# Presentation: 482785

## AN EVALUATION OF CALIFORNIA’S NEIGHBORHOOD INTERVENTION GEARED TO HIGH-RISK TESTING (NIGHT) OUTREACH PROGRAM

**1****U.S.A., State of California, Department of Health Services, Office of AIDS.**
**2****U.S.A., University of California, Office of the President, Universitywide AIDS Research Program.**

**H Rasmussen****1****, M Chen****1****, R Myrick****1,2****, S Truax****1**

## BACKGROUND

- 	Prior to 1996, California’s publicly-funded HIV Counseling and Testing (C&T) sites saw more low risk than high risk clients.
- 	Populations at highest risk for HIV were not being adequately served by traditional clinic-based C&T sites.
- 	In 1996, the California State Office of AIDS began implementing the NIGHT Outreach Program targeting HIV counseling, testing and referral activities to high-risk populations in venues they frequented.

- California Department of Health Services, Office of AIDS
- University of California, Office of the President, Universitywide AIDS Research Program

##     The goals of the NIGHT Outreach Program are to:

	Reach high-risk individuals who do not seek HIV testing
	Encourage clients to receive HIV C&T
	Increase client’s knowledge of HIV-related risks
	Provide targeted educational material and condoms

	Provide clients with appropriate referrals to other social support and/or medical services

- 	Reach high-risk individuals who do not seek HIV testing
- 	Encourage clients to receive HIV C&T
- 	Increase client’s knowledge of HIV-related risks
- 	Provide targeted educational material and condoms
- 	Provide clients with appropriate referrals to other social support and/or medical services

***PROGRAMMATIC GOALS***

- California Department of Health Services, Office of AIDS
- University of California, Office of the President, Universitywide AIDS Research Program

##      High-risk populations being targeted by the NIGHT Outreach Program include:

	Substance users, injection drug users and their sex and/or needle sharing partners

	Men who have sex with men 

	Sex industry workers

	People of color communities

	Women of childbearing age (12-45 years of age) who are eligible to receive Medi-Cal (a publicly-funded medical cost assistance program in California).

- 	Substance users, injection drug users and their sex and/or needle sharing partners
- 	Men who have sex with men
- 	Sex industry workers
- 	People of color communities
- 	Women of childbearing age (12-45 years of age) who are eligible to receive Medi-Cal (a publicly-funded medical cost assistance program in California).

***TARGET POPULATIONS***

- California Department of Health Services, Office of AIDS
- University of California, Office of the President, Universitywide AIDS Research Program

## COUNTIES WITH NIGHT

- Local Health Jurisdictions with NIGHT

***COUNTIES WITH NIGHT***

- California Department of Health Services, Office of AIDS
- University of California, Office of the President, Universitywide AIDS Research Program

**Notes:**
Counties and city health jurisdictions were funded for NIGHT based on its high HIV and STD incidence rate, and this is why you see a high concentration of NIGHT Outreach Programs in the bay area counties and along the coastal regions. 

## PROGRAM METHODS

**OUTREACH**
- Using mobile vans to provide onsite HIV C&T services at locations including:
-      Local parks
-      Shooting galleries
-      Near hotels used by sex industry workers
-      Recovery program sites
-      Bars
-      Health fairs
-      Near syringe exchange sites

**INTERVENTION**
- Emphasis is placed on HIV education
- and prevention:
- 	Provide on-going interaction between outreach workers and clients that motivates behavior change
- 	Provide prevention materials during encounters:
- Brochures
- Safer sex kits
- Harm reduction kits
- Hygiene kits

- California Department of Health Services, Office of AIDS
- University of California, Office of the President, Universitywide AIDS Research Program

## SERVICES PROVIDED

**REFERRALS**
- Social service referrals include:
- Food
- Shelter
- Medical and psychological services
- Drug treatment programs
- High-risk HIV negative clients are given referrals to the HIV Transmission Prevention Project.
- Clients who test positive for HIV are given referrals to agencies that provide early intervention services.

