Project Engage: Snowball Sampling and Direct Recruitment to Identify and Link Hard-to-Reach HIV-Infected Persons Who Are Out of Care.
Innovative strategies are needed to identify and link hard-to-find persons living with HIV (PLWH) who are out of care (OOC). Project Engage, a health department-based project in Los Angeles County, used a mixed-methods approach to locate and provide linkage for PLWH who have limited contact with HIV medical and nonmedical services.



Incentivized social network recruitment (SNR) and direct recruitment (DR) was used to identify eligible OOC alters for a linkage intervention that included HIV clinic selection, appointment and transportation support, reminder calls/texts, and clinic navigation.



Between 2012 and 2015, 112 alters were identified using SNR (n = 74) and DR (n = 38). Most alters were male (80%), African American (38%), and gay (60%). Sizable percentages were homeless (78%), had engaged in sex work (32%) in the previous 6 months, had injected drugs (47%), were incarcerated in the previous 12 months (50%), and had only received HIV care during the previous 5 years while incarcerated (24%). SNR alters were more likely than DR alters to be African American, uninsured, unemployed, homeless, sex workers, injection drug users, recently incarcerated, and have unmet service needs. Alters linked to care within 3 (69%), 4-6 (5%), and 7-12 months (8%), and 72% were retained at 6-12 months. The percent virally suppressed increased (27% vs. 41%) and the median viral load decreased (P = 0.003) between linkage and follow-up at 6-12 months.



The alternative approaches presented were effective at locating marginalized HIV-positive persons who are OOC for linkage and retention. The SNR approach was most successful at identifying alters with serious social challenges and gaps in needed medical/ancillary services.
*Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, CA; †OASIS Clinic, MLK-OC, Los Angeles, CA; ‡LA LGBT Center, Los Angeles, CA; §AIDS Project Los Angeles, Los Angeles, CA; and ‖UCLA Department of Medicine and School of Public Health, Los Angeles, CA.
Amy Rock
AR
Wohl
Natasha
N
Ludwig-Barron
Rhodri
R
Dierst-Davies
Sonali
S
Kulkarni
Jesse
J
Bendetson
Wilbert
W
Jordan
Robert
R
Bolan
Terry
T
Smith
William
W
Cunningham
Mario J
MJ
Pérez
D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D040343:Behavioral Risk Factor Surveillance System; D003159:Community-Institutional Relations / Q000639:trends; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D018579:Patient Selection; D012309:Risk-Taking; D012494:Sampling Studies; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D019562:Viral Load