Using Respondent-Driven Sampling to Identify High-Risk Unaware Persons Living With HIV/AIDS: Social Network HIV Testing

Issues: The overarching goal of the LA County PrEP and TLC+ for HIV Prevention (PATH) program is to implement a coordinated response to the local HIV/AIDS epidemic through a set of innovative, evidence-based interventions across the continuum of HIV prevention and care.  In 2011, approximately 21% of 59,000 HIV-infected persons in Los Angeles County(LAC) were unaware of their serostatus. Social network recruitment strategies are effective at identifying high-risk individuals, as well as providing important context relevant to risk behaviors. Social Network Testing(SNT) aims to identify and recruit high-risk individuals and their peers who may not be tested through conventional programs or mechanisms.

Description: Using respondent-driven sampling(RDS), recruiters(seeds) were enrolled from biomedical prevention programs, health education risk reduction programs and commercial sex venues. High-risk individuals(alters) were recruited through their social networks from seeds. Eligibility included HIV-negative adults who reported engaging in high-risk sexual behaviors in the past 6 months (i.e., unprotected sex with a partner whose status was positive/unknown, sex while under the influence, engaging in exchange sex, recent STI). Participants testing negative were referred to appropriate prevention services and individuals testing positive were linked to medical care.

Lessons Learned: As of Feb 2014, 20 seeds and 151 alters enrolled. The majority of the participants were male(92%), African-American(54%), men-who-had-sex-with-men(98%), and homeless(50%). Many(31%) were unaware of pre-/post-exposure prophylaxis. A 2.3% positivity rate for newly infected alters was observed, much greater than the 1.1% found across other publically-funded testing programs in LAC.

Recommendations: RDS can effectively identify high-risk individuals unaware of their status.