Researchers examine social/behavioral interventions to uncover undiagnosed HIV

December 9, 2016

Despite some evidence that HIV incidence rates in the United States are decreasing modestly in recent years, at least 44,000 people are still infected with HIV each year. Of concern, socioeconomically disadvantaged African American/Black and Hispanic persons are disproportionately affected by HIV, and thus over-represented in the HIV epidemic in comparison to their numbers in the general population. Overall, it is estimated that some 15% of people nation-wide living with HIV remain unaware of their infection.

"Undiagnosed HIV is a serious public health issue," said Marya Viorst Gwadz, Ph.D., the study's Principal Investigator from the Center for Drug Use and HIV Research (CDUHR) at New York University Rory Meyers College of Nursing. "At least a third of new HIV transmission events are linked to those with undiagnosed HIV, yet finding people with undiagnosed HIV is very challenging."

Nationally, heterosexual sex is the second most common route of HIV transmission after male-to-male sexual contact, accounting for an estimated 24% of newly reported infections annually and is the main route of transmission among women.

"Compared with other risk groups, heterosexuals are less likely to be tested for HIV over their lifetimes, and less likely to be tested annually, as the Centers for Disease Control and Prevention (CDC) recommends," notes Charles M. Cleland, PhD., a study Co-Investigator. "As many as 25% of HIV-infected heterosexuals are undiagnosed - a substantially higher rate of undiagnosed HIV than among other risk groups."

"We are interested mainly in heterosexuals considered at high-risk for HIV because they live in urban geographical areas with high rates of poverty, a primary risk factor for HIV infection, and high rates of prevalent HIV," said Noelle R. Leonard, PhD., another study Co-Investigator. "These 'heterosexuals at high-risk' for HIV, who are mainly African American/Black and Hispanic, have serious barriers to regular HIV testing. Many of the barriers are related to race/ethnicity and lower social status, including: fear of HIV stigma; distrust of medical settings; substance use problems; and the sense that heterosexuals are not at risk for HIV compared to other risk groups—such as men who have sex with men or persons who inject drugs."

"To substantially reduce the numbers of persons living with HIV who remain undiagnosed, the National Institute on Drug Abuse has spearheaded a research initiative on interventions to seek out persons with undiagnosed HIV, test them, and then, link those with HIV infection to health care in a timely fashion, called the 'Seek, Test, Treat, and Retain' (STTR) model," said Alexandra Kutnick, the study's project director.

In an effort to identify the best approaches to uncovering undiagnosed HIV, Dr. Gwadz and her research team compared the efficacy of three social/behavioral intervention strategies for heterosexual individuals at high risk (HHR) for HIV within an urban high-risk area (HRA) in central Brooklyn, New York.

The study, "Public Health Benefit of Peer-Referral Strategies for Detecting Undiagnosed HIV Infection among High-Risk Heterosexuals in New York City," published in JAIDS: Journal of Acquired Immune Deficiency Syndromes, looks at the relative "yield" of three Seek/Test methods: Respondent Driven Sampling with Anonymous Single-session Testing (RDS-AST); Respondent Driven Sampling with Confidential Two-session Testing (RDS-CTT); and Venue-based Sampling (VBS).

"The three interventions were designed to address the specific barriers to HIV testing that HHR experience, and all three interventions were culturally appropriate for African American/Black and Hispanic HHR," said Dr. Gwadz.

The researchers stress that efficient and potent active approaches to detect undiagnosed HIV among HHR are sorely needed to achieve the goal of elimination of HIV transmission in the U.S., and the present study addresses this gap in available HIV prevention programs.

"We examined the efficacy of these three intervention strategies to uncover undiagnosed HIV infection among HHR by seeking them out in their communities and providing HIV counseling and testing, said Dr. Gwadz. "Moreover, the CDC and others use both respondent-driven sampling (RDS), a peer-to peer recruitment method, and venue-based sampling (VBS) in their surveillance studies, but this is the first direct comparison of RDS and VBS to identify undiagnosed HIV prevalence among HHR."

Participants in all three interventions evidenced high rates of risk and behavioral factors such as poverty, unemployment, substance use, and incarceration - factors that place individuals at risk for HIV - but low rates of regular, annual HIV testing. The prevalence of confirmed newly diagnosed HIV infection was higher in the RDS-AST (4%) and RDS-CTT (1%) interventions than VBS (0.3%). Those in RDS-AST were least likely to have regular, annual HIV testing and most likely to have both sexual and substance use risk factors compared to RDS-CTT and VBS.

For example, 60% of those in RDS-AST evidenced substance use problems at a clinically significant level in the past year, compared to 37% in RDS-CTT. RDS-AST and RDS-CTT yielded comparable overall HIV prevalence rates (10.3% and 7.4%) - substantially higher than national estimates among HHR. VBS was feasible but produced a sustainability lower proportion of newly diagnosed HIV than the two RDS approaches.

