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

Gwadz, Marya PhD; Cleland, Charles M. PhD; Perlman, David C. MD; Hagan, Holly PhD; Jenness, Samuel M. PhD; Leonard, Noelle R. PhD; Ritchie, Amanda S. MAA; Kutnick, Alexandra MA

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 15th, 2017 - Volume 74 - Issue 5 - p 499–507
doi: 10.1097/QAI.0000000000001257
Implementation Science

Abstract: Identifying undiagnosed HIV infection is necessary for the elimination of HIV transmission in the United States. The present study evaluated the efficacy of 3 community-based approaches for uncovering undiagnosed HIV among heterosexuals at high-risk (HHR), who are mainly African American/Black and Hispanic. Heterosexuals comprise 24% of newly reported HIV infections in the United States, but experience complex multilevel barriers to HIV testing. We recruited African American/Black and Hispanic HHR in a discrete urban area with both elevated HIV prevalence and poverty rates. Approaches tested were (1) respondent-driven sampling (RDS) and confidential HIV testing in 2 sessions (n = 3116); (2) RDS and anonymous HIV testing in one session (n = 498); and (3) venue-based sampling (VBS) and HIV testing in a single session (n = 403). The main outcome was newly diagnosed HIV infection. RDS with anonymous testing and one session reached HHR with less HIV testing experience and more risk factors than the other approaches. Furthermore, RDS with anonymous (4.0%) and confidential (1.0%) testing yielded significantly higher rates of newly diagnosed HIV than VBS (0.3%). Thus peer-referral approaches were more efficacious than VBS for uncovering HHR with undiagnosed HIV, particularly a single-session/anonymous strategy, and have a vital role to play in efforts to eliminate HIV transmission.

*Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY;

Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY; and

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.

Correspondence to: Marya Gwadz, PhD, Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010 (e-mail:

Supported by the National Institute on Drug Abuse (R01DA032083, PI: Gwadz; P30DA011041, PIs: Deren and Hagan).

The authors have no conflicts of interest to disclose.

Received June 15, 2016

Accepted October 31, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.