Objectives

To explore acceptability of recruiting social contacts for HIV and STI screening in Lilongwe, Malawi.

Methods

In this observational study, three groups of “seed” patients were enrolled: 45 HIV-infected STI patients, 45 HIV-uninfected STI patients, and 45 community controls, who were also tested for HIV as part of the study. Each seed was given five coupons and asked to recruit up to five social contacts to the STI clinic. Seeds were told the programme for contacts would include HIV testing, STI screening, and general health promotion. Seeds were asked to return after one month to report on the contact recruitment process. Seeds received $2 for each successfully recruited contact.

Results

Eighty-nine seeds (66%) returned for one-month follow-up with no difference between the three seed groups (p=0.9). Returning seeds reported distributing most of their coupons (mean=4.1) and discussing each feature of the programme with most contacts—HIV testing (90%), STI screening (87%), and health promotion (91%). Seeds reported discussing their own HIV status with most contacts (52%), with a lower proportion of HIV-infected seeds discussing their HIV status (22%) than HIV-uninfected seeds (81%) or community seeds (64%) (p<0.001). Contact recruitment did not vary with socioeconomic status.

Conclusions

Most seeds distributed all coupons and reported describing all aspects of the programme to most contacts. STI patients are able to act as health promoters within their social networks and may be a critical link to increasing STI and HIV status awareness among high risk groups.