Peer-driven intervention increases rates of screening for AIDS clinical trials among persons living with HIV/AIDS from racial/ethnic minority backgrounds

Background: Persons living with HIV/AIDS (PLHA) from racial/ethnic minority backgrounds are under-represented in AIDS clinical trials (ACTs). PLHA gain access to ACTs through a screening process, but minorities face serious multi-level barriers to ACTs and are screened at low rates. We examined the efficacy of a peer-driven intervention (PDI) to increase rates of screening among minority PLHA.

Methods: A randomized controlled trial design examined the efficacy of PDI compared to a time/attention-matched control. PDI consisted of structured small group and individual sessions (6 hours) and the opportunity to educate three peers. Participants were recruited using respondent-driven sampling (N=342). Many (43.9%) participants were female, most (88.3%) were aged 41 years or older, and 91.5% were racial/ethnic minorities (64.9% African-American, 26.6% Latino). Most (93.3%) completed all intervention sessions and 61.4% recruited/educated peers. Baseline and 16 weeks post-baseline interviews were computer-assisted (94.4% follow-up rate). A logistic mixed model was used to examine intervention/other effects on screening for ACTs while accounting for clustering of participants in recruitment chains.

Results: Approximately half in the PDI (46.0%) were screened compared to 1.6% among controls. In the mixed model, screening was much more likely in the PDI than control arm (AOR=52.5; z=5.42, p < .0001), and among participants doing more recruiting/educating (AOR=1.39; z=2.63, p < .01).

Conclusions: Increasing rates of screening among PLHA from racial/ethnic minority backgrounds is critical to advance science. This intervention was highly efficacious and also can be adapted to other trial, biomedical research, and clinical settings where disparities persist.