Peer-Referral Strategies Improve HIV Diagnosis Rates

Peer referrals for testing can locate people with undiagnosed HIV better than health care providers.

The first comparison of 2 strategies for identifying undiagnosed HIV cases among high-risk heterosexuals (HHRs) suggests that peer-referral works significantly better than venue-based sampling, particularly when anonymous tests are immediately available.

Heterosexual sex accounts for an estimated 24% of new HIV infections annually, but mistaken beliefs about the relative safety of such activity leads to insufficient testing among high-risk individuals. Thus, as many as 25% of all infected heterosexuals are undiagnosed (compared to about 15% of all HIV cases) — which makes them more likely to further spread the disease by engaging in risky behavior.

Investigators compared 2 of the most popular strategies for breaking the cycle in a central Brooklyn neighborhood where many residents exhibit 3 of the most significant risk factors for undiagnosed heterosexual infection: low income, substance abuse problems, and black or Hispanic ethnicity.

The study actually tested 2 similar peer-referral strategies. Investigators recruited a small number of high-risk heterosexuals, tested them, educated them about HIV risk factors and asked each of them to recruit a few high-risk friends or acquaintances—who then recruited a few of their high-risk acquaintances and so on.

The recruits chose to attend one of 3 program options. Of the 3116 recruits who attended the 2-session program with confidential program, 1% had undiagnosed HIV. Of the 498 recruits who attended the 1-session program with anonymous HIV testing, 4% had undiagnosed HIV.

Both methods bested a venue-based sampling strategy that saw investigators go to venues which seemed like likely hangout spots for high-risk individuals. The investigators then offered education and testing to people at these venues and found undiagnosed HIV in just 0.3% of the 403 people who underwent testing.

“The 3 interventions were designed to address the specific barriers to HIV testing that HHR experience, and all 3 interventions were culturally appropriate for African American/Black and Hispanic HHR,” said principal investigator, Marya Viorst Gwadz, PhD, a senior research scientist from the Center for Drug Use and HIV Research at New York University’s Rory Meyers College of Nursing.

The newly published comparison is part of a longer study of “Seek, Test, Treat, and Retain” methods. The effort is funded as part of a larger push to discover better methods for finding and treating people with undiagnosed HIV—a push spearheaded by the National Institute on Drug Abuse and the National Institutes of Health.

People diagnosed with HIV through either of the peer-referral methods during the first part of the study will be randomly assigned to intervention or control during the “treat and retain” one-half of the study, which will assess outcomes using medical records and biomarkers such as HIV viral load.

The investigators targeted central Brooklyn because its population had the highest total risk factor rate of any area in New York City and because prior research indicates that its residents are less likely than some groups to get tested on their own.

“These ‘heterosexuals at high-risk’ for HIV, who are mainly African American/Black and Hispanic, have serious barriers to regular HIV testing,” said co-author Noelle R. Leonard, PhD. “Many of the barriers are related to race/ethnicity and lower social status, including: fear of HIV stigma; distrust of medical settings; substance use problems; and the sense that heterosexuals are not at risk for HIV compared to other risk groups—such as men who have sex with men or persons who inject drugs.”

The study, “Public Health Benefit of Peer-Referral Strategies for Detecting Undiagnosed HIV Infection among High-Risk Heterosexuals in New York City,” appeared November 29 in the online version of JAIDS: Journal of Acquired Immune Deficiency Syndromes. Quotations come from a New York University news release.