Leveraging social networks for identification of people living with HIV and high transmission potential

Published in International AIDS Society (IAS) 2023, 2023

Recommended citation: Cummins B, Johnson K, Schneider JA, Del Vecchio N, Moshiri N, Wertheim JO, Goyal R, Skaathun B (2023). "Leveraging social networks for identification of people living with HIV and high transmission potential." International AIDS Society (IAS) 2023. Poster.

Background. The Ending the HIV Epidemic initiative calls for rapidly engaging individuals in HIV services to curb HIV transmission. Engagement will potentially become more challenging as the epidemic becomes more concentrated among disenfranchised groups. Therefore, it is critical to investigate which engagement / re-engagement strategies best serve people with high HIV transmission potential.

Methods. We use a mathematical model (that incorporates sexual and contact networks, epidemic modeling, and phylogenetic methods) to compare two engagement strategies for Black men who have sex with men (BMSM) in Chicago—a group who are persistently impacted by HIV. The first strategy is recruitment based on social partners (SNS), while the second recruitment is based on sexual partners (CT). Our outcomes are the number of people living with HIV (PLWH) who are undiagnosed, PLWH who are out-of-care, PLWH who are members of molecular HIV transmission clusters (i.e., indirect HIV transmission pairs), and PLWH who are direct HIV transmission pairs.

Results. SNS significantly outperforms CT in identifying the number of PLWH who are undiagnosed and out-of-care, but the two strategies engage similar proportions among all recruits for these outcomes. These results are consistent across various recruitment acceptance rates. CT outperforms SNS in terms of proportions when HIV prevalence is <%20. Neither strategy is successful at identifying indirect or direct transmission pairs.

Conclusions. Our findings suggest that a larger proportion of the total population of PLWH can be identified by using a SNS strategy, with the number of administered tests being proportionately the same as CT for each newly diagnosed individual. If HIV prevalence is low, CT may yield more PLWH with fewer tests conducted. However, if a greater absolute number of undiagnosed individuals is the goal, SNS always outperforms CT. The inability to detect indirect or direct transmission pairs is likely due to small sample size.