Special Report on Prevention Initiatives

Massachusetts project cuts a wide swath of care

Nontraditional testing sites is main focus

A Massachusetts community-based organization (CBO) provides rapid HIV testing services to clients at homeless shelters, domestic violence shelters, youth groups, churches, a community college, and other sites, as part of a demonstration project funded by the Centers for Disease Control and Prevention (CDC).

The Health Services Partnership of Dorchester had provided comprehensive HIV services and testing for more than a decade before accepting CDC funding for the rapid HIV testing demonstration project, says George Odongi, MBChB, MPH, communicable disease prevention programs director.

"With this demonstration project, our target population is a minority population living within the city of Dorchester, close to downtown Boston. We serve a big population of African Americans, Hispanic, Vietnamese, Caribbean immigrants, and a sizeable number of people from Haiti," he adds.

The demonstration project’s intent is for the CBO to offer rapid HIV testing in nonclinical settings and then linking clients who test positive into care, Odongi explains.

Since the program began in October 2003, the CBO has tested more than 1,400 clients, finding 30 positive tests among them, he says.

"This is the highest amount of positives we’ve tested since I joined the program four years ago," Odongi adds. "So far, we’ve been able to respond because we have two HIV specialists at each center, working full time, and whenever there’s a new positive, that’s considered an emergency — and we get a doctor who will take the person into care immediately."

Those testing positive are encouraged to participate in a comprehensive HIV program with case managers who provide assessments and schedule clients for clinical evaluations, he points out. "We have comprehensive health care in two health care centers, and we have nearly everything: clinical care, women’s health, family medicine, eye clinic, and urgent care," Odongi notes.

Health Services Partnership also works with a high school, a community college, and a correctional department.

"We go to six different shelters within our service area, and we have four youth programs that we work with," he says.

In addition, the partnership has three different community-based programs for people from Haiti, a public health institute, and an Asian-Creole group, plus four groups for Hispanics, Odongi adds.

"We work with a faith-based initiative and meet with them periodically, offering our services at their site based on programs they’re having," he says.

"We also have a van for rapid testing with a mobile laboratory with counseling rooms, and we go to specific community-based sites and offer testing at those sites."

Each day, the van travels to six sites, Odongi says.

For example, every Wednesday evening, the van travels to a site where men who have been convicted of domestic violence meet for a court-mandated group session. When the session has breaks, the men are able to receive a rapid HIV test. HIV testing staff also provide prevention and health education to the men and offer them condoms and other preventive items, he says.

"Most of the men are there for a month or two, so the counselors engage them before the session begins, in between, and after — it’s a continuous process," Odongi explains. "It doesn’t end with just one visit."

The partnership has had a clinic within Dorchester High School for some time, which is managed by the organization, he says.

"One of our nurse practitioners manages the clinic, and we work with her as she prepares groups of students for prevention and health education," Odongi notes. "Students who would like to be tested for HIV are referred to our health center, which is across the street."

The partnership also provides HIV testing at Roxbury Community College every Thursday morning, and while no positive cases have been found so far, the response to the free testing has been favorable, he says.

The partnership’s staff includes 11 people from different ethnic backgrounds, so various languages found in the community, including Vietnamese, Asian-Creole, and Hispanic, are represented, Odongi adds.