Nationwide, nearly half of those tested for HIV at public testing sites do not return for their results. While Care for the Homeless has a higher-than-average return rate, we still want to do better. To counter this grim statistic, we have begun offering the OraQuick® Rapid HIV-1 Antibody Test. Approved by the FDA in November of 2002, this highly sensitive test involves a quick, painless finger stick, and produces results in only 20 minutes. Previously, the only HIV test available required a two-week wait, and many homeless clients cannot make the second trip.

Working with Care for the Homeless staff, and researching the issue for several months, Health Education Coordinator Shelly Moore designed a 26-week pilot project at Broadway Presbyterian Church, a soup kitchen in Manhattan. For some time, staff members had theorized that using rapid test technology would increase the number of clients who got tested for HIV, the number who received their results quickly, and the number successfully referred for primary care and intensive case management services.

Clients have less to fear from OraQuick® than they might from the standard test because it is less painful and they avoid two weeks of worry. If the result is positive, Shelly or Health Educator Jocelyn Apicello can refer the client immediately to the Care for the Homeless medical team and to George Wilkins, CFH’s on-site Intensive Case Manager, who can provide support and coordinate follow-up.

Every Monday, Shelly and Jocelyn set up at the soup kitchen, and one administers the tests while the other performs outreach with the individuals eating lunch. Clients who want to be tested first undergo a pre-test counseling session, in accordance with New York State Public Health Law. After taking a blood sample, the health educators discuss risk reduction and partner notification with their clients while the test is processing. Many providers and clients find this pre- and post-test counseling burdensome, but Shelly emphasizes its importance. “Care for the Homeless is clear about the law,” she says. “Our clients are particularly vulnerable, which makes it even more necessary that all the elements of informed consent remain in place.”

Shelly and Jocelyn conduct a brief, five-question quality assessment survey after they see each patient. All but one of the clients tested so far have been “very satisfied” with the test and that one was “satisfied.” All would take a rapid test again, one client exclaiming, “Without a doubt,” and another describing the test as “quick, easy and painless.” One client took the standard test once before, but didn’t return for the results because “it was too far out of the way.” Others explained that they did not want to take the standard test because “I did not want to feel nervous for two whole weeks waiting for my results,” and “Two weeks is so long.”