Using Peer-Referral Chains with Incentives to Promote HIV Testing and Identify Undiagnosed HIV Infections among Crack Users in San Salvador

In El Salvador, crack users are at high risk for HIV but they are not targeted by efforts to promote early HIV diagnosis. 

We evaluated the promise of peer-referral chains with incentives to increase HIV testing and identify undiagnosed HIV infections among networks of crack users in San Salvador. For 14 months, we offered HIV testing in communities with a high prevalence of crack use. For the following 14 months, we promoted chains in which crack users from these communities referred their peers to HIV testing and received a small monetary incentive. We recorded the monthly numbers of HIV testers, and their crack use, sexual risk behaviors and test results. 

After launching the referral chains, the monthly numbers of HIV testers increased significantly (Z = 6.90, p < .001) and decayed more slowly (Z = 5.93, p < .001), and the total number of crack-using testers increased nearly fourfold. Testers in the peer-referral period reported fewer HIV risk behaviors, but a similar percentage (~5 %) tested HIV positive in both periods. More women than men received an HIV-positive diagnosis throughout the study (χ²(1, N = 799) = 4.23, p = .040). 

Peer-referral chains with incentives can potentially increase HIV testing among networks of crack users while retaining a focus on high-risk individuals.

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By:   Glasman LR1, Dickson-Gomez J2, Lechuga J3, Tarima S4, Bodnar G5, de Mendoza LR6.

• 1Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N Summit Ave., Milwaukee, WI, USA. lglasman@mcw.edu.
• 2Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N Summit Ave., Milwaukee, WI, USA.
• 3Department of Psychology, University of Texas, El Paso, TX, USA.
• 4Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
• 5Departamento de Investigación, Fundación Antidrogas de El Salvador (FUNDASALVA), Santa Tecla, El Salvador.
• 6Department of Psychology, Universidad Centroamericana José Simeón Cañas, San Salvador, El Salvador. 

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