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HIV Testing and Screening in Non-Clinical Settings

Community HIV screening occurs in non-clinical settings. Community HIV screening programs are generally combined with education and outreach events such as health fairs. Some clinical settings may partner with community-based organizations to provide testing resources, including test kits and trained staff members.

Conducting screening in a community setting can help reach a broad set of people who are at risk and may be less likely to visit a clinic for a test. It can also be used to target screening efforts by going directly to places where people live and work.

Tearing Down Fences, a 2009 publication sponsored by the Rural Center for AIDS/STD Prevention at Indiana University, presents many useful strategies for implementing HIV testing among hard-to-reach and high-risk populations in rural America. Innovative strategies include interventions targeting migrant farmworkers, where HIV tests are conducted directly in the field during work hours, as well as providing truck drivers with HIV tests at truck stops and rest stops.

Other non-clinical, community settings for testing can include:

  • Health fairs
  • Schools
  • Substance use disorder treatment programs
  • Drug stores and pharmacies
  • Correctional facilities
  • Employment centers and workplaces
  • Social services organizations
  • College campuses
  • Community events
  • Faith-based organizations
  • Places where people socialize, like bars
  • Community-based residential facilities

Another option to make HIV screening more available and accessible is mobile testing units. In rural communities, trucks or vans are used to provide a safe space to conduct rapid HIV testing in a variety of locations. One advantage of mobile testing is the flexibility to travel to more remote areas where clinics may not offer free or low-cost HIV testing. Mobile testing can also reach people who are unable or unwilling to visit a clinic for a test because of concerns about confidentiality or their health insurance status. Mobile testing units can also offer a more private space for community-based organizations without a dedicated location for HIV screening. Further, mobile testing units reduce transportation barriers.

HIV self-testing (or HIV home testing) is another promising model, especially for people who lack access to healthcare services. One innovative HIV self-testing model involves a program in which city or state health departments offer free HIV self-testing kits to people at risk of HIV.

Another method of targeting high risk HIV/AIDS populations for testing in rural areas is by working with community-based organizations that support and treat people with substance use disorders. These organizations provide an ideal setting for HIV testing, since people with substance use disorders, especially injection drug users, are at a higher risk for acquiring HIV.

The Centers for Disease Control and Prevention (CDC) reports that cost-effectiveness studies of HIV screening programs conducted by community-based organizations have found that the cost per diagnosis ranges from $10,334 to $20,413 (2010 dollars). The cost for testing in corrections facilities or jails may vary significantly, depending on the prevalence of HIV and other implementation considerations.

Examples of HIV Testing and Screening Programs in Non-Clinical Settings:

  • The Nebraska AIDS Project (NAP) is a nonprofit advocacy and HIV prevention organization that also provides free rapid HIV testing and counseling both in-office and at other community locations. The program operates in Nebraska, eastern Wyoming, and southern Iowa.
  • Ursuline Sisters HIV/AIDS Ministry is a faith-based organization in Ohio that works with adults and children impacted by HIV/AIDS by providing health and social support services at three different locations in the Mahoning Valley region. Ursuline Sisters has increased HIV testing rates in a tri-county rural region by using state-certified peer navigators. In order to conduct testing in Ohio, peer navigators participate in a multi-day HIV counseling and testing certification course. Peer navigators travel to health departments, correctional facilities, substance use disorder treatment facilities, college campuses, health fairs, local stores, and other locations to conduct testing.
  • Faith-based organizations (FBOs) are key partners in HIV response and prevention efforts all over the world. FBOs can be found in communities most affected by disparities in HIV diagnosis, treatment, and linkage to care. For example, the Faith-based Anti-stigma Initiative Towards Healing HIV/AIDS (FAITHH) project is an HIV stigma-reduction intervention created to improve HIV knowledge and acceptance among Black/African American faith communities in the rural south.

Considerations for Implementation

There are several considerations for implementing HIV testing in community settings outside of a clinical environment. For instance, to ensure accuracy of screening tests, people who wish to conduct screenings outside of a healthcare setting need to have adequate training and are also required to obtain a Clinical Laboratory Improvement Amendment (CLIA) Certificate of Waiver by the Food and Drug Administration or to work with another agency that has a lab already CLIA-certified. More information on how to obtain this certification on the CDC's website.

Training for people who will deliver the tests is essential to make sure that people who test positive are linked to appropriate care and services as soon as possible. The CDC offers extensive resources and training materials to help organizations in non-clinical settings implement HIV testing.

In addition, stigma associated with HIV is a major barrier to screening. As such, confidentiality in testing is of the utmost importance. Mobile vans or screening programs can address stigma by offering screening for other conditions as well, such as high blood pressure or cholesterol. Organizations implementing HIV screening interventions outside of a clinical setting need strong partnerships and relationships within the community.

Another challenge is that it may be difficult to locate people who test positive during community HIV screenings. This issue can be resolved by only conducting rapid HIV testing at a single site. Providing a private and comfortable waiting area can also encourage people to stay at the site until their results are ready. Structural barriers, such as limited space to provide confidential HIV testing, may limit the feasibility of testing in some non-clinical settings such as correctional facilities. The CDC issued guidance for ensuring privacy and confidentiality in correctional facilities for HIV testing.

Resources to Learn More

HIV and Corrections
Document
Provides an overview of HIV prevalence within the U.S. correctional setting at the local, state and federal level. Discusses HIV epidemiology and prevention, testing, medical treatment, antiretroviral therapy, confidentiality, and chronic medical conditions of inmates with HIV.
Author(s): Strick, L.B., & Budak, J.Z.
Organization(s): National HIV Curriculum
Date: 8/2020

Implementing HIV Testing in Nonclinical Settings: A Guide for HIV Testing Providers
Document
Offers guidance for HIV testing providers interested in implementing rapid or non-rapid HIV test training in a community-based (non-clinical) setting. Includes suggestions on how to approach targeting and recruitment of potential clients, and outlines protocols and scripts to use during testing and counseling sessions.
Organization(s): Centers for Disease Control and Prevention (CDC), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Date: 3/2016