Special Report on Prevention Initiatives

Rapid HIV testing popular with Chicago CBO clients 

Testing has found 2% positive rate

The Night Ministry of Chicago provides rapid HIV testing in nonclinical settings, extending services to some of the most difficult to reach, high-risk populations, including homeless youths and others.

"It’s challenging to figure out ways to reach people and to continue to reach people," says Jenny Tsang, MPH, rapid HIV testing coordinator. "The Night Ministry has such a long history of working with homeless people that we have a decent reputation among people, and they trust us and come back to us."

The Night Ministry has conducted HIV testing for years and had started rapid HIV testing before receiving a grant from the Centers for Disease Control and Prevention (CDC).

"We worked with the city of Chicago and their pilot project, and that’s how we did rapid HIV testing in mobile units and figured out how to make it work," she says. "When we actually started testing for the CDC, we had a pretty good protocol in place on how to do things."

The Night Ministry works primarily with homeless people at night, but also has a health outreach bus that drives to seven different neighborhoods, each twice a week, Monday through Saturday, Tsang explains.

The organization also has a program for pregnant and parenting teens, and it runs a homeless shelter for youths, ages 14 to 21, who are not wards of the state, she says.

"On our bus, we have a nurse who can do general health care, diabetes monitoring, blood pressure monitoring, mental health services; and we always have a minister on board who can provide pastoral care," Tsang notes.

Building relationships

"The whole crux of our organization is we build relationships with people; people can always depend on us to be there," she explains. "We provide coffee, cookies, and condoms; and we have staff who provide a listening ear."

In a typical night, the bus staff will see about 200 people, including children, and provide adults sexually transmitted disease testing, hepatitis C testing and screening, and HIV testing, Tsang says.

Of the people tested for HIV, about 2% are positive, and that rate has been consistent since before the organization began the CDC demonstration project, she notes.

However, with the rapid testing, nearly everyone receives their test results, so there’s greater opportunity for interventions and referrals for HIV-positive clients, Tsang adds.

"We have two full-time staff dedicated to HIV testing," she says.

The rapid HIV test takes about 20 minutes to administer and is accompanied by pre-test results counseling, Tsang says.

Counseling ranges from the basic questions, such as, "What do you know about HIV? How is HIV transmitted?" to a risk assessment survey in which a client is asked about the last time he or she had sex and whether the sex was protected, etc., she adds.

"We have paperwork required by the CDC and the city, and so we go through all of that and do a slightly more extensive risk assessment," Tsang explains.

"When we’re done with all of the paperwork, we discuss what’s going on with that client and develop a risk-reduction plan with the client."

The risk-reduction plan may ask the client what he or she wants to do for protection in the future, including risk-reduction strategies of trying to use a condom 50% of the time, she says.

If the test results are positive for HIV, then clients are asked how they feel and a second, confirmatory test is offered, Tsang notes.

"We ask where they want to seek care, how they want to tell others, and then we review with the client basic prevention [information] and give them whatever referrals they need," she says.

"We have clients come back to us to pick up their confirmatory test results, and we provide them with bus cards to help them get to and from doctors’ appointments."

The Night Ministry also gives clients a telephone calling card they can use to make appointments, and staff refer clients to physicians who will provide HIV primary care, Tsang adds.

"Some of our clients are regulars with us; and with those clients, we check in and see how things are going whenever we see them," she says. "For clients who are not regulars, we give them the best referrals we can and hope they will follow up on these."