An HIV and hepatitis C testing outreach model conducted at a country music festival in Appalachia demonstrated success in engaging attendees in screening and revealed a “connected-to-care but not screened” gap among attendees, according to research presented at the annual meeting of AIDS 2026 in Rio de Janeiro.

“When we think about the importance of us going into communities that don’t know their vulnerability, that’s our mission,” A. Toni Young, MBA, executive director and founder of the Community Education Group (CEG), a nonprofit organization, told attendees. “We have to do it, and we have to do it with fewer and fewer resources as time and days go on.”

Young described a community outreach project the CEG led at Healing Appalachia, an annual music festival created by country music star Tyler Childers that’s held in Ashland, Kentucky, to raise money for people impacted by substance abuse disorder. The year they attended, 2025, the event sold approximately 20,000 tickets, and the group planned to do 1200 HIV and hepatitis C tests at the event until their medical partner pulled out at the last minute.

“In this climate of conservatism that we see going around the globe, for getting access to care and treatment and testing, what we really have to think about is, how do we create more on-ramps,” including in the US, where about 90 community-based organizations are at risk of losing funding, Young told attendees.

“For this population of people, primarily White, primarily heterosexually identified but impacted by substance use disorder, what we realized is that the same things that had worked in urban environments like Washington, DC, San Francisco, and other places, we had to do here — we had to take the test to them,” she said. “We couldn’t wait for folks to come into a clinic or come into a mobile unit and ask for an HIV test or a hepatitis C test. We knew that that just wouldn’t work.”

When CEG proposed bringing testing to those populations, however, “people told us was that we were bananas,” she said, “because they told us that HIV and hepatitis C didn’t reside here.”

But in a 2016 report from the CDC that listed the 220 most vulnerable counties in the US for HIV or hepatitis C infections, however, more than half were in Appalachia.

“If those counties that had high incidence of drug overdose had high incidence of hepatitis C, I kept saying HIV had to be around the corner,” she said. Several years later, an HIV outbreak was reported in West Virginia among people who inject drugs.

“We have to give a better emphasis to people who are using drugs and people who are living what they would identify as relatively normal lives, people who use drugs on a regular basis and still go to work, people who may be in recovery but still go to work,” she said. “We have to figure out new screening mechanisms, and this is how we ended up at Healing Appalachia.”

Although their medical partner pulled out, they attended the festival anyway without any budget to see if they could get people to test. They offered Starbucks gift cards that Young happened to have with her in exchange for agreeing to test.

“Now, think about it for a second. Rural Appalachia, middle of nowhere, a country western concert. You’re getting ready to see some of your biggest stars,” Young said. “Do you really think that you’re going to stop and get a Hep C and a HIV test that night? Nope. You’re looking for a cold beer, a hot dog, and a good time. But instead, 141 people said yes to the test.”

The CEG runs an initiative called Community Health and Mobilization Prevention Services (CHAMPS) that prepares local residents to become certified community health workers to address regional health disparities. CHAMPS program graduates approached random people in the crowd to offer education, conduct brief surveys, and provide information on navigation for prevention or care services. CEG also worked with Harm Reduction Ohio to provide rapid HIV and hepatitis C testing with 200 test kits for each that were donated by OraSure Technologies. Testing was offered to people approached in the crowd and those who visited a booth the organization set up at the festival.

Nearly half of the 225 people approached in the crowd (45.8%) agreed to test, including more than half of those approached who were aged 18-24 years (56.8%). Uptake declined with age, with only 30.8% of those approached aged 55 years or older agreeing to test. Most of the participants (71.8%) had HIV and hepatitis C co-testing, and 4.9% of them added syphilis testing.

Among the 141 total people screened, there were two HIV infections (1.4%) and 16 hepatitis C infections (11.3%). All but two of those individuals (88.9%) were linked to care.

In addition to those screened for both infections, the group collected 256 paper surveys and 46 surveys from visitors to their booth at the festival, after excluding those from people younger than age 18 years, those whose recent alcohol use precluded consent, and those who did not complete the full survey. A small subset of 46 people agreed to a more detailed survey at the booth.

Among these visitors, 87% had a regular healthcare provider, 78.3% said they would know where to seek treatment, and 65.2% were aware of preexposure prophylaxis. Over half of these booth visitors (58.7%) had never been tested for HIV, hepatitis C, or syphilis. Younger people and those with a history of injecting drugs were more likely to have previously tested (P = .01 and P = .0001, respectively). Notably, knowledge was not a barrier to testing, the group found: 91.9% of 210 people surveyed knew where to go for testing.

“This is another nontraditional approach to reach populations that have known risks for HIV and hepatitis C,” said Michael D. Virata, MD, an associate professor of internal medicine at Yale School of Medicine in New Haven, Connecticut. “Appalachia has many of the counties that are considered to some of the most vulnerable populations for HIV and Hep C in the US as it relates to the opiate crisis. Events such as Healing Appalachia are able to draw in a substantial crowd that may be part of this vulnerable population, and it opens up an opportunity to engage people in understanding how particular behaviors such as substance use might put them at risk for these infections and to be able to readily access screening and testing.”

Virata noted the challenge of carrying out this kind of intervention without a budget, as Young’s group had to do.

“The concept could probably be adopted in many types of venues similar to this one and tailored to the population being served provided it has a well-organized plan and plenty of resources with broad community buy-in and involvement,” Virata said.

The research was limited by convenience samples of those approached and those visiting the booth on a single day of a multiday event and reliance on self-reporting for testing history and behavior. The demographics were also limited to 91.3% White participants, reflecting the demographics of the event and region. Two of the 16 hepatitis C cases lacked confirmation because of no follow-up to care.

The project “surfaced a gap that clinic-based data would miss: a ‘connected-to-care but not screened population,’” the group reported. The next steps will be to strengthen confirmatory pathways so that every reactive screen reaches a documented result, standardize follow-up protocols for open cases, and tailor messaging for youth and first-time testers.

The project did not receive any funding but was conducted and/or supported by Harm Reduction Ohio, Hope in the Hills, and the CHAMPS program, with tests donated by OraSure Technologies. Young and Virata had no disclosures.

Tara Haelle has covered science and medicine for nearly two decades and is author of Vaccination Investigation and The Informed Parent: A Science-Based Resource for Your Child’s First Four Years. She is based in Dallas.