Implementing an HIV Rapid Testing Intervention for Homeless Veterans in Shelter Settings within Los Angeles County, USA

We implemented and evaluated an HIV rapid testing intervention in collaboration withthe US Department of Veterans Affairs and the Los Angeles County Department ofHealth to 1) increase HIV testing/receipt of results, and 2) increase veteran access to VA homeless services. Ninety-seven veterans recruited in 9 shelters as part of the Los Angeles Homeless Services Authority (LAHSA) emergency shelter program were randomized (2-to-1 ratio) into one of two interventional arms: rapid test (RT) arm (on-site HIV rapid testing/referral to VA homeless program) and referral arm (VA referral only). Recruiters approached 2664 individuals; 136 (5.1%) were eligible. Ninety-seven (71.3% of those eligible) accepted enrollment. Testing rates were 100.0% in RT arm and 3.3% in Referral arm (p<0.001). Test result receipt rates were 98.5% in RT arm and 0.0% in Referral arm (p<0.001). There was no increase in visits to VA homeless programs in either arm. HIV prevalence/rate of new incidence was 1.5%. While more than half admitted high-risk behaviors in the past 12 months, 78% reported chances of HIV infection as "none" or "low" rather than "moderate" or "high." On-site rapid testing in homeless shelters is feasible and acceptable for testing hard-to-reach and vulnerable populations. More robust outreach efforts are needed to improve linkage to care.