SPTHB ETHIC Native Test - Native Test: Delivering HIV Self-Testing Kits to Doorsteps Across Indian Country, Striving for Syndemic Elimination The Oklahoma Tribal Epidemiology Center (OKTEC) seeks to raise the health of American Indians/Alaskan Natives (AI/ANs), specifically striving for the elimination of the HIV/STI syndemic by participating in activities to prevent, diagnose, treat, and respond at the individual, family, community, and system levels, as outlined in the Indigenous HIV/AIDS Syndemic Strategy. The OKTEC aims to increase the number of AI/ANs that know their HIV status by delivering HIV self-testing kits to doorsteps across Indian Country through innovative methods such as an SMS-based texting system, website, and community-based efforts for requesting an HIV self-testing kit. The OKTEC program activities attempt to address the gap in HIV self-testing (HIVST) for AI/AN communities most affected by HIV transmission by 1) increasing knowledge of HIV status; 2) reducing the incidence of HIV among AI/ANs; 3) increasing engagement and access to HIV treatment and prevention support services; and 4) increasing access and use of safe spaces for priority populations. These activities are conducted through the Native Test program, a unique texting service established in 2021 to request an HIV self-test kit without internet access. Native Test, a nationwide reaching project coordinated by the OKTEC, has 63 partner organizations across Indian Country. This program is for anyone nationwide 13 years or older including both AI/AN individuals and non-Native individuals. The platform also provides individuals with access to information on HIV preventative care (PrEP) and links to free STI testing, in select areas. Native Test has distributed over 7,000 HIV self-test kits, linked over 30 people to PrEP care and distributed over 100,000 condoms. With the IHS ETHIC II funds, Native Test will seek to expand, continue to prioritize HIVST education and test kit distribution, enhance program promotion and outreach, expand community collaborations and partnerships, and encourage linkages to HIV treatment, prevention, and other essential services. Implementation and Quality Improvement of CEDAR: Controlling Epidemics by Designing Accessible Responses The Southern Plains Tribal Health Board (SPTHB) and the Oklahoma Area Tribal Epidemiology Center (OKTEC) seeks to raise the health of American Indian/Alaska Natives (AI/ANs), specifically striving for the reduction of Syphilis/HIV/Hepatitis/STI syndemic by participating in activities to prevent, diagnose, treat, and respond at the individual, community, and system levels; as outlined in the Indigenous HIV/AIDS Syndemic Strategy (indigi-HAS) and the Ending the HIV Epidemic: A Plan for America (EHE). The OKTEC aims to increase the number of AI/AN persons that know their status and are engaged in care. This aim is supported by the proposed activities in this application to promote quality improvement plans (QIPs) for Syphilis/HIV/Hepatitis/STIs through IHS/Tribal/Urban (I/T/U) health facilities. The QIPs will be supported by the Controlling Epidemics by Designing Accessible Responses (CEDAR) framework. The CEDAR framework will approach QPIs through a syndemic lense and consider the accessibility of the care continuum from community to completion of treatment and retention in care. The six objectives in the workplan guide a path to the goals outlined in the indigi-HAS and EHE, by increasing the knowledge of status, increasing the retention in care, and reducing the burden and spread of disease through viral suppression or completed treatment plans for Syphilis/HIV/Hepatitis/STIs. Previous work SPTHB and Tribal health systems have accomplished in Hepatitis C Elimination, PrEP prescribing training initiatives, Syphilis cluster response, and HIV care continuum evaluation; have created the foundation for a syndemic quality improvement plan that encompasses indigenous values, traditional practice, and novel approaches.
