Rapid HCV Testing as an HIV Testing Strategy in Rural Areas

Description

According to Epidemiologic Profiles of HIV, STD, and Hepatitis in Missouri 2021, there were 13,856 Missourians living with HIV in 2021. Since HIV testing still carries stigma in rural areas, the Butler County Health Department in southeast Missouri uses an approach that meets another health need in the region while navigating around the HIV stigma. The department provides HCV (Hepatitis C Virus) rapid tests and then offers an HIV rapid test.

The project serves a 20-county area. Sites where the service is provided include:

• Local health departments
• Treatment centers
• Drug courts
• Domestic violence shelters
• Homeless shelters
• Affordable housing organizations
• Juvenile offices and group homes
• Probation and parole offices
• Schools
• City parks
• Senior citizen centers
• Other locations by request

Patients with a presumptive positive are provided with a materials packet that includes general information, resources, and a letter to give to their healthcare provider or clinic. The letter is to be returned to the project staff, allowing tracking of patients' follow-through.

Services offered

• Rapid HCV test, followed by offer of an HIV rapid test
• HIV antigen/antibody test for high-risk patients
• Rapid syphilis antibody tests
• Prevention education for high school students and high-risk individuals
• Condom distribution
• Pre-exposure prophylaxis (PrEP) information
• PrEP clinic, offered on a sliding scale or free

Results

The project began in October 2012. By August 2013:

• 458 rapid HCV tests were conducted, finding 64 positives (14%).
• Of those persons who were offered an HIV test at the time, 407 accepted the offer.

There were no positive HIV test results in the first year of the program. However, this project allowed people who may not have gotten an HIV test to get risk reduction messages, affirmations for reducing their risks, and a chance to find out their current status. It allowed 64 people to find out their positive HCV status and get referrals for services.

In the 9 months prior to the pilot, when only an HIV rapid test was offered, just 21 persons were tested.

The project saw continued success in the following years:

• In 2014, 646 rapid HCV tests were conducted, finding 94 positives (14.5%), and 734 HIV tests were conducted, finding 1 positive.
• In 2015, 900 rapid HCV tests were conducted.
• In 2016, 525 rapid HCV tests were conducted, finding 55 positives (10.5%), and 595 HIV tests were conducted, finding 1 positive.
• In 2017, 475 rapid HCV tests have been conducted, finding 25 positives (5.3%), and 331 HIV tests were conducted, finding 0 positives.

Challenges

Transportation remains a huge barrier for rural residents. Butler County Health Department is training other areas in southeast Missouri so that these community partners can also provide rapid testing and decrease clients' travel time. In addition, traveling to clients and providing education in multiple settings help reduce stigma.

Replication

Project coordinators in the southeast region meet four times each year to discuss topics such as transmission and prevention.

The pilot revealed where this approach was most successful. More people opted to get the rapid HCV test in community settings and were less likely to accept the offer at a local county health department. Outdoor settings saw more traffic when organizers offered free items like gift cards, T-shirts, sunglasses, and hygiene products.

This referral letter (available for use and adaptation) is given to patients with a presumptive positive, to share with their healthcare provider or clinic.

The department used to advertise mainly through flyers but is relying more on social media channels. Project coordinators also created a website to help people in southeast Missouri find testing sites in their counties and learn whether those sites charge a fee for testing.

Contact Information

Karsyn Abernathy, Ending the HIV Epidemic Specialist/PrEP Navigator
Butler County Health Department
Karsyn.Abernathy@lpha.mo.gov