**OTHER**
- 	STD screening
- 	Hepatitis screening
- 	Tuberculosis screening
- 	Lead screening
- 	Family planning services
- 	Immunizations, and etc.

- California Department of Health Services, Office of AIDS
- University of California, Office of the President, Universitywide AIDS Research Program

## MOBILE VANS

- The NIGHT Program funds the operation of 7 large mobile vans that are used in urban areas...

- as well as 12 smaller vans that are used throughout the rest of California.

- California Department of Health Services, Office of AIDS
- University of California, Office of the President, Universitywide AIDS Research Program

## MOBILE VANS

- California Department of Health Services, Office of AIDS
- University of California, Office of the President, Universitywide AIDS Research Program

## The objective of the study is to assess the effectiveness of NIGHT as a means of outreach to high priority populations for HIV C&T.  We seek to answer the following questions:

Has the NIGHT outreach effort increased HIV C&T for individuals at elevated risk for contracting HIV?

How do characteristics differ between clients who were referred to HIV C&T by NIGHT and those who were not?

- Has the NIGHT outreach effort increased HIV C&T for individuals at elevated risk for contracting HIV?
- How do characteristics differ between clients who were referred to HIV C&T by NIGHT and those who were not?

***EVALUATING NIGHT***

- California Department of Health Services, Office of AIDS
- University of California, Office of the President, Universitywide AIDS Research Program

## Data Source:

Information collected on individuals who tested for HIV at publicly funded anonymous and confidential HIV C&T sites between 1990 and 2001 in local health jurisdictions that have implemented NIGHT, via the HIV Counseling Information System.

Data Analysis:

We examined trends in percent of overall HIV tests performed by mobile vans and for high risk clients.

Using a multivariate logistic regression model, we examined and compared demographic characteristics, HIV-related risk behaviors, HIV serostatus, HIV testing history, and no-show rates (failure to return for test result) between clients who were referred to HIV C&T by NIGHT and those who were not.

- Information collected on individuals who tested for HIV at publicly funded anonymous and confidential HIV C&T sites between 1990 and 2001 in local health jurisdictions that have implemented NIGHT, via the HIV Counseling Information System.
_***Data Analysis:***_
- We examined trends in percent of overall HIV tests performed by mobile vans and for high risk clients.
- Using a multivariate logistic regression model, we examined and compared demographic characteristics, HIV-related risk behaviors, HIV serostatus, HIV testing history, and no-show rates (failure to return for test result) between clients who were referred to HIV C&T by NIGHT and those who were not.

***EVALUATION METHODS***

- California Department of Health Services, Office of AIDS
- University of California, Office of the President, Universitywide AIDS Research Program

## Figure 1. Trends in HIV Tests Performed by Mobile Van Unitsin Local Health Jurisdictions with NIGHTCalifornia, 1994 – 2001

**Number of HIV tests**
**by mobile vans**

**% of overall HIV**
**tests by mobile vans**

**Trend line based on**
**% of overall HIV tests**
**by mobile vans**

***Testing H****o****:   Slope = 0  (p<0.0001)**

**Slope = 0.72***

**Notes:**
This chart shows the tends in percent of HIV testing performed by mobile van clinics in counties and city health jurisdictions that have implemented NIGHT.

The state began implementing NIGHT during 1996, by the 3rd quarter of 1997, about 11% of the HIV testing in those counties and city health jurisdiction were done at mobile vans.

As you can see that the percentage has increased over the past 4 years, by the 2nd quarter of 1999, this percentage has increased to 19.2% and has remained stable since then.

## Figure 2. Trends in HIV Tests Performed for High-Risk Clients in Local Health Jurisdictions with NIGHTCalifornia, 1990 – 2001

**Total number of HIV tests**

**% ****High risk**

**Trend lines based on**
**% high risk**

**Slope****1**** = -1.01***

**Slope****2**** = 0.56***

***Testing H****o****:   Slope****1****=Slope****2****  (p<0.0001)      Testing H****o****:   Slope****1****=0  (p<0.0001)      Testing H****o****:   Slope****2****=0  (p<0.0001)**

**Notes:**
This chart shows the tends in percent of HIV testing performed by mobile van clinics in counties and city health jurisdictions that have implemented NIGHT.

