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HIV seropositivity rates in outreach-based counseling and testing services: program evaluation
W DiFranceisco1, D R Holtgrave, N Hoxie
1Cost-Effectiveness Studies Core, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee 53226, USA. wayned@mcw.edu
Summary
Outreach HIV counseling and testing may not reach higher HIV prevalence populations. Race significantly impacts the relationship between service setting and HIV test outcomes, suggesting targeted strategies are needed.
Area of Science:
- Public Health
- Epidemiology
- Behavioral Science
Background:
- Outreach-based HIV counseling and testing (HCT) services are often assumed to reach populations with higher HIV seroprevalence compared to clinic-based services.
- Understanding the differential reach and effectiveness of various HCT service settings is crucial for optimizing public health interventions.
Purpose of the Study:
- To examine the assumption that outreach-based HCT services serve a clientele with higher HIV seroprevalence than clinic-based services.
- To investigate the relationship between HCT service setting and HIV test outcomes, considering various demographic and behavioral factors.
Main Methods:
- Analysis of anonymous Wisconsin HIV counseling and testing client records (n=62,299) from 1992 to 1995.
- Bivariate analysis and logistic regression were used to examine the association between service setting (outreach vs. clinic) and HIV seropositivity.
- Interactions between service setting and covariates including age, race, gender, testing history, risk exposure, and region were analyzed.
Main Results:
- Initial bivariate analysis suggested outreach contacts were 23% more likely to test HIV-seropositive than clinic-based contacts (OR, 1.23).
- Logistic regression revealed an inverted relationship, with outreach contacts being significantly less likely to test HIV-positive in some subpopulations (OR, 0.65).
- Race was identified as a critical factor, significantly modifying the relationship between service setting and HIV test outcomes.
Conclusions:
- The effectiveness of outreach HCT services in reaching higher HIV prevalence populations is not universally supported and varies by demographic factors.
- Retargeting outreach services is recommended to enhance overall effectiveness, with a focus on "marketing" HCT to nonwhite populations.
- Selective resource allocation towards gay/bisexual men across all races is advised for greater impact.
Keywords:
Acquired Immunodeficiency SyndromeAmericasBehaviorBiologyBlacksClinic ActivitiesCorrelation StudiesCounselingCultural BackgroundDelivery Of Health CareDemographic FactorsDeveloped CountriesDiseasesEthnic GroupsExaminations And DiagnosesHealthHealth FacilitiesHiv InfectionsHiv SerodiagnosisHomosexualsLaboratory Examinations And DiagnosesNorth AmericaNorthern AmericaOrganization And AdministrationPopulationPopulation CharacteristicsProgram ActivitiesProgram DesignProgram EvaluationProgramsResearch MethodologyResearch ReportRisk FactorsSex BehaviorStatistical StudiesStudiesTarget PopulationUnited StatesViral DiseasesWhitesWisconsin