Doing One Thing: Learning from a Targeted HIV/HCV Testing and Treatment Awareness Program

At a seminar at the 2013 United States Conference on AIDS (USCA), Amy Nunn, ScD, MS, reported on the Do One Thing campaign. This HIV and hepatitis C virus (HCV) testing information and awareness program provides unique comprehensive neighborhood-based services out of Philadelphia, which has an HIV infection rate that is five times the national average. Dr. Nunn is an Assistant Professor of Medicine (Research) in the Division of Infectious Diseases, and an Assistant Professor of Behavioral & Social Sciences (Research) at Brown Medical School, at the Alpert Medical School of Brown University. In 2012, she founded the "Do One Thing" HIV testing and treatment campaign in southwest Philadelphia.

For Dr. Nunn, the project has a moral imperative. Some urban neighborhoods in the US have higher HIV infection rates than in many countries of Sub-Saharan Africa. Dr. Nunn also noted that HCV infection can be fatal even though it is treatable. “It at least five times more prevalent than HIV, and we’ve ignored it for too long.”

The program utilizes a unique strategy, focusing on a small pocket of the city with high infection and AIDS-related mortality rates. Dr. Nunn said, “The idea with this project was to see what would happen if we totally saturated a high-risk community with new services.” She explained that the project targets a community in southwest Philadelphia within only one zip code.

Dr. Nunn explained that the Do One Thing Program includes multiple components that work together synergistically to help HIV-positive individuals and their community. A key component of the program provides free HIV and HCV testing through mobile units and through local clinics. Program trainees go door to door, canvassing the neighborhood for individuals who might like to be tested. They provide both rapid HIV and rapid HCV testing, connecting individuals who test positive with health care providers. The full project aims to test 12,000 individuals.

At least as important is the media campaign component of the program. This includes a large-scale social marketing and media promotion plan. The project leaders have also reached out to members of the clergy and other community leaders and local institutions to destigmatize testing and promote its benefits.

The program isn’t perfect. Dr. Nunn told the audience that “One of the things that keeps me up at night is the high decline rate” (with 55 percent of people contacted declining testing in the clinical setting). “We’re probably missing people,” she added.

The program is constantly tweaking its messaging and modifying its training programs for volunteers to help increase these numbers. When asked the reasons people decline testing, Dr. Nunn replied that there’s a common belief among community members that “everybody’s at risk except for me.” She also said that many individuals falsely believe that their doctor has already tested them.

Since the program began, however, the number of individuals tested for HIV and HCV has increased at least fifteen-fold. In the mobile unit setting, close to one and a half percent test positive for HIV, and almost five percent for HCV. In the clinical setting, the percentages for both HIV and HCV are somewhat lower, down to half a percent for HIV.

For Dr. Nunn, the Do One Thing Program is a work in progress. They continually assess the demographics of their participants, trying to tweak the program to get better results. Though providing new diagnoses of HIV and HCV is a key goal of the campaign, another important benefit has been reconnecting individuals with known HIV or HCV with follow-up care. Dr. Nunn said that individuals with HCV are especially likely to dismiss the importance of getting treatment, since the disease is often without symptoms in its early stages. “What really matters is getting people into care,” she concluded.