Free, in-pharmacy HIV testing may sound like a good idea—and it was, in Milwaukee, until the COVID-19 crisis put an end to it. Walgreens, in partnership with the Wisconsin Department of Health Services, had been offering free HIV tests at five Milwaukee-area pharmacies. But in March, the pharmacy chain suspended these services out of “abundance of caution for those with chronic conditions or weakened immune systems,” a Walgreens spokesperson said. The tests had averaged fewer than one per day.
The U.S. Centers for Disease Control and Prevention (CDC) have estimated that HIV testing is down as much as 70% since February, just before stay-at-home orders were issued throughout the nation. Many AIDS services organizations are still in virtual mode, at least in part, and that has hampered their ability to reach everyone who needs or wants HIV or STD testing. Many providers have moved to offer in-home testing, but even with that, they say the amount of people getting tested is way down from “before COVID days,” when in-person testing was the norm.
But the pharmacy chain has thrown its support behind in-home testing, and it has partnered with Greater Than AIDS to provide 10,000 OraQuick In-Home HIV Test kits for local health agencies and community-based organizations throughout the U.S. this fall.
Tina Hoff, senior vice president at Kaiser Family Foundation, which oversees Greater Than AIDS, told TheBody in an email that they’ve received requests for kits from 208 HIV service and health agencies and expect the kits to be distributed in early September, “at which time the receiving organizations will make them available at no cost to individuals in need in their communities.” Hoff added that a map with a list of participating organizations would be available [through their website GreaterThan.org] once the kits are available, and Greater Than AIDS will provide targeted outreach in those communities.
“These self-tests offer a complement to the other ways HIV organizations are pivoting to keep their clients connected to care, including telehealth, pop-up locations, and safe in-person services.” In addition to the 10,000 HIV self-tests being distributed this fall, Walgreens and Greater Than AIDS have distribute more than 57,000 free HIV tests across the nation, through HIV/AIDS service organizations and health departments, a Walgreens spokesperson said.
“COVID Threw a Wrench in Testing”
The United States Preventive Services Task Force has recommended universal HIV screening since 2013, and reaffirmed that recommendation in 2019. But since the start of the COVID-19 health crisis, AIDS services organizations throughout Wisconsin and the U.S. have severely cut back on their testing and are relying on home testing kits. But home testing, while accurate, is not making up for the cutbacks in in-person testing, they say.
Ruthie Weatherly, clinical operations manager at BESTD Clinic in Milwaukee, said that they’re offering home HIV-testing kits, which can be picked up curbside from their storefront clinic or sent through the postal service, but significantly fewer in-person tests. And those tests are by appointment only, no walk-ins.
“I would imagine there are a group of patients putting off or delaying visits due to worry about [COVID] exposure,” Weatherly said. She added that COVID has caused other problems. “We face increased PPE needs, shortages, and delayed delivery times. We are an all-volunteer clinic, except for myself, and some are in an increased-risk age group, so we have faced some volunteer shortages.”
Bill Keeton, chief advocacy officer at Vivent Health, which operates throughout Wisconsin and several other states, said COVID “threw a wrench in testing,” not just for HIV and STDs, but also for a variety conditions.
“Providers are seeing lost opportunities to do regular cancer screenings and other tests because of COVID, and we’re very worried about reaching out to the medically vulnerable,” Keeton told TheBody. Vivent, which provides wraparound services, only gives in-person HIV tests for those wanting PrEP. Keeton says that since moving to HIV home testing, the number of tests provided has been more than cut in half.
“Imagine that the most vulnerable population, young sexually active men, might be living with roommates or their parents, and they might not want anyone in the household to know they’re getting an HIV test,” Keeton said.
Keeton added that HIV and STD testing should be universal and conducted at every annual physical. “No disrespect to providers, but so much of health care interaction is done over laptop, even before COVID. Indications for testing are driven by what a provider sees on a screen.” And that interaction, he said, misses potential for testing vulnerable populations, because it’s often incumbent upon the patient to request HIV or STD tests.
“What I keep hearing from young, vulnerable men is, ‘I didn’t know about HIV testing.’ And often, until they’ve been in contact with someone who has contracted [HIV], it continues to fly under the radar.”