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More Positive HIV Tests Via Social Networks Than Standard Approach
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IDWeek 2014, October 8-12, 2014, Philadelphia
Mark Mascolini
HIV tests at 48 Wisconsin sites yielded positive results with a Social Networks Strategies (SNS) approach more than twice as often as with standard client-driven HIV testing [1]. HIV risk increased over time in people recruited for testing by SNS.
SNS represents a "programmatic, peer-driven recruitment strategy to reach persons at highest risk of HIV," according to researchers at the University of Wisconsin and the Wisconsin Division of Public Health. The strategy is simple: agencies enlist or employ people with a high HIV risk and ask them to recruit "network associates" or peers to get tested for HIV. In a 7-city CDC-funded demonstration project, HIV prevalence stood at 5.6% in people recruited through SNS, compared with about 1% in publicly funded standard HIV testing programs [2].
But because SNS often relies on financial incentives, it costs more than typical client-driven testing and may encourage frequent testing by relatively low-risk people who want to make money. With those potential shortcomings in mind, the Wisconsin team conducted this study to compare SNS with conventional counseling, testing, and referral (CTR) and to determine whether the effectiveness (defined as proportion of HIV-positive tests) of SNS drops over time. Declining effectiveness could indicate abuse of the system by recruiters or tested people.
This retrospective study analyzed data from 65,693 state-funded HIV tests in Wisconsin from 2008 through 2014 at 48 public health departments and community-based organizations. The researchers determined the proportion of tests positive by SNS versus CTR and used generalized linear mixed models accounting for intranetwork correlation to determine whether the difference in positivity rate was statistically significant. Then they created an HIV risk score based on demographic and risk behavior data from all tested people in the study. They used the risk score to see if the likelihood of HIV diagnosis via SNS decreases if recruiters (1) refer a growing number of network associates over time or (2) continue recruiting for prolonged periods.
Over the 7-year study period, 580 of 63,073 HIV tests (0.92%) conducted through CTR proved positive, compared with 64 of 2620 (2.44%) conducted through SNS, a highly significant difference (P < 0.0001). The 2620 network associates tested via SNS got referred by 536 recruiters (4.89 per recruiter).
The Wisconsin researchers saw a trend toward increasing HIV risk among network associates referred (1) by the same recruiter and (2) over time. When the investigators considered joint effects of increasing numbers of clients recruited and time elapsed since first recruitment, they recorded a significant increase in HIV risk with ongoing recruitment (P = 0.0326).
In this population, the investigators concluded, "HIV risk level of clients recruited using SNS did not diminish when recruiters identified large numbers of network associates, nor over time." They believe their findings "suggest SNS is an effective approach to identifying individuals with undiagnosed HIVinfection."
References
1. Peng M, Hess T, Elderbrook M, et al. Comparative effectiveness of social networks-based strategies versus standard counseling, testing and referral for HIV screening in a state-wide testing program. IDWeek 2014. October 8-12, 2014, Philadelphia. Abstract 84. https://idsa.confex.com/idsa/2014/webprogram/Paper47488.html
2. Centers for Disease Control and Prevention. Use of social networks to identify persons with undiagnosed HIV infection--seven U.S. cities, October 2003-September 2004. MMWR. 2005;54:601-605 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5424a3.htm
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