Abstract
IntroductionProviding HIV healthcare and Treatment as Prevention both depend on diagnosing HIV cases, preferably soon after initial infection. We hypothesized that tracing risk networks recruits higher proportions of undiagnosed positives than outreach‐based testing or respondent‐driven sampling (RDS) in Odessa, Ukraine.MethodsThe Transmission Reduction Intervention Project (TRIP) used risk network tracing to recruit sexual and injection networks of recently‐infected and longer‐term infected (LTs) seeds (2013 to 2016). Integrated Biobehavioural Surveillance (IBBS) (2013) used RDS to recruit people who inject drugs (PWID). Outreach Testing tested PWID for HIV at community outreach sites (2013 to 2016). Proportions of undiagnosed positives among those tested were compared TRIP versus IBBS; TRIP versus Outreach Testing and between TRIP arms. Costs were compared across the projects.Results TRIP tested 1252 people (21% women) in seeds’ risk networks; IBBS tested 400 (18% women); Outreach Testing 13,936 (31% women). TRIP networks included a higher proportion of undiagnosed positives (14.6%) than IBBS (5.0%) or Outreach Testing (2.4%); odds ratio (OR) 3.25 (95% CI 2.07, 5.12) versus IBBS and 7.03 (CI 5.95, 8.31) versus Outreach Testing respectively. Findings remained significant in analyses stratified by sex and when PWID in TRIP networks were compared with Outreach Testing and IBBS. Within TRIP, recently‐infected participants’ networks contained higher proportions of undiagnosed positives (16.3%) than LTs’ networks (12.2%); OR 1.41 (CI 1.01, 1.95). TRIP located undiagnosed positives less expensively than did RDS or Outreach Testing.Conclusions TRIP's recruiting techniques, including prioritizing networks of the recently infected, find undiagnosed HIV‐positive people efficiently. They should be integrated with standard practice to improve case‐finding. Research should test these techniques in other socio‐epidemiologic contexts.Clinical trial registryRegistered ClinicalTrials.gov: NCT01827228.
Highlights
Providing HIV healthcare and Treatment as Prevention both depend on diagnosing HIV cases, preferably soon after initial infection
Transmission Reduction Intervention Project (TRIP) was a network intervention study with an intervention arm consisting of members of risk networks that were traced beginning with recently infected seeds, and a comparison arm consisting of risk network members of the longer-term positive seeds
The TRIP sample had higher rates of homeless and unemployed than did Integrated Biobehavioural Surveillance (IBBS), and had a higher rate who were in drug or alcohol treatment
Summary
Providing HIV healthcare and Treatment as Prevention both depend on diagnosing HIV cases, preferably soon after initial infection. Conclusions: TRIP’s recruiting techniques, including prioritizing networks of the recently infected, find undiagnosed HIVpositive people efficiently They should be integrated with standard practice to improve case-finding. Current global strategies to care for the infected and to limit HIV transmission depend to a large degree on locating and intervening with HIV-infected persons. We hypothesize that they should be able to locate more undiagnosed positives per test (and perhaps per staff member) than current testing approaches [2,3,4] This is because HIV is transmitted through risk (sexual and injection) networks, and those who are unaware that they are infected may be more likely to engage in condomless sex [5] or sharing of potentially-infected injection paraphernalia. Social norms and rumours about the advantages and disadvantages of HIV testing and HIV therapy are likely to spread and to be sustained in social networks (which often overlap with risk networks [6,7,8,9,10,11])
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