Background

Patients with newly diagnosed HIV may be part of social networks with elevated prevalence of undiagnosed HIV infection. Social network recruitment by persons with newly diagnosed HIV may efficiently identify undiagnosed cases of HIV infection. We assessed social network recruitment as a strategy for identifying undiagnosed cases of HIV infection.

Methods

In an STI clinic in Lilongwe, Malawi, three groups of 45 “seeds” were enrolled: STI patients with newly diagnosed HIV, STI patients who were HIV-uninfected, and community controls. Seeds were asked to recruit up to 5 social “contacts” (sexual or non-sexual). Mean number of contacts recruited per group was calculated. HIV prevalence ratios and number of contacts needed to test to identify one new case of HIV were compared between groups using generalized estimating equations with exchangeable correlation matrices.

Results

Mean number of contacts recruited was 1.3 for HIV-infected clinic seeds, 1.8 for HIV-uninfected clinic seeds and 2.3 for community seeds. Contacts of HIV-infected clinic seeds had a higher HIV prevalence (PR: 3.2, 95% CI: 1.3, 7.8) than contacts of community seeds, but contacts of HIV-uninfected clinic seeds did not (PR: 1.1, 95% CI: 0.4, 3.3). Results were similar when restricted to non-sexual contacts. To identify one new case of HIV it was necessary to test 8 contacts of HIV-infected clinic seeds, 10 contacts of HIV-uninfected clinic seeds, and 18 contacts of community seeds.

Conclusions

Social contact recruitment by newly diagnosed STI patients efficiently led to new HIV diagnoses. Research to replicate findings and guide implementation is needed.