Strategies to uncover undiagnosed HIV infection among heterosexuals at high risk and link them to HIV care with high retention: a “seek, test, treat, and retain” study

Abstract

BackgroundOver 50,000 individuals become infected with HIV annually in the U.S., and over a quarter of HIV infected individuals are heterosexuals. Undiagnosed HIV infection, as well as a lack of retention in care among those diagnosed, are both primary factors contributing to ongoing HIV incidence. Further, there are racial/ethnic disparities in undiagnosed HIV and engagement in care, with African Americans/Blacks and Latinos remaining undiagnosed longer and less engaged in care than Whites, signaling the need for culturally targeted intervention approaches to seek and test those with undiagnosed HIV infection, and link them to care with high retention.Methods/DesignThe study has two components: one to seek out and test heterosexuals at high risk for HIV infection, and another to link those found infected to HIV care with high retention. We will recruit sexually active African American/Black and Latino adults who have opposite sex partners, negative or unknown HIV status, and reside in locations with high poverty and HIV prevalence. The “Seek and Test” component will compare the efficacy and cost effectiveness of two strategies to uncover undiagnosed HIV infection: venue-based sampling and respondent-driven sampling (RDS). Among those recruited by RDS and found to have HIV infection, a “Treat and Retain” component will assess the efficacy of a peer-driven intervention compared to a control arm with respect to time to an HIV care appointment and health indicators using a cluster randomized controlled trial design to minimize contamination. RDS initial seeds will be randomly assigned to the intervention or control arm at a 1:1 ratio and all recruits will be assigned to the same arm as the recruiter. Participants will be followed for 12 months with outcomes assessed using medical records and biomarkers, such as HIV viral load.DiscussionHeterosexuals do not test for HIV as frequently as and are diagnosed later than other risk groups. The study has the potential to contribute an efficient, innovative, and sustainable multi-level recruitment approach and intervention to the HIV prevention portfolio. Because the majority of heterosexuals at high risk are African American/Black or Latino, the study has great potential to reduce racial/ethnic disparities in HIV/AIDS.Trial registrationClinicalTrials.gov, NCT01607541, Registered May 23, 2012.

Loss to Follow-Up among HIV Positive Pregnant and Lactating Mothers on Lifelong Antiretroviral Therapy for PMTCT in Rural Uganda

“…However, mothers that either did not have a clear contact address or had no telephone contact recorded in the individual ART card were disregarded. The selected respondents were physically identified using their telephone contacts and physical address as recorded in their individual ART cards and ANC/PMTCT/ ART clinic registers, with the help of peer educators and or village health teams (VHTs), a method that has also been suggested by Gwadz [10].…”

Public Health Benefit of Peer-Referral Strategies for Detecting Undiagnosed HIV Infection Among High-Risk Heterosexuals in New York City

“…Similar to past NHBS studies, 6,20 the present study was conducted in a well-defined HRA in central Brooklyn in New York City. As described elsewhere, 21 for each Brooklyn ZIP code, an “HRA index” was calculated by combining Census-based poverty levels and case surveillance-based heterosexual HIV prevalence, with each standardized to the values of those variables for all Brooklyn ZIP codes together, and then ranked. Next, a core HRA (7 ZIP codes) was identified using the local indicators of spatial association (LISA) procedure.…”

“…Next, a core HRA (7 ZIP codes) was identified using the local indicators of spatial association (LISA) procedure. 21 To reduce artificial restrictions on RDS recruitment, a larger HRA was then demarcated, adding remaining ZIP codes in the top 50% of the empirical distribution of the HRA index (12 additional ZIP codes). The three interventions were conducted in the same HRA during the same time period (2012–2015).…”

“…Components were culturally targeted to the barriers African American/Black and Hispanic HHR experience to HIV testing (e.g., low perceived risk, fear of HIV stigma) and carried out by trained, mainly master’s level staff. 21,22 The study’s primary outcome was the proportion of newly diagnosed HIV infections identified. All three Seek/Test interventions included components to refer those testing HIV-negative to prevention services, and link newly diagnosed individuals to HIV primary care (i.e.…”

Oral Hairy Leukoplakia: Clinical Indicator of an Immunusuppressive Condition and Challenges in Patient Management

“…This strategy consists of seeking people at risk who have not been recently tested for HIV infection (seeking), engaging them in HIV testing (testing), initiating, monitoring, and maintaining treatment for those testing positive (treating) and retaining patients in care (retaining). 16 One of the seeking strategies is to detect the oral lesion that could show a clinical sign of the immunodeficiency status of HIV. In 2009, the Government of Canada initiated the Seek and Treat Strategic for Optimal Prevention of HIV/AIDS in BC (STOP HIV/AIDS in the British Columbia province, BC).…”