Rapid HIV Testing in Shelters for the Homeless

The Goal of the Study

The goal of this study is to increase HIV testing rates, learn more about how to provide testing to people living in homeless shelters and connect HIV-positive people to care.

First Goal: Providing Routine HIV Rapid Testing

The first goal would be to provide homeless shelter residents with routine HIV rapid testing. The first theory is that most homeless people have insufficient access to HIV fast testing services or none.

Second Goal: Identifying Reasons for Lack of HIV Awareness

The second goal is to identify possible reasons why most homeless people are unaware of their HIV status. The theory is that among the homeless, lower return-for-result rates are a significant factor.

Methods

Sample Collection

Researchers will gather participants from 10 homeless shelters across the US. Random samples will be used to increase the likelihood of using a broad range of representatives of homeless people for the study (Korn, & Graubard, 2011). 50 homeless individuals from each of the 10 homeless shelters will be picked randomly to create a cluster sample. Cluster samples are useful when the target population members have a wide geographical dispersion (Bowles et al., 2008; Korn, & Graubard, 2011). A random purposeful sampling method will be employed while recruiting participants for this research. This technique improves the credibility of data collected besides helping to identify cases that are rich in information (Buchanan, Kee, Sadowski, & Garcia, 2009). Preferred participants should be between 18-26 years to fit in our criterion of importance in which the targets should be youths to young adults. Studies show that homeless youths have a higher risk of HIV infection than their adult counterparts (Aidala, Cross, Stall, Harre, & Sumartojo, 2005; Goodman & Berecochea, 1994). The age limits make our sample be a criterion sample in which participants are supposed to have a predetermined characteristic (Korn, & Graubard, 2011; Leaver, Bargh, Dunn, & Hwang, 2007). Researchers will give participants incentives in the form of a $20 gift card at the end of the research. Flyers and loudspeaker notifications will be used to disseminate information about the initiative. Graduate students well versed with data collection will be recruited to help in collecting data. Health care providers will train research assistants on the usage of the HIV rapid testing kits.

Data Collection

Written surveys will be conducted to enquire about the HIV status of homeless people. Preliminary rapid screening tests will be carried out to check the HIV status of participants. Scheduling an appointment for a confirmatory test will be done. Health care providers will conduct HIV confirmatory tests in the area hospital where counselors will link seropositive individuals to care. The number of participants who return for their results besides the new HIV diagnosis cases will be recorded. Interviews will be registered in an audio and transcribed into text. The study will take 3 years. Individuals who will test positive per every confirmatory test will be the dependent variable.

Data Analysis

It will involve qualitative and quantitative research (Korn, & Graubard, 2011). Qualitative techniques will require an analysis of the numbers of tests administered, the number of positive cases at the introductory level and after confirmatory tests. Quantitatively, the research team will review the transcripts to identify general themes. Researchers will base themes on the participants’ perception of why most homeless people do not know their status, their feelings on how adequate are testing centers and on survey questions related to their HIV status. Common themes identified will be correlated with prior studies done on the topic (Holtgrave & Curran, 2006). A simple regression test will be used to analyze the relationship between the variables (Korn, & Graubard, 2011).

Ethics

Since the interview in the study is of human beings over sensitive issues about their health, IRB authorization has been acquired (Bowles et al., 2008). Subjects will be required to consent before agreeing to have their HIV status screened (Leaver, Bargh, Dunn, & Hwang, 2007). Counseling of participants will take place before and after testing. Only the subjects and their care providers will know their HIV status. Data recorded will be in coded form and transcripts will be de-identified to maintain the confidentiality of subjects.

Data Sharing

Due to the extreme sensitivity of the data collected, results of the HIV status of research subjects will not be published. Other researchers will not be given the raw data as it will only be available to the research team. Researchers will withhold the names of the respondents.

Timeline

Preliminary testing for all the shelters will take 3 months after which confirmatory tests will be conducted after 3 months elapse. Confirmatory tests will take another 2 months. The interviews will take 1 year during which three interviews will be performed for each subject. The total of 1500 interviews will be transcribed in 8 months. Themes in each interview will be analyzed by the large team of researchers in 8 months. Compiling of results and writing the discussion will take 6 months.

Conclusion

Homelessness, a major problem in the US, predisposes homeless people to higher mortality and morbidity. The relationship between HIV and homelessness is intricate. Homelessness is considered as a great predictor of HIV prevalence rates. Homeless people have a higher risk of being infected with HIV as compared to people stably housed. Despite the high prevalence rates, homeless people have inadequate testing opportunities. Even among those who are tested, failure to return for the confirmatory test has contributed significantly to the spread of HIV among the homeless. Due to the high chances of people who are unaware of their seropositivity infecting others, availing HIV rapid testing to the homeless would be a sure step in controlling the epidemic.

References

Aidala, A., Cross, J. E., Stall, R., Harre, D., & Sumartojo, E. (2005). Housing status and HIV risk behaviors: Implications for prevention and policy. AIDS and Behavior, 9(3), 251-265.
Bowles, K. E., Clark, H. A., Tai, E., Sullivan, P. S., Song, B., Tsang, J., & Aguirre, D. (2008). Implementing rapid HIV testing in outreach and community settings: results from an advancing HIV prevention demonstration project conducted in seven US cities. Public Health Reports, 123(3_suppl), 78-85.
Buchanan, D., Kee, R., Sadowski, L. S., & Garcia, D. (2009). The health impact of supportive housing for HIV-positive homeless patients: a randomized controlled trial. American Journal of Public Health, 99(S3), S675-S680.
Bucher, J. B., Thomas, K. M., Guzman, D., Riley, E., Dela Cruz, N., & Bangsberg, D. R. (2007). Community‐based rapid HIV testing in homeless and marginally housed adults in San Francisco. HIV medicine, 8(1), 28-31.
Goodman, E., & Berecochea, J. E. (1994). Predictors of HIV testing among runaway and homeless adolescents. Journal of Adolescent Health, 15(7), 566-572.
Holtgrave, D. R., & Curran, J. W. (2006). What works, and what remains to be done, in HIV prevention in the United States. Annu. Rev. Public Health, 27, 261-275.
Korn, E. L., & Graubard, B. I. (2011). Analysis of health surveys (Vol. 323). John Wiley & Sons.
Leaver, C. A., Bargh, G., Dunn, J. R., & Hwang, S. W. (2007). The effects of housing status on health-related outcomes in people living with HIV: a systematic review of the literature. AIDS and Behavior, 11(2), 85-100.