Gwadz Marya, Cleland Charles M, Perlman David C, Hagan Holly, Jenness Samuel M, Leonard Noelle R, Ritchie Amanda S, Kutnick Alexandra
*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.
J Acquir Immune Defic Syndr. 2017 Apr 15;74(5):499-507. doi: 10.1097/QAI.0000000000001257.
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.
在美国，识别未被诊断出的艾滋病毒感染对于消除艾滋病毒传播至关重要。本研究评估了三种基于社区的方法在高危异性恋者（HHR）中发现未被诊断出的艾滋病毒的效果，这些高危异性恋者主要是非洲裔美国人/黑人以及西班牙裔。异性恋者占美国新报告艾滋病毒感染病例的24%，但在接受艾滋病毒检测方面面临复杂的多层次障碍。我们在艾滋病毒感染率和贫困率均较高的一个独立市区招募了非洲裔美国人/黑人和西班牙裔高危异性恋者。测试的方法包括：（1）应答驱动抽样（RDS）和分两阶段进行的保密艾滋病毒检测（n = 3116）；（2）RDS和在一个阶段进行的匿名艾滋病毒检测（n = 498）；以及（3）基于场所抽样（VBS）和在一个阶段进行的艾滋病毒检测（n = 403）。主要结果是新诊断出的艾滋病毒感染。与其他方法相比，采用匿名检测且在一个阶段进行RDS的方式接触到的高危异性恋者艾滋病毒检测经验较少且危险因素更多。此外，采用匿名检测（4.0%）和保密检测（1.0%）的RDS新诊断出艾滋病毒的比例显著高于VBS（0.3%）。因此在发现未被诊断出艾滋病毒的高危异性恋者方面同伴推荐方法比VBS更有效，尤其是单阶段/匿名策略，并且在消除艾滋病毒传播的努力中发挥着至关重要作用
