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

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Abstract

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.

Resumen

En El Salvador, los usuarios de crack tienen alto riesgo de contraer el VIH pero no reciben intervenciones para promover el diagnóstico temprano del VIH. Evaluamos la posibilidad de usar cadenas de derivación de pares incentivadas monetariamente para incrementar el acceso a la prueba del VIH e identificar infecciones del VIH sin diagnosticar entre redes de usuarios de crack en San Salvador. Durante 14 meses, ofrecimos la prueba del VIH a adultos en comunidades con alta prevalencia de uso de crack. Por los 14 meses siguientes, alentamos la formación de cadenas en las cuales usuarios de crack de estas comunidades refirieron a sus pares a recibir una prueba del VIH y recibieron un incentivo monetario. Documentamos el número mensual de personas que recibieron la prueba del VIH, y su uso de crack, conductas de riesgo y resultados de la prueba del VIH. Después de la introducción de las cadenas de derivación incentivadas, el número mensual de personas que recibieron la prueba aumentó significativamente (Z = 6.90, p < .001) y disminuyó más lentamente (Z = 5.93, p < .001), y el número total de usuarios de crack testeados para el VIH casi se cuadriplicó. Aunque los participantes referidos por sus pares reportaron menos conductas de riesgo del VIH, un porcentaje similar (~ 5 %) testeó VIH positivo en los dos periodos. En todo el estudio, más mujeres que hombres recibieron un diagnóstico positivo del VIH (χ2(1, N = 799) = 4.23, p = .040). Las cadenas de derivación de pares con incentivos tienen potencial para aumentar el acceso a la prueba del VIH dentro de las redes de usuarios de crack sin perder el foco sobre los individuos en alto riesgo.

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References

  1. Smutt M, Miranda J. El fenómeno de las pandillas en El Salvador. San Salvador: UNICEF, FLACSO; 1998.

    Google Scholar 

  2. Santacruz Giralt M, Concha-Eastman A. Barrio adentro: La solidaridad violenta de las pandillas. San Salvador: OAS, Instituto Universitario de Opinión Pública; 2001.

  3. United Nations Development Program. El impacto de las drogas en la violencia: Buscando soluciones. San Salvador: United Nations Development Program; 2004.

    Google Scholar 

  4. Day M, Rangugni V, Cymerman P. A review of the state of harm reduction in Latin America and the Caribbean. Assessing the current situation and response. HIV/STI project of the Pan American Health Organization; 2010. Available at: http://www.academia.edu/12749886/A_review_of_the_state_of_harm_reduction_in_Latin_America_and_the_Caribbean_Assessing_the_current_situation_and_response. Accessed 15 April 2015.

  5. Dormitzer CM, Gonzalez GB, Penna M, Bejarano J, Obando P, Sanchez M, et al. The PACARDO research project: Youthful drug involvement in Central America and the Dominican Republic. Rev Panam Salud Publica. 2004;15(6):400–16.

    Article  PubMed  Google Scholar 

  6. Salas-Wright CP, Olate R, Vaughn MG. Religious coping, spirituality, and substance use and abuse among youth in high-risk communities in San Salvador, El Salvador. Subst Use Misuse. 2013;48(9):769–83.

    Article  PubMed  PubMed Central  Google Scholar 

  7. (7) United Nations Office for Drug Control and Crime Prevention (UNDP). World Drug Report; 2005. Available at: http://www.unodc.org/pdf/WDR_2005/volume_1_web.pdf. Accessed 10 Apr 2015.

  8. Shoptaw S, Montgomery B, Williams CT, El-Bassel N, Aramrattana A, Metsch L, et al. Not just the needle: the state of HIV-prevention science among substance users and future directions. J Acquir Immune Defic Syndr. 2013;63(Suppl 2):S174–8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Strathdee S, Stockman JK. Epidemiology of HIV among injecting and non-injecting drug users: current trends and implications for interventions. Curr HIV/AIDS Rep. 2010;7(2):99–106.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hacker MA, Malta M, Enriquez M, Bastos FI. Human immunodeficiency virus, AIDS, and drug consumption in South America and the Caribbean: epidemiological evidence and initiatives to curb the epidemic. Rev Panam Salud Publica. 2005;18(4–5):303–13.

