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Stories From the Field: Implementing HIV Self-Testing with Limited Staff Capacity

Jul 27, 2020 | Julia Zigman

In May 2020, NACCHO conducted a brief survey to assess local health departments’ (LHDs) HIV self-testing capacity and challenges. The survey highlighted a need for information about the variety of approaches health departments use to implement innovative HIV testing strategies. To fill that need, NACCHO has launched this ‘Stories from the Field’ series on HIV self-testing programs at LHDs. This is Part 1 of the series. Read about other models of self-testing at local health departments on our blog.


From stigma to COVID-19-related clinic closures, there are many reasons why individuals are unwilling or unable to access HIV testing through facility-based testing methods. Through its HIV In-Home Testing Program, Denver Public Health works with Orasure Technologies to provide free, anonymous HIV testing to eligible clients. The program has empowered hundreds to know their HIV status.

Denver Public Health (DPH) is one of the many local health departments (LHDs) offering self-testing for HIV as a way to expand access to HIV testing to all individuals. Self-testing is one innovative strategy recommended by the CDC to scale up testing in communities who are unable or unwilling to access in-person testing due to stigma, geographic constraints, clinic closures, and many other barriers.

DPH’s Model to Implementing Self-testing

HIV self-testing expands testing beyond the HIV/STI clinic by allowing individuals to take an HIV test and find out the result in their own home or other private location. The kits, manufactured by Orasure Technologies®, include an oral swab HIV test with illustrated instructions on administering and interpreting the test, along with post-test resources such as contact information for prevention and treatment service providers and a 24/7 hotline for questions.

Following an increase in HIV diagnoses, particularly among women and people who inject drugs, Denver Public Health decided there was a need to provide a low-barrier testing program with broad eligibility criteria. DPH began developing its self-testing program in 2019, opening its pilot to anyone over 18 in its jurisdiction and focusing on those who had injected drugs or had condomless sex within the last year.

To conserve staff time, DPH took advantage of Orasure’s option to purchase coupon codes from Orasure that can be used by individuals to order a free test directly from the manufacturer. Additionally, Orasure’s in-house design team works with clients such as DPH to create custom inserts (see front and back) with information about health departments’ and CBOs’ post-testing resources and next steps.

The process is outlined below:

  • DPH purchases a list of coupon codes, which can be used to redeem test kits, from Orasure.
  • Interested clients fill out an online Redcap survey on Denver’s website to share basic demographic information and confirm eligibility.
  • Once eligibility is confirmed, an LHD staff member emails a coupon code and more information about the testing process to a client.
  • The client enters the code and their mailing address on Orasure’s website.
  • Orasure mails a custom test kit with information about resources in the client’s zip code for linkage to prevention and treatment care; what to do if the results are reactive/non-reactive; and mental health support.
  • Clients complete the test according to the package’s instructions and can reach out to DPH, Orasure, or one of the community-based organizations (CBOs) listed in the kit for support and linkage to care.

For DPH, Orasure’s ability to manage the kit logistics – such as proper storage, tracking expiration dates, and preparing and shipping the kits – makes the program sustainable across a larger population, with little staff involvement. The pilot program took one year to develop, but through a combination of Orasure’s management and automated survey software, the program requires minimal staff time to manage. DPH employs a CDC Public Health Associate Program (PHAP) Fellow who uses some of their time to oversee the self-testing program, allowing program staff to spend the majority of their time on other HIV outreach programs.


Coupon Code Model: Tips for Success

  • Ordering coupon codes from Orasure supports LHDs with low capacity for self-testing by “outsourcing” the purchasing, packaging, and mailing of kits.
  • Send automatic reminders to clients to redeem their test from Orasure after receiving a coupon code.
  • Generally, only one coupon code may be redeemed for a single shipping address. Identify shelters and other locations in your jurisdiction where multiple tests may be shipped and share these addresses with the manufacturer.

Moving Forward

The program has received much interest in the region, and DPH staff envision an even greater reach for the program in 2020 and beyond. Due to budget cuts in the fall of 2019, DPH has little capacity for marketing and outreach. With more funds, the program hopes to use programs such as AdTaxi to reach priority populations across more platforms. Currently, DPH promotes the program on their website and social media accounts; dating apps; and through local CBOs offering HIV testing through the collaborative network Test Colorado. Denver’s model shows that even with limited staff time, HIV self-testing is an attainable and popular service LHDs can offer to expand access to testing and, consequently, reduce transmission of HIV.

Resources

  • Visit the OraQuick® In-Home HIV Test website to learn more about how you can partner with them to implement self-testing in your communities.

Contact Us

Please contact Latisia Grant (she/her) at lgrant@naccho.org or Julia Zigman (she/her) at jzigman@naccho.org for questions about implementing self-testing or Denver’s approach.


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About Julia Zigman

Pronouns: she/her

Julia Zigman is a Program Analyst on the NACCHO HIV, STI, & Viral Hepatitis team. Julia focuses primarily on NACCHO’s Ending the HIV Epidemic portfolio and is a lead staff member for the HIV, STI, and Viral Hepatitis Workgroup. Learn more about these programs here.

More posts by Julia Zigman

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