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.
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
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  ClinicalTrials.gov, NCT01607541, Registered May 23, 2012.
authors.affiliation: NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA. mg2890@nyu.edu.
authors.forename: Marya
authors.initials: M
authors.lastname: Gwadz
authors.affiliation: NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA. cmc13@nyu.edu.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Cleland
authors.affiliation: NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA. hh50@nyu.edu.
authors.forename: Holly
authors.initials: H
authors.lastname: Hagan
authors.affiliation: Department of Epidemiology, University of Washington, Box 357236, Seattle, WA, 98195, USA. sjenness@uw.edu.
authors.forename: Samuel
authors.initials: S
authors.lastname: Jenness
authors.affiliation: NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA. alexandra.kutnick@nyu.edu.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kutnick
authors.affiliation: NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA. nrl4@nyu.edu.
authors.forename: Noelle R
authors.initials: NR
authors.lastname: Leonard
authors.affiliation: NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA. eliz.applegate@gmail.com.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Applegate
authors.affiliation: NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA. asr5@nyu.edu.
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Ritchie
authors.affiliation: NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA. adb12@nyu.edu.
authors.forename: Angela
authors.initials: A
authors.lastname: Banfield
authors.affiliation: NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA. mjf223@nyu.edu.
authors.forename: Mindy
authors.initials: M
authors.lastname: Belkin
authors.affiliation: NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA. bridgetcross@gmail.com.
authors.forename: Bridget
authors.initials: B
authors.lastname: Cross
authors.affiliation: NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA. montserrat@nyu.edu.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Del Olmo
authors.affiliation: NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA. kathyha@gmail.com.
authors.forename: Katharine
authors.initials: K
authors.lastname: Ha
authors.affiliation: NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA. bym1@nyu.edu.
authors.forename: Belkis Y
authors.initials: BY
authors.lastname: Martinez
authors.affiliation: NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA. talaya.mccrightgill@nyu.edu.
authors.forename: Talaya
authors.initials: T
authors.lastname: McCright-Gill
authors.affiliation: NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA. qls1982@gmail.com.
authors.forename: Quentin L
authors.initials: QL
authors.lastname: Swain
authors.affiliation: Mount Sinai Beth Israel, Baron Edmond de Rothschild Chemical Dependency Institute, 120 Water Street, Floor 24, New York, NY, 10038, USA. dperlman@chpnet.org.
authors.forename: David C
authors.initials: DC
authors.lastname: Perlman
authors.affiliation: NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA. ack160@nyu.edu.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Kurth
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D003466:Cultural Characteristics; D005006:Ethnicity / Q000145:classification; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000208:ethnology* / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D020010:Heterosexuality / Q000208:ethnology*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D012309:Risk-Taking; D014481:United States / Q000453:epidemiology; D055815:Young Adult