A total of 116 adults receiving services from emergency and transitional housing providers in Memphis were recruited to develop a cross-sectional, convenience sample. Inclusion criteria required participants to report they were currently sleeping at a housing shelter or had no place to sleep and were at least 18 years of age. Upon completion of a written informed consent form, participants were asked to complete an interviewer-administered survey and then offered voluntary HIV testing services. Survey data collected from seven participants were excluded due to incomplete data or non-eligibility, resulting in a final sample of 109 participants for data analysis. Participants received a gift card to a local grocery store in the amount of five dollars for completing the survey.
This study describes a number of predisposing, enabling, and need factors under the Behavioral Model for Vulnerable Populations with relation to utilization of HIV testing services (17–18). This model addresses factors relevant to understanding the health and health-seeking behaviors of vulnerable populations and has been applied in other studies to identify challenges in obtaining needed services for the homeless (19–20). Utilization of HIV testing services were documented in two ways: the interviewer-administered survey [see attachment] included a question to document self-report of HIV testing within the past 12 months, and interviewers also recorded whether or not the participant accepted or refused voluntary HIV testing services following the survey.
Assessment of predisposing variables included socio-demographic factors (gender, age, race, and education), duration of homelessness, history of incarceration, alcohol abuse or dependence, and general physical and mental health status. This study employed The Alcohol Use Disorders Identification Test – Consumption (AUDIT-C), a validated, three-item screening tool, to assess alcohol abuse or dependence (21). To evaluate general physical and mental health status, a standardized measure included self-report response options of excellent, very good, fair, or poor. Enabling factors were defined as those that affect health education opportunities and HIV-risk assessment. These variables included current health insurance coverage, when and where the participant last accessed a doctor, and whether or not the participant had one person considered as a personal doctor or healthcare provider. To evaluate factors related to need for HIV testing, variables were collected to describe self-perceived susceptibility and risk behaviors. Perceived susceptibility for HIV infection was evaluated using a scale from zero to four, where zero represented the participant was “not worried at all” about being infected, and four indicated the participant was “extremely worried.” This scale has previously been utilized in research studies with homeless adults and has been assessed for internal reliability and predictive validity (22). The Fogg HIV Screening Questionnaire was employed to assess HIV-risk behaviors in the 12 months prior to the survey. This tool has been evaluated for reliability within homeless populations; it utilizes eight questions to assess self-report of specific sexual risk behaviors and two additional questions to assess injection drug use and diagnosis of a sexually transmitted infection (23).
Utilization of HIV testing services are described as a percent of participants 1) ever tested for HIV, 2) tested within the past 12 months, and 3) accepting HIV testing at the time of the survey. Bivariate chi-square analyses were performed to determine the association between predisposing, enabling, and need variables with HIV testing history in the past 12 months. All analyses were performed using the SAS Statistical Analysis package (SAS Institute, Cary, NC, USA).
A community engaged partnership approach was employed between a local health department, university, and community federally qualified health center to develop the study design, co-create the survey instrument, administer surveys, and disseminate study findings (24). The community health center was identified as a viable research partner given their range of medical and supportive services for persons living with HIV/AIDS, prior experience in providing outreach HIV testing services for the homeless population, and long-standing partnership with the local health department. Approval of an Institutional Review Board was obtained from the University of Memphis (Protocol #2049).