Abstract
BackgroundAfrican-born individuals in the U.S. are disproportionately affected by HIV yet have low HIV testing rates. We conducted a mixed methods study to assess the uptake and feasibility of a novel strategy for integrating HIV testing into residential health fairs among African-born individuals in Seattle, WA.MethodsFrom April to May 2018, we held six health fairs at three apartment complexes with high numbers of African-born residents. Fairs included free point-of-care screening for glucose, cholesterol, body mass index, blood pressure, and HIV, as well as social services and health education. The health fairs were hosted in apartment complex common areas with HIV testing conducted in private rooms. Health fair participants completed a series of questionnaires to evaluate demographics, access to health services, and HIV testing history. We conducted 18 key informant interviews (KIIs) with health fair participants and community leaders to identify barriers to HIV testing among African-born individuals.ResultsOf the 111 adults who accessed at least one service at a health fair, 92 completed questionnaires. Fifty-five (61%) were female, 48 (52%) were born in Africa, and 55 (63%) had health insurance. Half of African-born participants accepted HIV testing; all tested negative. The most common reasons for declining testing were lack of perceived risk for HIV and knowledge of HIV status. We identified a high prevalence of non-communicable diseases (NCDs) among health fair participants; among those tested, 77% (55/71) were overweight/obese, 39% (31/79) had blood pressure > 140/90 mmHg, and 30% (22/73) had total cholesterol > 200 mg/dL. KIIs identified community stigma and misinformation as major barriers to HIV testing among African-born individuals.ConclusionsResidential health fairs are a feasible method to increase HIV testing among African-born individuals in Seattle. The high prevalence of NCDs highlights the importance of integrating general preventive services within HIV testing programs in this population.
Highlights
Foreign-born individuals comprise an estimated 16% of people newly diagnosed with HIV in the U.S [1] In King County, Washington, African-born individuals account for 2% of the population yet 10% of new HIV diagnoses [2,3]
The high prevalence of non-communicable diseases (NCDs) highlights the importance of integrating general preventive services within HIV testing programs in this population
We report results for general health care, HIV, and non-communicable disease (NCD) outcomes stratified by place of birth (US-born, African-born, or other foreign-born)
Summary
Foreign-born individuals comprise an estimated 16% of people newly diagnosed with HIV in the U.S [1] In King County, Washington, African-born individuals account for 2% of the population yet 10% of new HIV diagnoses [2,3]. Identifying HIV testing models that effectively engage African-born individuals is important for public health programs. Community-based HIV testing provides services outside of health facilities and is sometimes integrated with non-communicable disease screening to increase coverage and decrease stigma. In sub-Saharan Africa, community-based testing has been shown to achieve high coverage, identify HIV-positive people at higher CD4 counts, and reach populations who are less likely to seek care at health facilities [13]. Community-based HIV testing programs for African-born populations in the U.S have been primarily located in the northeast, with varying levels of uptake [14,15,16]. We conducted a mixed methods study to assess the uptake and feasibility of a novel strategy for integrating HIV testing into residential health fairs among African-born individuals in Seattle, WA
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