Integrated HIV Testing & Mental Health Counselling
Addressing mental health barriers that prevent HIV testing among GBTQ individuals.
Created by ACT
Aiming to increase the uptake of HIV testing and mental health counselling services, this weekly intervention addresses the mental health issues that often contribute to delaying or avoiding routine testing services.
How does integrating mental health counselling with HIV testing enhance uptake?
Service users who report high levels of HIV-related anxiety (or low levels of HIV awareness) are directed to in-house mental health workers who provide short-term counselling and psychoeducation support. Our program’s intent is to overcome identified barriers and motivate positive behaviours - including routine testing, uptake of combination HIV prevention interventions, substance use support, and so on.
In short, an integrated service with both HIV testing and mental health counselling increases the overall impact of the HIV testing interactions. This occurs by addressing healthcare access barriers at the individual level.
Program Development
Prepared for Positive is centred on sharing relatable narratives of positive HIV diagnosis and living a long, healthy life.
In 2018, ACT conducted a community consultation with 24 cis and trans gay, bi, queer guys in Toronto - investigating experiences when accessing primary care, STBBI testing and treatment services, and mental health counselling.
Respondents reported a common need for culturally competent STBBI testing and treatment services free from the sex and substance abuse shaming, and privacy violations experienced by community members. They also reported needing an increased number of patient-centered services offering rapid point-of-care testing in:
more locations,
with longer hours,
and shorter wait times.
Respondents also reported a need for culturally competent and free/low barrier mental health counselling services.
By integrating HIV testing and mental health counselling interventions as a pilot, ACT aims to address these identified service gaps. ACT is also developing resources to share the knowledge gained with other service providers.
Program Logistics
Location
This intervention is provided weekly services on Wednesday evening 4-8 PM. Services have not been offered since March 2020 due to COVID-19 restrictions to satellite HIV testing services. Services are offered at ACT located in downtown Toronto steps from the Church-Wellesley Village.
Recruitment and Engagement
The following figures summarize engagement activities that resulted in program participation (with online recruitment having the most impact):
Source:
Website/social media: 46%
Referral from ACT: 19%
Referral from friend/word of mouth: 14%
Referral from service provider: 14%
Not listed: 5%
Poster in community: 2%
The following inputs are required to animate this pilot:
Human Resources
1 program coordinator (approx. 15 hours/week)
1 community trainee (approx. 7.5 hours/week)
1-2 HIV testing counsellors (nurses or lay professionals, provided by a partner organization)
1 mental health counsellor (approx. 7.5 hours/week)
5 volunteers (approximately 4-8 hours/month)
Training and Development:
Orientation
Best practices training (informed by findings from 2018’s community consultation)
Weekly debrief meetings
Material Resources:
Designated waiting room for HIV testing service users
Chairs, tables, computers (2), coffee and tea, candy, pens, photocopying (intake and feedback forms)
2 private offices for HIV testing
1 private office for mental health counselling
HIV testing supplies (provided by a partner organization)
Print promotional materials
Digital marketing tools
Financial resources:
Supplies do not exceed $50 per month
Paid online advertising ranges between $50-$100 per month
Resources for External Service Providers
A number of resources were also developed for service providers as the pilot project was implemented. Based on the findings of community consultation, program evaluations, and job analyses, these resources (including job aids and learning programs) assist service providers in implementing a similar combination HIV prevention interventions in their local contexts.
All knowledge mobilization resources can be accessed online: http://hivtestingtoronto.com/for-service-providers/.
The COVID-19 pandemic disrupted some plans to share knowledge mobilization resources. Implementation and evaluation activities will resume as restrictions are lifted.
Challenges
It is difficult for ACT to anticipate the demand for services (some days the organization would provide 20+ tests while other days only five). In response, the team attempts to limit wait times to under 30 minutes by bringing on an additional HIV testing counsellor, but this is not always possible.
The pilot also struggles to engage with trans-masc+ folks. Upon completing a community consultation for this population, ACT identified a number of strategies to increase accessibility of these services. For a full report, please visit www.hivtestingtoronto.com/for-service-providers.
Successes
ACT aims to provide patient-centered care that addresses healthcare access barriers experienced by cis and trans gay, bi, queer guys. The data from the pilot’s Service User’s Feedback Survey helps indicate the success of ACT’s efforts to improve service accessibility:
The following indicators were measured using a 5-point scale (1 being very dissatisfied and 5 being very satisfied). These scores indicate a very positive user experience through a weighted average of 244 responses:
Comfort of the waiting room: 4.90
Ease of the intake process: 4.93
Time waited in the waiting room: 4.75
Tester’s professionalism: 4.95
Comfort level with tester: 4.91
Overall experience: 4.93
When asked, how likely are you to return to ACT’s HIV testing and mental health counselling services (1 being not returning and 5 being very likely), respondents’ weighted average score is a very positive 4.63.
For further information, please contact:
Mike Smith
Gay Men's Health Systems Coordinator, ACT
msmith@actoronto.org
416-340-8484 ext. 455
543 Yonge Street, 4th Floor
Toronto, ON
M4Y 1Y5