HCV and HIV Counseling and Testing Integration in California: An Innovative Approach to Increase HIV Counseling and Testing Rates

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Abstract
In California, injection drug users (IDUs) comprise the second leading risk group for human immunodeficiency virus (HIV) infection and the majority of hepatitis C virus (HCV) cases. Innovative disease screening and prevention activities are needed to improve disease surveillance and to guide appropriate public health responses. This study tested the hypothesis that offering HIV counseling and testing (C&T) concurrently with HCV C&T will increase HIV C&T rates among IDUs. From February through June 2003, HIV and HCV C&T were integrated in five California local health jurisdictions. HIV C&T and disclosure rates among IDUs were monitored when HIV C&T was offered alone during a baseline phase and when offered with HCV C&T during an intervention phase. Among IDUs, HIV C&T rates were significantly higher when HIV and HCV C&T were offered together (27.1%, 354/1,305) than when HIV C&T services were offered alone (8.4%, 138/1,645) (p,0.05). HIV disclosure rates increased from 54.3% (75/138) when only HIV test results were disclosed to 71.8% (254/354) when HIV test results were disclosed concurrently with HCV test results (p,0.05). HCV prevalence among IDUs tested ranged from 23% to 75% at the five project sites. Integrating HIV and HCV C&T increased overall C&T time required for staff and clients and increased stress among counselors due to the number of positive test results (HCV) given to clients. Study results suggest that integrating HIV and HCV C&T can increase disease screening rates among IDUs. Careful planning of integrated staff activities and schedules is recommended.