HIV SEROPOSITIVITY RATES IN OUTREACH-BASED COUNSELING AND TESTING SERVICES - PROGRAM-EVALUATION

A common assumption is that outreach-based HIV counseling and testing services reach a clientele with a higher HIV seroprevalence than clini c-based counseling and testing. To examine this assumption, we analyze d Wisconsin's anonymous counseling and testing client records for 62,2 99 contacts (testing episodes) from 1992 to 1995. Bivariate analysis o f counseling and testing service setting (outreach-based or clinic-bas ed) and HIV test results suggested that outreach contacts were 23% (od ds ratio [OR], 1.23; 95% confidence interval [95% CI], 1.0-1.5) more l ikely to test HIV-seropositive than clinic-based contacts. Relations b etween HIV test outcome and variables for client age, race, gender, pr evious testing history, mode of risk exposure, and region, as well as service setting, were examined by logistic regression. An inverted rel ation between service setting and seropositivity (OR, 0.65; 95% CI, 0. 5-0.8) indicated that, within some subpopulations, outreach contacts w ere significantly less likely to test HIV-positive than clinic-based c ontacts. Analysis of interactions among the covariates identified race as a critical codeterminant in the relation between service setting a nd test outcome. These results support retargeting outreach services t o enhance their overall effectiveness. Specific recommendations includ e the need for aggressive strategies to better ''market'' HIV counseli ng and testing to nonwhite populations, and to focus resources more se lectively on gay/bisexual men of all races.