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Testing HIV Testers

A team led by Penn Nursing’s José A. Bauermeister, PhD, MPH, Presidential Professor of Nursing, developed an innovative study that employs a mystery shopper methodology to assess HIV testing services for young men who have sex with men.

Improving rates of HIV testing among young men who have sex with men (YMSM) is a crucial public health strategy to stem the increasing HIV epidemic and to end HIV in the United States by 2030. The United States Centers for Disease Control and Prevention (CDC) promotes HIV testing every six months among YMSM to facilitate entry into HIV prevention, treatment, and care services.

An HIV test is often an individual’s first experience with clinical HIV prevention services. As such, it is especially important that this event is a positive experience for youth, as a negative experience may deter future testing or engagement in care. At present, however, limited research has explored the quality of HIV/STI testing services for YMSM. Understanding the quality of these services is crucial, as the new effort to End the HIV Epidemic in the United States by 2030 Initiative relies on a strong and competent HIV health force.

An innovative study from the University of Pennsylvania School of Nursing (Penn Nursing) used a youth-driven mystery shopper methodology to assess YMSM’s testing experiences in three metropolitan cities highly impacted by the HIV epidemic. Similar to the announced standardized patient evaluation used in medical training, mystery shopping is used to evaluate healthcare delivery in community settings. Results showed variable performance across cities and testing sites, underscoring the importance of improving HIV testing services for this highly HIV-affected demographic.  

While research indicates that YMSM may feel more willing to take part in HIV counseling, testing, and referral (CTR) services, there are no systematic assessments to evaluate the quality of agencies’ CTR services, nor an understanding of how YMSM clients perceive and react to the testing services delivered,” said Penn Nursing’s José A. Bauermeister, PhD, MPH, Presidential Professor of Nursing and principal investigator of the study. “This study’s systematic collection of YMSM’s experiences when seeking HIV testing and prevention services in three large metropolitan areas is an important step toward improving these services for youth. This youth-oriented approach offers agencies new insights from the consumers’ perspective on how they are implementing HIV prevention services.”

Results of the study are set for publication in an upcoming issue of the Journal of Acquired Immune Deficiency Syndromes in an article titled “Testing the Testers: Are Young Men Who Have Sex with Men Receiving Adequate HIV Testing & Counseling Services?”

The study focused on 66 youth-accessible HIV testing sites in Philadelphia, Atlanta and Houston. Mystery shoppers were recruited and trained, and each testing site was shopped by two different mystery shoppers. The breadth and quality of CTR sessions varied greatly and discrepancies were common between sites advertised and actual service availability. Scores are provided back to the sites, alongside an invitation for technical assistance and capacity building.

“Taken together, these findings highlight the need to strengthen agencies’ delivery of culturally competent care through systems-level interventions,” said Bauermeister. “If we are to achieve the Ending the HIV Epidemic in the United States by 2030 initiative goals, investment in system-level interventions and strategies will be necessary to optimize HIV prevention and care delivery for YMSM.”

Co-authors of the study include J.M. Golinkoff and W.Y. Lin, both of Penn Nursing; K.F. Claude and L. Hightow-Weidman, both of the University of North Carolina - Chapel Hill; K.J. Horvath of the University of Minnesota; N. Dowshen, A. Schlupp, W.J. Vickroy, K. Desir, A.V. Lopez, M. Castillo and M. Tanney, all of the Children’s Hospital of Philadelphia; T.A. Wimbly, K. Leung  and P.S. Sullivan, all of Emory University; D. Santiago, R. Hernandez and M.E. Paul, all of Baylor’s College of Medicine; S. Lee of the Eunice Kennedy Shriver National Institute of Child Health and Human Development; and R. Stephenson of the University of Michigan.

This research was supported by the National Institutes of Health Adolescent Medicine Trials Network for HIV/AIDS Interventions and the University of North Carolina/Emory Center for Innovative Technology (U19HD089881). This work was also supported by the Center for AIDS Research at the University of Pennsylvania (P30 AI 045008), Emory University (P30AI050409) and the University of North Carolina at Chapel Hill (P30AI50410).