, November 6, 2013 : 1:15 p.m. - 1:30 p.m.

Joseph Catania, PhD, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR
M. Margaret Dolcini, PhD, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR
Daniel Dowhower, MS, MPH, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR
Gary W. Harper, PhD, MPH, Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
Natalie Teixeira, BS, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR
Background: The At-home HIV test (AHT) has the potential to increase knowledge of HIV status and linkage to care globally among populations that avoid testing due to fear of stigmatization. In the U.S., many young African Americans remain untested, resulting in negative medical outcomes. Our prior work showed that untested high-risk youth favored AHT over clinic-based approaches, but research on AHT dissemination strategies is lacking.

Method: To understand the barriers and facilitators of AHT dissemination, we conducted 9 focus groups (5 youth groups; 4 provider groups), an ethnographic study of pharmacies (n = 10), and had individual providers evaluate AHT kits (n = 5). Youth were from low-income neighborhoods in Chicago and providers worked in non-clinical community-based (CBOs) agencies serving these communities.

Results: Youth and providers identified some advantages of AHT in reducing barriers to testing posed by clinic venues, especially for African American males. Furthermore, they identified multiple advantages of delivering AHT through CBOs as opposed to pharmacies (e.g., increased confidentiality, reduced stigma, lower costs), and suggested that CBOs may be able to facilitate follow-up counseling and linkage-to-care. Ethnographic data indicated that pharmacy dissemination has additional challenges (e.g., limited access, availability, competing motives). Providers emphasized the need for achieving proper fit between AHT and agency programs and goals.

Conclusions: Findings suggest that, given proper attention to fit, AHT dissemination to urban African American youth could be facilitated through distribution by non-medical CBOs. This work has global implications for the test-and-treat programs in cultures with high levels of HIV stigma.

Learning Areas:

Planning of health education strategies, interventions, and programs
Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe the challenges of pharmacy-based dissemination of the At-home test for populations that experience stigma, such as urban African American youth. Discuss alternative approaches to pharmacy-based dissemination and the importance of program ‘fit’ in determining the appropriate role for non-clinical community-based agencies in dissemination of ATH.

Keyword(s): HIV Interventions, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have over 25 years experience as PI or co-PI on federally funded research on HIV/STI prevention. My experience includes research with urban African American youth and I conducted some of the earliest studies of HIV testing and counseling.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.