Spotlight - POCAAN and HIV Counseling and Testing: The CARE Tool Project

People of Color Against AIDS Network (POCAAN), which was founded in 1987, is a Seattle-based community AIDS prevention organization focused on communities of color. Since 2002, POCAAN has offered mobile HIV Counseling and Testing through its Health on Wheels (HOW) Program. The HOW program one of the first community-based programs to offer rapid HIV counseling and testing to clients in outreach venues such as parks, bars and drug treatment settings. Dr. Freya Spielberg, SPRC Core Coordinator, assisted POCAAN in the original program design and continues to serve as their volunteer medical director.

In January 2006, POCAAN started using a new computer tool to improve the consistency, quality, and efficiency of their services, and to also improve their program’s capacity for evaluation. The CARE (Computer Assessment & Risk Reduction Education) tool is an interactive multimedia computer tool that allows patients to receive individualized HIV/STI risk assessment, information about rapid HIV testing, and provides evidence-based HIV/STI risk reduction counseling.

There are five elements in a typical CARE session: (1) Anonymous Login, Welcome, and Selection of Counselor; (2) Risk Assessment; (3) Tailored Feedback and Counseling, including skill-building videos; (4) Individualized Risk Reduction Plan; and (5) Printed Report and Referrals, if applicable. If rapid HIV testing is offered, the session also includes HIV testing consent and a video after the first step.

The use of the CARE tool provided POCAAN with the potential to increase their capacity for HIV counseling and testing among high risk populations by providing alternative counseling options, facilitating data collection, reducing staff time needed for data entry, and providing more time for client recruitment and outreach.

As part of its mission to expand linkages with community organizations, in February 2006, the Sociobehavioral and Prevention Research Core (SPRC) provided a small grant, to adapt the CARE tool to comply with upcoming Centers for Disease Control (CDC) regulations for HIV testing data collection and reporting (PEMS). The revised CARE tool was then made available to POCAAN to pilot. Since implementing the CARE tool with its automated data entry, POCAAN has more than doubled the number of clients getting HIV tests each month. In addition to helping them target their intervention efforts, the new reporting function has also enabled POCAAN to meet their Public Health reporting requirements in a timely matter. Before using the CARE tool it often took months for the data to be entered into a database and summarized. POCAAN staff and their clients also appreciate the automated risk reduction plans and recommended referrals for other health needs such as depression and substance use. POCAAN staff have indicated that these reports have also increased their counseling efficacy. In addition, the CARE tool provides more security for confidential client information. Prior to the use of the CARE tool, client data was kept in a number of file folders. Therefore, the CARE tool eliminates the fear of client information being viewed by others, misplaced, and/or lost during busy outreach sessions where the awareness of files and their contents can sometimes become precarious.

The CARE tool has the potential to bridge the gap between the needs of community organizations that can often operate in settings where it is difficult to provide risk reduction counseling and to also collect the necessary data required by the CDC and other funders that are essential to assess the impact of prevention interventions. Given the new national focus to expand HIV testing (the CDC soon will recommend at least one HIV test for everyone aged 13 to 64 who visits a doctor), interventions such as the CARE tool, which can extend scarce human resources, will facilitate access to HIV/STI prevention and treatment.