1. Implementing an HIV Rapid Testing Pilot Project Among Homeless Veterans in Los Angeles County Henry D. Anaya, PhD Jamie E. Feld, BA Herschel Knapp, PhD, MSSW Tuyen Hoang, PhD Tuyen Hoang, PhD Steven M. Asch, MD MPH

2. Recent Statistics on Homelessness in the United States 3.5 million homeless nationwide 3.5 million homeless nationwide Los Angeles County homeless estimates: 80,000 homeless individuals on any given night Los Angeles County homeless estimates: 80,000 homeless individuals on any given night 38-40% (≈30,000) are U.S. veterans 38-40% (≈30,000) are U.S. veterans

3. U.S. Homeless at High Risk for HIV City/ Population Seroprevalence % Years Denver0.91990-1994 Los Angeles, Adult Women 1.6, 2.0 1997, 1998 San Diego, Homeless adults 3.02004 San Francisco, Homeless adults 9.42003-2004 San Francisco, Marginally housed adults 10.51993-1994 Phoenix, Homeless adults 16.01994 Miami, Homeless adults New York City, Homeless at-risk adults 14.3, 20.0 62 1993, 1994 1989

4. Why do homeless have low rates of HIV testing? Barriers Barriers –Conventional HIV C&T requires 2 appointments –Patients/providers do not prioritize prevention –Transportation issues –Competing priorities (food, safety, and shelter)

5. Outreach Services For Veterans Could be Effective ≈ 60% of homeless veterans have never accessed U.S. Department of Veterans Affairs (VA) health services ≈ 60% of homeless veterans have never accessed U.S. Department of Veterans Affairs (VA) health services Homeless vets more likely to access outreach services at shelters than VA Homeless vets more likely to access outreach services at shelters than VA How to implement routine HIV testing for homeless veterans? How to implement routine HIV testing for homeless veterans?

6. HIV Rapid Testing in Shelter Settings

7. Study Aims Partnered with: Los Angeles County Homeless Services Authority Aim 2: HIV Testing & Receipt of Results Aim 1: Veteran Access to VA Homeless Services

8. On-site HIV rapid testing Study Design Patients randomized to one of two models: + Referral to VA homeless services Referral to VA homeless services Referral to VA homeless services

9. Study Design (Continued) Endpoints HIV test providedHIV test provided Receipt of HIV test resultsReceipt of HIV test results Enrollment in VA homeless programEnrollment in VA homeless programCovariates Demographics: (age, gender, ethnicity, education, employment status, sexual preference, mental health comorbidities)Demographics: (age, gender, ethnicity, education, employment status, sexual preference, mental health comorbidities) Access to health services:Access to health services: (last time tested for HIV, Hep C, use of VA services ever and in past year) HIV risk factors: (multiple sex partners, sex without condoms, drug use, sex with high risk partner)HIV risk factors: (multiple sex partners, sex without condoms, drug use, sex with high risk partner)

10. Referral Flyers

11. Enrollment and Randomization Approached 2664 Approached 2664 Eligible 136 Excluded 2528 Eligible 136 Excluded 2528 Enrolled 97 Enrolled 97 Referral Only On-site Rapid Test 30 30 67 Not veteran status HIV test within past year Not between 18-65 yrs Not competent to consent

12. Results: HIV test provided?

13. HIV results received?

14. Conclusions: HIV rapid testing feasible/acceptable at shelters HIV rapid testing feasible/acceptable at shelters Collaboration with federal and non-federal agencies practical Collaboration with federal and non-federal agencies practical Referral model (flyer only) non-effective; more robust model needed Referral model (flyer only) non-effective; more robust model needed Feasible to train paraprofessionals to administer HIV rapid testing 1 Feasible to train paraprofessionals to administer HIV rapid testing 1 1 Knapp H, Anaya HD & Feld JE. Expanding HIV Rapid Testing Via Point-of-Care Paraprofessionals. J STD & AIDS, Sept 2008.