Young people who are at high risk for acquiring HIV and who undergo testing for the infection are more likely to seek the test results if they have the option of doing so by telephone than if they have to visit a clinic, according to findings from an outreach project in Portland, Oregon.1 Nearly three in five youth who could choose to learn their HIV status by telephone obtained their test results, compared with roughly two in five of those who did not have this option; young people who had the telephone option also received their results significantly sooner than those whose only choice was in-person notification. Because many high-risk youth face barriers to traditional medical care--including financial and logistical obstacles, unfamiliarity with the health care system and distrust of providers--programs that facilitate their access to necessary services are crucial.
Using mobile vans, the project offered testing at sites where homeless and high-risk young people gather: parks, community events, a dance club, alternative schools and social service agencies. Local youth were involved in all aspects of project development and implementation, including recruiting participants. The study was open to 13-24-year-olds who requested HIV counseling and testing, and who were able to give informed consent.
Participants received confidential HIV counseling from trained medical and public health students before undergoing oral testing; the clinician told them that their results would be available two weeks after the test. Youth were randomly assigned to obtain their test results in one of two ways: Half were instructed to report to a community clinic, and half were told that they could either visit or call the clinic. If young people with positive or inconclusive test results did not request their results within six weeks, project staff asked a county health department program to contact them so that they could get the care they needed.
Between September 1998 and October 1999, the project tested 351 young people, of whom 71% were white, 9% were black and the rest were members of other racial or ethnic groups; participants were equally divided between males and females. About half were aged 13-18, and half aged 19-24. The group given the telephone option and the group assigned to in-person notification were similar in terms of race, ethnicity and age; females outnumbered males among those who had the choice of phoning for their results.
In interviews conducted at the time of counseling and testing, half of participants reported ever having engaged in at least one high-risk behavior: injecting drugs; sharing needles; exchanging sex for money, food, drugs or shelter; having a partner who is HIV-infected or is at high risk of infection; or, for males, having same-sex partners. Overall, males were more likely than females to report such behaviors, but when men who had sex with men were excluded, the difference was not statistically significant. Half of youth had never received HIV counseling and testing before; these young people were less likely than others to report risky behavior.
Eleven percent of participants considered themselves to be at high risk for acquiring HIV infection. However, substantial proportions of young people who reported risky behavior--14% of those who shared needles, 54% of those who injected drugs and 67-85% of those who engaged in high-risk sexual activity--said that they had little or no risk of infection, or were unsure of their level of risk.
In all, 48% of participants requested their test results; the proportion was significantly higher among youth who had the telephone option (58%) than among those who were required to visit the community clinic (37%). The vast majority of young people in the telephone option group who obtained their results (88%) did so by telephone. On average, youth who had the telephone option received their results within about 19 days of the test, significantly sooner than those who had to go to the clinic for their results (24 days). Two participants, both in the group requiring in-person notification, tested positive for HIV. These young people failed to visit the clinic to obtain their results, and the project had the county program contact them.
The option of telephone notification increased the proportion of young people obtaining test results regardless of their age, race or ethnicity, HIV testing history or reports of engaging in any risk behaviors. This option did not affect the likelihood of requesting results among females, youth who had been tested at a site outside a downtown area, those who never used drugs or who used hard drugs during sex, those who considered themselves to be at high risk of acquiring HIV and those who injected drugs.
An important limitation of the study, the researchers note, is that it was based on a convenience sample of youth from one metropolitan area, and the results therefore may not be widely generalizable. Furthermore, motivations for testing and follow-up may differ between young people who are brought into an outreach program and those who have to seek services on their own. Nevertheless, the investigators note that the outreach effort was able to provide access to HIV services for young people at high risk, and they conclude that in this population, the option of telephone notification "appears to be an effective way to increase the proportion who receive...test results."--D. Hollander
1. Tsu RC et al., Telephone vs. face-to-face notification of HIV results in high-risk youth, Journal of Adolescent Health, 2002, 30(3):154-160.