Peer referral for HIV case-finding among men who have sex with men.
OBJECTIVE
To evaluate the effectiveness and cost-effectiveness of a health department-based peer referral program for identifying previously undiagnosed cases of HIV among men who have sex with men (MSM).


METHODS
Between 2002 and 2005, 283 MSM peer recruiters were enrolled in a public health program in King County, Washington, USA. Peer recruiters were enrolled from a sexually transmitted disease (STD) clinic, an HIV clinic, via media advertisements and through collaboration with community-based organizations (CBO). The peer recruiters underwent a brief training and were then paid US$ 20 for each peer they referred to be tested for HIV, STD and viral hepatitis. Peers were paid US$ 20 for being tested. The main outcome measure was the number of new cases of HIV identified and cost per case of HIV identified.


RESULTS
Recruiters referred 498 peers for HIV, STD and hepatitis testing. Among 438 peers not previously diagnosed with HIV, 22 (5%) were HIV positive, of whom 18 received their HIV test results. Other infections were variably prevalent among tested peers: gonorrhea [23/307 (8%)], chlamydia [6/285 (2%)], syphilis [1/445 (0.2%)], hepatitis C [61/198 (31%)], surface antigen positive hepatitis B [8/314 (3%)]. Excluding the costs of testing for viral hepatitis and STDs other than HIV, the cost per new HIV case identified was US$ 4929. During the same period, the cost per new case of HIV detected through bathhouse-based HIV testing and through the county's largest CBO-based HIV testing program were US$ 8250 and US$ 11 481, respectively.


CONCLUSIONS
Peer referral is an effective means of identifying new cases of HIV among MSM.
Golden
Matthew R
MR
Division of Infectious Diseases and the Center for AIDS & STD, Public Health-Seattle & King County, University of Washington, Seattle, WA 98104, USA. golden@u.washington.edu
Gift
Thomas L
TL
Brewer
Devon D
DD
Fleming
Mark
M
Hogben
Matthew
M
St Lawrence
Janet S
JS
Thiede
Hanne
H
Handsfield
H Hunter
HH
D015492:AIDS Serodiagnosis; D000293:Adolescent; D000328:Adult; D004812:Epidemiologic Methods; D015658:HIV Infections / Q000175:diagnosis*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D010379:Peer Group; D011634:Public Health; D012017:Referral and Consultation