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. 2014 Apr 15;65(5):e162-9.
doi: 10.1097/QAI.0000000000000066.

STI patients are effective recruiters of undiagnosed cases of HIV: results of a social contact recruitment study in Malawi

Nora E Rosenberg  1 , Gift Kamanga, Audrey E Pettifor, Naomi Bonongwe, Clement Mapanje, Sarah E Rutstein, Michelle Ward, Irving F Hoffman, Francis Martinson, William C Miller
Affiliations

STI patients are effective recruiters of undiagnosed cases of HIV: results of a social contact recruitment study in Malawi

Nora E Rosenberg et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Patients with newly diagnosed HIV may be part of social networks with elevated prevalence of undiagnosed HIV infection. Social network recruitment by persons with newly diagnosed HIV may efficiently identify undiagnosed cases of HIV infection. We assessed social network recruitment as a strategy for identifying undiagnosed cases of HIV infection.

Methods: In a sexually transmitted infection (STI) clinic in Lilongwe, Malawi, 3 groups of 45 "seeds" were enrolled: STI patients with newly diagnosed HIV, STI patients who were HIV-uninfected, and community controls. Seeds were asked to recruit up to 5 social "contacts" (sexual or nonsexual). Mean number of contacts recruited per group was calculated. HIV prevalence ratios (PRs) and number of contacts needed to test to identify 1 new case of HIV were compared between groups using generalized estimating equations with exchangeable correlation matrices.

Results: Mean number of contacts recruited was 1.3 for HIV-infected clinic seeds, 1.8 for HIV-uninfected clinic seeds, and 2.3 for community seeds. Contacts of HIV-infected clinic seeds had a higher HIV prevalence (PR: 3.2, 95% confidence interval: 1.3 to 7.8) than contacts of community seeds, but contacts of HIV-uninfected clinic seeds did not (PR: 1.1, 95% confidence interval: 0.4 to 3.3). Results were similar when restricted to nonsexual contacts. To identify 1 new case of HIV, it was necessary to test 8 contacts of HIV-infected clinic seeds, 10 contacts of HIV-uninfected clinic seeds, and 18 contacts of community seeds.

Conclusions: Social contact recruitment by newly diagnosed STI patients efficiently led to new HIV diagnoses. Research to replicate findings and guide implementation is needed.

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Figures

Figure 1
Figure 1. Study Schematic
Figure 1 illustrates the study design. There were 45 participants (depicted by rectangles) in each seed group. Each seed could recruit up to five contacts (depicted by circles). The total number of contacts who presented by seed group is reported.
See this image and copyright information in PMC

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