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BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Study protocol

Strategies to uncover undiagnosed HIV infection among heterosexuals at high risk and link them to HIV care with high retention: a “seek, test, treat, and retain” study

Authors: Marya Gwadz, Charles M. Cleland, Holly Hagan, Samuel Jenness, Alexandra Kutnick, Noelle R. Leonard, Elizabeth Applegate, Amanda S. Ritchie, Angela Banfield, Mindy Belkin, Bridget Cross, Montserrat Del Olmo, Katharine Ha, Belkis Y. Martinez, Talaya McCright-Gill, Quentin L. Swain, David C. Perlman, Ann E. Kurth, the BCAP Collaborative Research Team

Published in: BMC Public Health | Issue 1/2015

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Abstract

Background

Over 50,000 individuals become infected with HIV annually in the U.S., and over a quarter of HIV infected individuals are heterosexuals. Undiagnosed HIV infection, as well as a lack of retention in care among those diagnosed, are both primary factors contributing to ongoing HIV incidence. Further, there are racial/ethnic disparities in undiagnosed HIV and engagement in care, with African Americans/Blacks and Latinos remaining undiagnosed longer and less engaged in care than Whites, signaling the need for culturally targeted intervention approaches to seek and test those with undiagnosed HIV infection, and link them to care with high retention.

Methods/Design

The study has two components: one to seek out and test heterosexuals at high risk for HIV infection, and another to link those found infected to HIV care with high retention. We will recruit sexually active African American/Black and Latino adults who have opposite sex partners, negative or unknown HIV status, and reside in locations with high poverty and HIV prevalence. The “Seek and Test” component will compare the efficacy and cost effectiveness of two strategies to uncover undiagnosed HIV infection: venue-based sampling and respondent-driven sampling (RDS). Among those recruited by RDS and found to have HIV infection, a “Treat and Retain” component will assess the efficacy of a peer-driven intervention compared to a control arm with respect to time to an HIV care appointment and health indicators using a cluster randomized controlled trial design to minimize contamination. RDS initial seeds will be randomly assigned to the intervention or control arm at a 1:1 ratio and all recruits will be assigned to the same arm as the recruiter. Participants will be followed for 12 months with outcomes assessed using medical records and biomarkers, such as HIV viral load.

Discussion

Heterosexuals do not test for HIV as frequently as and are diagnosed later than other risk groups. The study has the potential to contribute an efficient, innovative, and sustainable multi-level recruitment approach and intervention to the HIV prevention portfolio. Because the majority of heterosexuals at high risk are African American/Black or Latino, the study has great potential to reduce racial/ethnic disparities in HIV/AIDS.

Trial registration

ClinicalTrials.gov, NCT01607541, Registered May 23, 2012.
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Metadata
Title
Strategies to uncover undiagnosed HIV infection among heterosexuals at high risk and link them to HIV care with high retention: a “seek, test, treat, and retain” study
Authors
Marya Gwadz
Charles M. Cleland
Holly Hagan
Samuel Jenness
Alexandra Kutnick
Noelle R. Leonard
Elizabeth Applegate
Amanda S. Ritchie
Angela Banfield
Mindy Belkin
Bridget Cross
Montserrat Del Olmo
Katharine Ha
Belkis Y. Martinez
Talaya McCright-Gill
Quentin L. Swain
David C. Perlman
Ann E. Kurth
the BCAP Collaborative Research Team
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-1816-0

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