Recruitment of clients/target groups for testing

It is important to widely disseminate information about testing possibilities in the low-threshold services through announcement or the distribution of informative leaflets among the clients in order to reach a wide spectrum services users.

During the approaching and recruitment phase, the role of social workers and peers is fundamental. They represent the link between the target group and the health-care services because they can more effectively motivate people who use drugs to get tested (explaining the benefits and advantages of such service) and other safer behaviors, given that their relation with clients is based on trust and confidence. Staff members can use techniques typical of “motivational interviewing”, combining elements of empathy and negotiation with the aim to improve the client’s motivation toward his/her own health status.

The model of approaching must be clearly defined. Example: If someone says "I have been tested already and I was negative", this is not sufficient to exclude the person from the program. Check when the person was tested for the last time and if he/she has risk behaviors since that time.

On the other hand, for the clients willing to get tested, a second important selection step is required: to check their eligibility for testing according to the specific characteristics of the target group and the basic requirements for valid HIV and HCV testing. In order to check eligibility, the recruited clients should be asked the following “supplementary” questions:

• Have you been tested for HIV or HCV before? If yes, when?
• Have you been using drugs (heroin, cocaine, methamphetamine, amphetamines, opioid analgesics, buprenorphine) regularly in the past 3/6 months both injecting and not injecting?
• Are you willing to answer a questionnaire for risk assessment/data collection, and do you consent to the follow up or possible visits to clinic?
• Do you clearly understand the purposes and procedures of testing?

If somebody is unable to understand the objectives of the intervention and to give the informed consent, he/she must be considered not eligible for the testing! Moreover, it’s necessary to bear in mind the specific characteristics of the target group attending low-threshold services, particularly PWUD. Motivating these clients toward testing can be very hard, because they have other priorities and needs: they are in a hurry and don’t have enough time for getting tested; they are afraid of getting tested because they have engaged in risk behaviors; they want to avoid presence on the street because of fear of police. To cope with these problems, a solution can be the use of rewards and incentives such as phone cards, food or food tickets. Often, even the simple empathy, provision of a cup of coffee/ tea and some biscuits helped to approach people and motivate them to dedicate some time to their own health.

Criteria for selection of locations for testing

The collaboration with other local services and facilities is useful for enlarging the number of potential beneficiaries and facilitating access to testing by high-risk groups of drug users such as homeless people. It is highly recommended to select places where the testing has never been offered, or is not provided on a regular basis, in order to reach people who most probably have never been tested or may prefer to get tested in non-medical settings. In addition, cooperation with other local low-threshold services can bring benefits in the long-term also, promoting the set-up of networks and referral systems which facilitate the access by people who use drugs to the required care, support and treatment programs.

Of course these networks are highly effective and fruitful if the cooperation among local actors is well-functioning and supported by a joint willingness to cooperate. This is not always easy to reach, in particular when talking about cooperation with public health services, which may have different opinions and methods of working with PWUD.