Community-Based Participatory Research to Develop a School-Based HIV Screening Program for Low-Income Urban Adolescents Adolescents are increased at risk for HIV infection due to the prevalence of risk behaviors (e.g., unprotected sex, substance use) during this developmental period. In addition, African American and Hispanic communities are disproportionately affected by HIV/AIDS. The "test and treat" approach is a promising HIV prevention strategy to slow the spread of HIV through affected communities. HIV testing and counseling increase opportunities for early detection of HIV infection, entry into life sustaining treatment, and development of risk-reduction strategies. However, less than one-third of teens who have engaged in unprotected sex and only 1 in 8 of all high school age teens report having been tested for HIV despite CDC recommendations that all adolescents ages 13 and older be screened routinely for HIV. Of concern, adolescents at the highest risk for HIV are among the least likely to access healthcare services due to lack of insurance, not knowing how to seek healthcare, and mistrust of healthcare providers. In addition, ethnic minority youth are less likely to receive regular medical care than their non-minority peers. These findings suggest an important role for an intervention that can better reach adolescents to increase routine HIV testing. One innovative approach that has not been examined is school-based HIV screening. A school-based program would represent a shift in clinical practice paradigms that would increase access to HIV testing services in convenient, youth-friendly community settings. However, little is known about the acceptability of school-based HIV screening to adolescents, parents, and school nurses and administrators, or whether this approach would be feasible or sustainable. Thus, the present research would use a sequential multilevel mixed methods design within a community-based participatory research (CBPR) framework to assess acceptability, feasibility, and sustainability. As such, this project will be a unique collaboration between an experienced HIV prevention research team and a public school setting. In particular, our research team will partner with the Central Falls and Pawtucket School Districts in Rhode Island to identify whether a school-based HIV screening program would be acceptable, feasible, and sustainable for low-income urban adolescents and other key stakeholders in their community. The project will begin with a qualitative phase including in-depth individual interviews with school administrators and focus groups with adolescents, parents, and school nurses to develop a preliminary program of school-based HIV screening for urban adolescents. The qualitative phase will inform the development of a survey during the quantitative phase of the study designed to assess baseline levels of HIV risk, knowledge and stigma, motivation for testing, skills, general healthcare attitudes and healthcare utilization in order to determine what educational, psychosocial, and organizational supports would be needed for the school-based HIV screening program to be successful. This phase will also quantify participants'attitude towards the collaboratively developed school-based universal HIV screening program. During the integration phase, data from the qualitative and quantitative phases will be synthesized and analyzed in order to yield important information regarding agreement between inferences from different methods and across multiple levels of informants, strengthen our understanding of the needs and priorities of the community, and finalize the preliminary school-based HIV screening program. The information gained in this project will improve our understanding of how to increase access to and uptake of routine HIV testing among urban adolescents. Additionally, this project will inform the development of a larger research program of HIV prevention intervention that uses school settings to provide HIV testing and counseling outreach to community adolescents. Specifically, findings of this two-year study will lead to the development of feasibility trial to examine the efficacy of the collaboratively developed school-based HIV screening program at increasing rates of HIV testing among adolescents from low-income urban communities.
The present research proposes to use a community-based participatory research (CBPR) approach to identify whether a school-based HIV screening program would be acceptable and feasible to low-income urban adolescents and other key stakeholders in their community (i.e., parents, school nurses, and administrators). Information gained in the project will help inform the development of a sustainable HIV screening program that could be implemented in school settings to increase adolescent HIV testing rates and serostatus awareness.