Using social and risk networks helps identify people undiagnosed with HIV

January 22, 2018, New York University

Conducting HIV testing among the social and risk networks of those recently diagnosed with HIV helps identify undiagnosed cases of HIV at significantly higher rates and at a lower cost than other testing approaches, finds a new study conducted in Ukraine by an international research team.

The study, led by Samuel R. Friedman of National Development Research Institutes (NDRI) and the Center for Drug Use and HIV/HCV Research (CDUHR) at NYU Rory Meyers College of Nursing and the, is published in the Journal of the International AIDS Society.

Caring for people with HIV and limiting HIV transmission both depend on locating and diagnosing HIV cases, ideally soon after infection. Large-scale testing and various forms of outreach to key populations are common strategies for locating people who are undiagnosed. However, in many countries, including Ukraine, considerable resources are spent on HIV testing and a large number of HIV-negatives are found for each person who tests positive.

"Tracing social and risk networks has been found to help locate people recently infected with HIV, given that the virus is transmitted through sexual and injection risk networks," said Friedman, director of the Institute for Infectious Disease Research at NDRI and associate director and senior theoretician at CDUHR. "In addition, since social norms and rumors about HIV testing and treatment are likely to spread through social networks, which overlap to considerable degree with risk networks, this also lets us zero in on groups who would usually be unlikely to get tested on their own."

In this study, the researchers compared three projects and their ability to identify undiagnosed cases of HIV: The Transmission Reduction Intervention Project (TRIP), integrated biobehavioral surveillance, and outreach testing. The research took place in Odessa, a large city in southern Ukraine and one of the areas where injection drug use and then an HIV epidemic began in the 1990s.

In TRIP, the researchers conducted network-based recruiting, counseling, and HIV testing from 2013 through 2016. Researchers recruited "seeds," or participants who were potentially recently infected and whose risk networks could then be tested. Risk networks included sexual partners, people participants injected drugs with, people who were present while participants were having sex or using drugs, and people recruited from small-size venues where participants went to inject drugs or locate sexual partners.

TRIP looked at two types of "seeds" - those recently infected plus their risk members, as well as those with longer-term HIV infections and their networks. Recently infected participants are an important target group for intervention because transmission is particularly likely during this time due to high viral loads, lack of immune response, and potentially elevated rates of risky behaviors.

Integrated biobehavioral surveillance used respondent-driven sampling - where people from a hard-to-reach population recommend other people they know - to recruit people who inject drugs. In the outreach testing project, people who inject drugs were tested for HIV at community outreach sites.

The researchers found that recruiting the risk networks of people infected with HIV through TRIP led to locating a significantly higher rate of undiagnosed positives than did either integrated biobehavioral surveillance or outreach testing. TRIP tested 1,252 people for HIV, 183 (14.6 percent) of whom were HIV positive; the integrated biobehavioral surveillance project tested 400 people and found 20 (5 percent) undiagnosed cases of HIV, while outreach testing was conducted on 13,936 people and found 331 (2.4 percent) undiagnosed cases of HIV.

"The superiority of TRIP as a way to recruit undiagnosed positives probably stems from its design. TRIP zeroes in on the social networks most likely to be infected rather than attempting to use 'weak ties' to recruit people who inject drugs who are socially and geographically distant from the 'seeds,'" Friedman said.

In addition, within TRIP, recently infected participants' networks contained higher proportions of undiagnosed positives (16.3 percent) than the networks of longer-term infected (12.2 percent).

Finally, TRIP was found to be a cost-effective method for identifying undiagnosed cases of HIV. For each person detected, the cost was $250 for TRIP, $387 for integrated biobehavioral surveillance, $941 for outreach testing in 2013-14, and $653 for outreach testing in 2015-16.

Given the success of TRIP in Ukraine and similar findings from Athens and San Diego, the researchers recommend that TRIP's recruiting techniques, including prioritizing networks of the recently infected, be integrated with existing HIV testing programs to improve the identification of new HIV cases.

Explore further: War in Ukraine has escalated HIV spread in the country: study

More information: Pavlo Smyrnov et al. Risk network approaches to locating undiagnosed HIV cases in Odessa, Ukraine, Journal of the International AIDS Society (2018). DOI: 10.1002/jia2.25040

Related Stories

War in Ukraine has escalated HIV spread in the country: study

January 15, 2018
Conflict in Ukraine has increased the risk of HIV outbreaks throughout the country as displaced HIV-infected people move from war-affected regions to areas with higher risk of transmission, according to analysis by scientists.

Around 9 million Europeans are affected by chronic hepatitis B or C

July 26, 2017
An estimated 4.7 million Europeans are living with chronic hepatitis B and almost 4 million (3.9) with chronic hepatitis C infection. However, large numbers of them are not even aware of their infection as they have not yet ...

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 ...

An HIV test can be the first step to a healthy life

December 4, 2017
On this World AIDS Day, health experts at Baylor College of Medicine are reminding everyone that knowing whether or not you are infected with HIV is the first step to living a healthy life.

In US, people with HIV often go 3 yrs without knowing

November 28, 2017
People who are infected with HIV in the United States often go for years without being diagnosed, with the median, or midpoint, being three years, according to US government data Tuesday.

Hepatitis C is transmitted by unprotected sex between HIV-infected men

July 21, 2011
Sexual transmission of hepatitis C virus (HCV) is considered rare. But a new study by researchers at Mount Sinai School of Medicine, working with the Centers for Disease Control and Prevention (CDC), provides substantial ...

Recommended for you

Researchers find new way to defeat HIV latency

March 8, 2018
HIV, the virus that causes AIDS, has a secret life. Though anti-retroviral therapy can reduce its numbers, the virus can hide and avoid both treatments and the body's immune response.

Broadly neutralizing antibody treatment may target viral reservoir in monkeys

March 5, 2018
After receiving a course of antiretroviral therapy for their HIV-like infection, approximately half of a group of monkeys infused with a broadly neutralizing antibody to HIV combined with an immune stimulatory compound suppressed ...

HIV begins to yield secrets of how it hides in cells

March 2, 2018
UC San Francisco scientists have uncovered new mechanisms by which HIV hides in infected cells, resting in a latent state that evades the body's immune system and prevents antiviral drugs from flushing it out.

HIV exports viral protein in cellular packages

February 15, 2018
HIV may be able to affect cells it can't directly infect by packaging a key protein within the host's cellular mail and sending it out into the body, according to a new study out of a University of North Carolina Lineberger ...

Can gene therapy be harnessed to fight the AIDS virus?

February 13, 2018
For more than a decade, the strongest AIDS drugs could not fully control Matt Chappell's HIV infection. Now his body controls it by itself, and researchers are trying to perfect the gene editing that made this possible.

Big data methods applied to the fitness landscape of the HIV envelope protein

February 7, 2018
Despite significant advances in medicine, there is still no effective vaccine for the human immunodeficiency virus (HIV), although recent hope has emerged through the discovery of antibodies capable of neutralizing diverse ...


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.