For many Americans, access to health care is spotty, especially when it comes to testing and treatment for those at risk for HIV/AIDS.
Researchers have found a potential solution to limited access—community-based care. A recent study from the Albert Einstein College of Medicine at Yeshiva University in the Bronx, New York shows that community-based pharmacies can be effective locations for offering rapid HIV tests and connecting those who test positive with proper medical care on the spot.
While the HIV/AIDS epidemic may seem like a nightmare from the 1980s, the Centers for Disease Control and Prevention (CDC) estimate that approximately 50,000 new cases of HIV infection occur every year—and that number hasn't changed in over a decade.
“Despite great gains in HIV treatment and care, there has been little change to the annual incidence of HIV in the USA in 20-plus years. Much of the public at risk for HIV is marginalized from health care due to poverty and social barriers,” said study author Jason Leider, M.D., Ph.D., an associate professor of clinical medicine at Albert Einstein. “Free HIV testing in publicly acceptable sites like pharmacies brings the latest testing diagnostics without impediment to the community."
By combining these testing efforts with access to care for those who test positive, it’s possible that the 20 percent of infected people who are unaware of their HIV status can enter into treatment and avoid transmitting the virus by accident, Leider told Healthline.
Community-Based Testing Takes to the Streets
Leider and his colleagues partnered with five community-based pharmacies in the Bronx and Manhattan, training public health advocates (PHAs) to approach people in the pharmacies and on the sidewalks outside to offer free HIV testing. The study ran for 294 days, during which time more than 2,000 people agreed to be tested.
The PHAs used a rapid HIV test, which produces results in 20 minutes, requiring only a swab of saliva. While the participants were waiting, they filled out an HIV-risk factor questionnaire and received counseling based on their answers. If they tested positive, they were offered an immediate escort by the PHA to a nearby HIV clinic where a trained specialist saw them less than an hour after the diagnosis.
Six people tested positive, and five of the six agreed to go with a PHA to an HIV clinic. After further testing, it was revealed that all five had good CD4 counts of over 500 white blood cells/mL, meaning that they were at a relatively early stage of infection.
One of the benefits of a PHA, Leider said, is that they can create a certain amount of comfort for clients and help turn “getting tested” into something more routine—or at least less scary. “Many people in the community stated there were no others providing service. This was especially true among young [men who have sex with men],” he said.
For some groups, community-based testing is ideal and can catch HIV infection earlier than a more formal setting. “Compared to patients testing in the medical setting, many more of the pharmacy clients are younger, uninsured, and Spanish-only speaking. People testing HIV positive in the pharmacy also had higher CD4 counts than those in traditional medical settings,” Leider said.
HIV Testing, Aisle 4
There still are some concerns among patients about privacy and safety in community settings. Healthline's HIV Awareness communities on Facebook and Google+ weighed in about community-based HIV testing and care in pharmacies.
Facebook user Cory B. said that it’s a “great idea but treatment/counselors should be available at the time of testing.” David B. raised concerns about privacy: “Unless there was a private room in which the test could be administered, then fine. But a little ‘space’ in the corner like you see at CVS & Walgreens where you go for medicinal consultations—NO!”
For those living with little to no access to HIV care, a community pharmacy could make all the difference. Google+ user Tim B., who lives in a rural area, has to drive a hundred miles to get HIV medication, and often, the pharmacy he goes to runs out of medication. “That is standard,” he said. “If there was a community pharmacy, it would be sane. Today, it is insane.”
Leider agrees that access to care is the name of the game. “This approach further establishes pharmacies as true cornerstones of community health care services,” he added. “Training about HIV prevention, testing, counseling, risk reduction, and community engagement are key.”