(P104) Success through Partnerships: Lessons Learned from an HIV/HCV Testing Program in Rural Washington State

Project: Through funding from Gilead’s FOCUS grant, Cascade AIDS Project (CAP) has initiated a program supporting rapid point-of-care testing for HIV and Hepatitis C in both in-office and outreach settings in rural southwest Washington. Testing clients may be referred to preventative services such as PrEP or to treatment.

Issue: CAP’s rural WA testing program addresses the following:

In rural settings where transportation and service access may be limited, how do we provide equitable access to testing and treatment for HIV and HCV?

How do we motivate clients at the greatest risk for HIV and HCV transmission to self-select into testing?

Results:

Our partnerships with existing community services were repeatedly shown to make or break our ability to reach testing clients effectively. Our top priority population was unhoused individuals residing at a local houseless encampment, which we entered by working alongside a team of community nurses and shelter advocates providing street medicine to the camp. Many residents experienced past or current injection drug use, and were at exceptionally high risk of HIV/HCV transmission. Providing testing at the encampment allowed us to engage with those unable to transport themselves to another location. However, when the camp became city-operated and resident barriers to entry were raised, many high-need clients were forced out and became unreachable to us.

Many high-risk clients had more immediate health or survival concerns than testing, such as unmanaged chronic conditions and food or housing insecurity. We mitigated this by providing incentives for testing. Gift cards were provided to encampment residents, which meant that the immediate benefits of testing outweighed the time they lost to address other needs.

Lessons Learned:

Any new rural HIV provider should strive to connect with other community services, whether or not they are HIV-focused, to take advantage of their knowledge and established relationships with the target population. By working outside a clinic setting, and instead providing testing where clients are already visiting such as resource fairs or unhoused encampments, barriers to care access are reduced. Incentives for testing may also assist clients with competing survival priorities to receive care without sacrificing other needs.