142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Project Engage: Snowball Sampling and Direct Recruitment of Out of Care HIV-Infected Persons

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 12:45 PM - 1:00 PM

Rhodri Dierst-Davies, MPH , Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, CA
Saloniki James, MA , Division of HIV & STD Programs, Los Angeles County Department of Public Health, Los Angeles, CA
Amy Wohl, MPH, PhD , Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, CA
Issues: The LA County PrEP and TLC+ for HIV Prevention (PATH) program is designed to implement a coordinated response to the local HIV/AIDS epidemic through innovative, evidence-based interventions stretching across the continuum of care.  An estimated 47% of HIV-infected persons in Los Angeles County(LAC) were retained in care in 2011. Project Engage(PE) was designed to find hard-to-reach out of care (OOC) HIV-infected persons and link them to HIV care.

Description: A combination of snowball sampling and direct recruitment was used. Recruiters(seeds) were from HIV clinics/agencies. OOC persons(alters) were identified either through social networks, directly by clinic/agency staff,  or flyers. OOC was defined as no care visits in >12mo; no care visits in 7-12mo and most recent VL>200copies/ml; newly-diagnosed and not linked to care within 3mo; or recently released from jail and no provider. OOC status was verified using LAC-HIV surveillance. Staff advocated for linkage and negotiated barriers.

Lessons Learned: To date, 24 OOC persons were enrolled via social networks(n=22) or direct recruitment(n=2). OOC were: African-Americans(46%), MSM(83%), the uninsured(67%), recently incarcerated(58%), homeless(75%) and individuals engaged in exchange sex(25%). On average, participants were OOC for 10mo; report a history of ART(67%); and had elevated VL pre-enrollment(mean=50,565copies/ml). It took an average of 12 days to link clients to care. Among patients enrolled, 18/24(75%) linked were to care, with 7/8(88%) retained in care at 6mo. Program acceptability was high.

Recommendations: A combination of snowball sampling and direct recruitment is feasible for engaging hard-to-reach, severely marginalized OOC HIV-infected persons in order to provide linkage support.

Learning Areas:

Planning of health education strategies, interventions, and programs
Public health or related research

Learning Objectives:
Compare the effectiveness of different recruitment techniques for identifying and re-engaging HIV infected person who have fallen out of care.

Keyword(s): HIV/AIDS, HIV Interventions

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have multiple years of experience in the fields of HIV research and program evaluation. I have also performed program management for multiple federally funded research projects related to HIV prevention and health care delivery.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.