The state began implementing NIGHT during 1996, by the 3rd quarter of 1997, about 11% of the HIV testing in those counties and city health jurisdiction were done at mobile vans.

As you can see that the percentage has increased over the past 4 years, by the 2nd quarter of 1999, this percentage has increased to 19.2% and has remained stable since then.

## Table.   Comparison of Clients’ Characteristics Between NIGHT-Referred HIV Tests and Non-NIGHT-Referred HIV TestsCalifornia, July 1, 1997 – December 31, 2001

- * Analysis excluded all HIV tests with missing information on gender, race/ethnicity, age, sexual orientation, history of HIV-related risk factors, HIV test results, HIV testing history and failure to return for test result.  Results for NIGHT program location are not shown.
- 1 The odds ratio compares the likelihood of the HIV test being a NIGHT-referred test for a client with the characteristic in question with the likelihood for a client in the reference group.  C.I. denotes confidence interval.
- 2 Other includes Asian/Pacific Islander, Native American, and other.
- 3 Odds ratio for an increase in 10 years of age.

## Table (continued).   Comparison of Clients’ Characteristics Between NIGHT-Referred HIV Tests and Non-NIGHT-Referred HIV TestsCalifornia, July 1, 1997 – December 31, 2001

- * Analysis excluded all HIV tests with missing information on gender, race/ethnicity, age, sexual orientation, history of HIV-related risk factors, HIV test results, HIV testing history and failure to return for test result.  Results for NIGHT program location are not shown.
- 1 The odds ratio compares the likelihood of the HIV test being a NIGHT-referred test for a client with the characteristic in question with the likelihood for a client in the reference group.  C.I. denotes confidence interval.
- 2 Other substance does not include alcohol.

## Table (continued).   Comparison of Clients’ Characteristics Between NIGHT-Referred HIV Tests and Non-NIGHT-Referred HIV TestsCalifornia, July 1, 1997 – December 31, 2001

- * Analysis excluded all HIV tests with missing information on gender, race/ethnicity, age, sexual orientation, history of HIV-related risk factors, HIV test results, HIV testing history and failure to return for test result.  Results for NIGHT program location are not shown.
- 1 The odds ratio compares the likelihood of the HIV test being a NIGHT-referred test for a client with the characteristic in question with the likelihood for a client in the reference group.  C.I. denotes confidence interval.

## 	In local health jurisdictions that have implemented NIGHT, the percent of HIV tests performed by mobile testing vans increased markedly from 5.2% in the 4th quarter of 1996 to 18.2% during the same time period in 2001.

	Prior to the implementation of NIGHT in 1996, roughly 36.2% of publicly-funded HIV tests were conducted among high-risk clients annually at these health jurisdictions.  Since then, this percentage has risen to 49.9% and 52.5% in 1997 and 2001 respectively.

- 	Prior to the implementation of NIGHT in 1996, roughly 36.2% of publicly-funded HIV tests were conducted among high-risk clients annually at these health jurisdictions.  Since then, this percentage has risen to 49.9% and 52.5% in 1997 and 2001 respectively.

***CONCLUSION***

- California Department of Health Services, Office of AIDS
- University of California, Office of the President, Universitywide AIDS Research Program

## 	In California, street outreach has proven to be particularly useful in increasing HIV testing among high-risk people of color communities, substance users, and sex industry workers.

	Although clients who were referred to HIV testing by NIGHT were less likely than others to return for their test results, a return rate of 65.8% among the type of clients served by NIGHT is comparable to the rates seen in STD clinics.

- 	Although clients who were referred to HIV testing by NIGHT were less likely than others to return for their test results, a return rate of 65.8% among the type of clients served by NIGHT is comparable to the rates seen in STD clinics.

***CONCLUSION (continued)***

- California Department of Health Services, Office of AIDS
- University of California, Office of the President, Universitywide AIDS Research Program