Recruiting High-Risk Transgender Women into an HIV Prevention Study in NYC: Comparing Peer-based Referrals vs. Institution-based Recruitment

Background: Transgender women (TW) are at high risk for HIV.  Due to social and economic challenges, this population is often hard to reach and present unique recruitment barriers for HIV prevention interventions. To date, little research examines which types of recruitment strategies work best for this population.

Methods: One hundred TW were screened by telephone to determine eligibility for a motivational interviewing and cognitive behavioral skills-based intervention aimed at reducing sexual risk behaviors and substance use. Eligibility criteria included 2 days of condomless anal or vaginal intercourse and 3 days of illicit drug use within the past 60 days. Participants were recruited through self-report non-incentivized peer-based referrals, community-based organizations, community health centers, and research staff members.  For these analyses, recruitment strategies were grouped as peer-based or institution-based.

Findings: Chi-square analyses indicated no significant differences in age or race of those recruited through peer-based referrals compared to institution-based strategies; however, women who reported that they learned about the study through their friends or peer networks were significantly more likely to engage in higher rates of condomless sex and substance use in the past 60 days than those who reported learning about the study through institution-based recruitment strategies (p=.009).

Conclusions: These findings demonstrate that TW are more likely to self-report higher HIV risk behaviors when referred to the study by peers compared to other methods. This suggests that snowball sampling techniques may be more successful for reaching and recruiting TW who engage in high risk behaviors.