title: Improving the efficiency of HIV testing with peer recruitment, financial incentives, and the involvement of persons living with HIV infection.
abstract: BACKGROUND
  The authors piloted an HIV testing and counseling (HTC) approach using respondent-driven sampling (RDS), financial incentives, and persons living with HIV infection (PLHIV).
  
  
  METHODS
  Eligible participants were aged 30-60 years, African American or black, and residents of Oakland, CA. Participants were tested for HIV infection and asked to refer up to 3 others. The authors compared the efficiency of RDS to conventional outreach-based HTC with the number needed to screen (NNS). They evaluated the effect of 2 randomly allocated recruitment incentives on the enrollment of high-risk or HIV-positive network associates: a flat incentive ($20) for eligible recruits or a conditional incentive ($10-35) for eligible recruits in priority groups, such as first-time testers.
  
  
  RESULTS
  Forty-eight participants (10 PLHIV and 38 HIV negative) initiated recruitment chains resulting in 243 network associates. Nine (3.7%) participants tested HIV positive, of whom 7 (78%) were previously recognized. RDS was more efficient than conventional HTC at identifying any PLHIV (new or previously recognized; RDS: NNS = 27, 95% CI: 14 to 59; conventional: NNS = 154, 95% CI: 95 to 270). There was no difference between the 2 incentive groups in the likelihood of recruiting at least 1 high-risk HIV-negative or HIV-positive network associate (adjusted odds ratio = 0.89, 95% CI: 0.06 to 13.06) or in total number of high-risk HIV-negative or HIV-positive associates (adjusted odds ratio = 0.79, 95% CI: 0.23 to 2.71).
  
  
  CONCLUSIONS
  Social network HTC strategies may increase demand for HTC and efficiently identify PLHIV. The flat incentive was as successful as the conditional incentive for recruiting high-risk individuals. Unexpectedly, this method also reidentified PLHIV aware of their status.
authors: Division of Epidemiology, School of Public Health, University of California, Berkeley, CA 94704, USA. smccoy@berkeley.edu
authors: Sandra I
authors: SI
authors: McCoy
authors: Karen
authors: K
authors: Shiu
authors: Tyler E
authors: TE
authors: Martz
authors: Carla Dillard
authors: CD
authors: Smith
authors: Loris
authors: L
authors: Mattox
authors: Dale R
authors: DR
authors: Gluth
authors: Neena
authors: N
authors: Murgai
authors: Marsha
authors: M
authors: Martin
authors: Nancy S
authors: NS
authors: Padian
mesh_terms: D015492:AIDS Serodiagnosis; D000328:Adult; D003376:Counseling / Q000191:economics*; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009042:Motivation; D018579:Patient Selection; D010379:Peer Group