1. Risk network approaches to locating undiagnosed HIV cases in Odessa, Ukraine
- Author
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Smyrnov, Pavlo, Williams, Leslie D, Korobchuk, Ania, Sazonova, Yana, Nikolopoulos, Georgios K, Skaathun, Britt, Morgan, Ethan, Schneider, John, Vasylyeva, Tetyana I, and Friedman, Samuel R
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Drug Abuse (NIDA only) ,Infectious Diseases ,Substance Misuse ,Prevention ,HIV/AIDS ,Clinical Research ,Infection ,Good Health and Well Being ,Adult ,Female ,HIV Infections ,Humans ,Male ,Risk Reduction Behavior ,Ukraine ,HIV prevention ,early infection ,risk networks ,social network ,HIV diagnosis ,treatment as prevention ,Public Health and Health Services ,Other Medical and Health Sciences ,Clinical sciences ,Epidemiology ,Public health - Abstract
IntroductionProviding HIV healthcare and Treatment as Prevention both depend on diagnosing HIV cases, preferably soon after initial infection. We hypothesized that tracing risk networks recruits higher proportions of undiagnosed positives than outreach-based testing or respondent-driven sampling (RDS) in Odessa, Ukraine.MethodsThe Transmission Reduction Intervention Project (TRIP) used risk network tracing to recruit sexual and injection networks of recently-infected and longer-term infected (LTs) seeds (2013 to 2016). Integrated Biobehavioural Surveillance (IBBS) (2013) used RDS to recruit people who inject drugs (PWID). Outreach Testing tested PWID for HIV at community outreach sites (2013 to 2016). Proportions of undiagnosed positives among those tested were compared TRIP versus IBBS; TRIP versus Outreach Testing and between TRIP arms. Costs were compared across the projects.ResultsTRIP tested 1252 people (21% women) in seeds' risk networks; IBBS tested 400 (18% women); Outreach Testing 13,936 (31% women). TRIP networks included a higher proportion of undiagnosed positives (14.6%) than IBBS (5.0%) or Outreach Testing (2.4%); odds ratio (OR) 3.25 (95% CI 2.07, 5.12) versus IBBS and 7.03 (CI 5.95, 8.31) versus Outreach Testing respectively. Findings remained significant in analyses stratified by sex and when PWID in TRIP networks were compared with Outreach Testing and IBBS. Within TRIP, recently-infected participants' networks contained higher proportions of undiagnosed positives (16.3%) than LTs' networks (12.2%); OR 1.41 (CI 1.01, 1.95). TRIP located undiagnosed positives less expensively than did RDS or Outreach Testing.ConclusionsTRIP's recruiting techniques, including prioritizing networks of the recently infected, find undiagnosed HIV-positive people efficiently. They should be integrated with standard practice to improve case-finding. Research should test these techniques in other socio-epidemiologic contexts.Clinical trial registryRegistered ClinicalTrials.gov: NCT01827228.
- Published
- 2018