Increasing Access to HIV Testing for Young People in Baltimore

While young people ages 18–24 are disproportionately affected by HIV, only 27% have ever been tested, far below the national average of 39%. Closing that gap requires innovative approaches that meet young people where they are and make HIV prevention a routine part of care. 

With funding from the Bloomberg American Health Initiative, Bloomberg Fellow Yeng Yang set out to accomplish just this. Working in a primary care clinic serving Baltimore City, Yang and colleagues implemented a quality improvement initiative that integrated the Centers for Disease Control and Prevention's routine HIV screening and neutral-status care models, helping normalize HIV testing while reducing stigma around prevention and treatment. These models recommend that physicians annually screen patients who are at an increased risk of contracting HIV, offer HIV testing to everyone as routine care to reduce the stigma around the disease, and talk to patients openly about HIV and prevention at checkups. 

To implement these models, Yang and his team trained fifteen staff members and volunteers become certified to provide HIV testing and linkage-to-care services through the Maryland Department of Health. More than 50 physician residents received training on HIV prevention, risk reduction, and screening practices, equipping the next generation of providers with the tools needed to address HIV in primary care settings. 

During the project period, the clinic conducted 944 HIV tests, an 18.6% increase from the previous year. Overall, the program achieved a 41% HIV testing rate, and half of the young people recommended for screening completed testing and received their results. These improvements strengthened the clinic's ability to identify individuals who could benefit from HIV prevention services or treatment and connect them with appropriate care. 

Every patient who received an HIV test also received prevention counseling, including information about routine testing, safer sex practices, partner communication, condom use, and preventive medications such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). Nearly all patients accepted condoms to take home, while transportation assistance helped remove barriers for individuals attending appointments and laboratory visits related to HIV prevention medications. 

Importantly, the program focused on communities facing disproportionate HIV burdens and other social challenges. By integrating community health workers into outreach, education, and testing efforts, the program created a more person-centered model of care that supports both patients and providers, while helping to build a healthier future for young people.