Comparative Effectiveness of Social Networks-Based Strategies Versus Standard Counseling, Testing and Referral for HIV Screening in a State-Wide Testing Program
Background: Social Networks Strategies (SNS) for HIV testing have been demonstrated in some community-based settings to yield a higher proportion of reactive HIV screening tests than standard, client-initiated counseling, testing and referral (CTR) programs. However, the common use of financial incentives in SNS can make this approach relatively costly, and may invite abuse of the system by encouraging frequent testing by relatively low HIV risk individuals. Using data from a large, publicly-funded testing program supporting both SNS and CTR approaches in Wisconsin, we sought to determine (1) the relative effectiveness of each strategy and (2) whether the level of HIV risk reported by network associates of high-volume recruiters diminishes sequentially and/or over time.
Methods: We collected data from 45 testing sites in Wisconsin between 2008 and 2012. Using a generalized mixed model accounting for intra-network correlation, we compared the effectiveness (defined as the proportion of HIV tests that were reactive) of SNS testing to standard CTR during this period (SNS = 2,169, CTR = 48,318). Data from a standardized risk questionnaire administered to all clients were used to create a risk score reflecting the probability of having a reactive HIV test. For SNS clients, we used generalized additive models to investigate whether HIV risk diminished over time, or with subsequent network associates identified by a single recruiter.
Results: The HIV test was reactive for 2.49% of clients recruited via SNS, compared with 0.91% of clients using CTR (p<0.001). Within the SNS program, we observed a trend toward increased HIV risk among subsequent network associates identified by an individual recruiter (Figure 1A) and over time (Figure 1B). Considering joint effects of increasing number of clients recruited and time elapsed since first recruitment, there was a significant increase in HIV risk level with ongoing recruitment (Figure 2).
Conclusion: SNS yield a substantially higher proportion of reactive HIV tests compared to standard CTR. In this sample, the HIV risk level of clients recruited using SNS did not diminish when recruiters identified large numbers of network associates, nor over time. These findings suggest SNS is an effective approach to identifying individuals with undiagnosed HIV infection.
M. Elderbrook, None
C. Schumann, None
J. Vergeront, None
R. Westergaard, None