"Our study findings suggest VBS is not an optimal approach for HHR, perhaps because heterosexuals at high-risk for HIV are embedded in physical spaces that include lower-risk individuals, and VBS is an inefficient means of gaining access to those at highest risk," said Dr. Leonard. "These findings, on the other hand, underscore the utility of peer-to-peer recruitment methods such as RDS, particularly in conjunction with low-threshold and easy-access interventions that provide HIV testing at the first contact, and which directly ameliorate potential barriers such as perceived HIV stigma."

The researchers note that rates of newly diagnosed HIV found in this study were lower than initially hypothesized at the time the study was planned, which may be a result of the set of effective HIV prevention strategies implemented in New York City during the study period. As of 2012, New York State had one of the lowest rates of undiagnosed HIV (7%) in the U.S. Lower rates of newly diagnosed HIV in RDS-CTT intervention compared to RDS-AST also suggest that variations in the timing and content of intervention components can impact sample composition and the intervention's efficiency with respect to uncovering undiagnosed HIV infection.

This study is the first to prospectively demonstrate the value of potentially replicable Seek and Test interventions to identify HHR with undiagnosed HIV; namely, peer-referral methods focused in large socially-networked populations with high HIV prevalence. Thus it provides further support for utility of social network approaches to identify undiagnosed HIV in vulnerable populations.

"Implemented on a continual basis in urban HRAs, such approaches can complement institutionally-based HIV testing programs and play a vital role in eliminating HIV transmission by promoting regular HIV testing among populations at high risk for HIV, including substance users," said Dr. Gwadz.

Explore further: CDC examines prevalence of undiagnosed HIV

Related Stories

CDC examines prevalence of undiagnosed HIV

June 30, 2015
(HealthDay)—Many people have undiagnosed HIV, with the prevalence varying by geographic area, according to a report published in the June 26 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality ...

Estimated prevalence of diabetes among adolescents higher than previously reported

July 19, 2016
In a study appearing in the July 19 issue of JAMA, Andy Menke, Ph.D., of Social & Scientific Systems, Silver Spring, Md., and colleagues estimated the prevalence of diabetes among U.S. adolescents, the percentage of those ...

HIV transmission at each step of the care continuum in the United States

February 23, 2015
Individuals infected but undiagnosed with the human immunodeficiency virus (HIV) and those individuals diagnosed with HIV but not yet in medical care accounted for more than 90 percent of the estimated 45,000 HIV transmissions ...

Asian-Americans are at high risk for diabetes but rarely get screened

November 15, 2016
Less than half of Asian Americans who ought to be screened for type 2 diabetes actually get tested, according to a study published Nov. 15, 2016, in the Journal of General Internal Medicine. Asian Americans have a high prevalence ...

Focus on undiagnosed HIV

January 20, 2014
A new study that aims to identify rates of undiagnosed HIV in Australia's gay community will offer free testing across six states and territories, including at Sydney's Gay and Lesbian Mardi Gras.

DIY sampling kits accessed through gay men's social media unearth new HIV cases

May 24, 2016
Offering DIY sampling kits for HIV using online dating apps and social media targeting gay men, successfully unearths previously undiagnosed cases of the infection, reveals an evaluation of the first large-scale dedicated ...

Recommended for you

Three-in-one antibody protects monkeys from HIV-like virus

September 20, 2017
A three-pronged antibody made in the laboratory protected monkeys from infection with two strains of SHIV, a monkey form of HIV, better than individual natural antibodies from which the engineered antibody is derived, researchers ...

Fighting HIV on multiple fronts might lead to vaccine

September 20, 2017
A combination antibody strategy could be the key to halting the spread of HIV, according to results from two promising animal studies.

HIV-AIDS: Following your gut

September 18, 2017
Researchers at the University of Montreal Hospital Research Centre (CRCHUM) have discovered a way to slow viral replication in the gastrointestinal tract of people infected by HIV-AIDS.

Study finds cutbacks in foreign aid for HIV treatment would cause great harm

August 30, 2017
Proposed reductions in U.S. foreign aid would have a devastating impact on HIV treatment and prevention programs in countries receiving such aid, an international team of investigators reports. In their paper published online ...

Cancer drug can reactivate HIV

August 24, 2017
People living with HIV must take a combination of three or more different drugs every day for the rest of their lives. Unfortunately, by following this strict treatment plan, they can suffer from side effects ranging from ...

New injectable antiretroviral treatment proved to be as effective as standard oral therapy

August 3, 2017
Intramuscularly administered antiretroviral therapy (ART) may be as effective for HIV treatment as current oral therapies. This is the main conclusion of a Phase II clinical trial carried out by 50 research centers around ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.