    PubMed  Google Scholar 

  11. Dickson-Gomez J, Lechuga J, Glasman LR, Pinkerton SD, Bodnar G, Klein P. Prevalence and incidence of HIV and sexual risk behaviors in crack users in the San Salvador Metropolitan Area, El Salvador. World J AIDS. 2013;3(4):357–63.

    Article  Google Scholar 

  12. (12) Ministerio de Salud, Programa Nacional de ITS/VIH/SIDA. Ministerio de Salud, El Salvador. Informe nacional de progreso en la lucha contra el SIDA; 2014. Available at http://www.unaids.org/sites/default/files/country/documents//SLV_narrative_report_2014.pdf. Accessed 27 Mar 2015.

  13. Magnus M, Kuo I, Phillips G 2nd, Shelley K, Rawls A, Montanez L, et al. Elevated HIV prevalence despite lower rates of sexual risk behaviors among black men in the District of Columbia who have sex with men. AIDS Patient Care STDS. 2010;24(10):615–22.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Treatment as prevention for HIV. Lancet Infect Dis. 2011;11(9):651.

  15. Eyawo O, Hogg RS, Montaner J. The Holy Grail: the search for undiagnosed cases is paramount in improving the cascade of care among people living with HIV. Can J Public Health. 2013;104(5):e418–9.

    PubMed  Google Scholar 

  16. Dickson-Gomez J, Bodnar G, Guevara CE, Rodriguez K, De Mendoza LR, Corbett AM. With God’s help I can do it: crack users’ formal and informal recovery experiences in El Salvador. Subst Use Misuse. 2011;46(4):426–39.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Dickson-Gomez J, Bodnar G, Petroll A, Johnson K, Glasman L. HIV Treatment for alcohol and non-injection drug users in El Salvador. Qual Health Res. 2015;25(12)1719–32.

    Article  PubMed  Google Scholar 

  18. McCoy SI, Shiu K, Martz TE, Smith CD, Mattox L, Gluth D, et al. Improving the efficiency of HIV testing with peer recruitment, financial incentives, and the involvement of persons living with HIV infection. J Acquir Immune Defic Syndr. 2013;63(2):56–63.

    Article  Google Scholar 

  19. Girault P, Green K, Clement NF, Rahman YA, Adams B, Wambugu S. Piloting a social networks strategy to increase HIV testing and counseling among men who have sex with men in Greater Accra and Ashanti Region, Ghana. AIDS Behav. 2015;19(11):1990–2000.

    Article  PubMed  Google Scholar 

  20. Rogers EM. Diffusion of innovations. New York: Free Press of Glencoe; 1962.

    Google Scholar 

  21. Inter-American Drug Abuse Control Commission. (OAS Official Records Series; O EA Ser. L). Report on drug use in the Americas. Washington, DC: 2011. 2012.

  22. (22) UNAIDS/WHO policy statement on HIV testing Geneva: WHO; 2004: Appendix 1. Available at: http://www.who.int/ethics/topics/en/hivtestingpolicy_who_unaids_en_2004.pdf. Accessed 10 Apr 2015.

  23. Azim T, Bontell I, Strathdee SA. Women, drugs and HIV. Int J Drug Policy. 2015;26(Suppl 1):S16–21.

    Article  PubMed  PubMed Central  Google Scholar 

  24. El-Bassel N, Terlikbaeva A, Pinkham S. HIV and women who use drugs: double neglect, double risk. Lancet. 2010;376(9738):312–4.

    Article  PubMed  Google Scholar 

  25. El-Bassel N, Wechsberg WM, Shaw SA. Dual HIV risk and vulnerabilities among women who use or inject drugs: no single prevention strategy is the answer. Curr Opin HIV AIDS. 2012;7(4):326–31.

    Article  PubMed  Google Scholar 

  26. Hecksher D, Hesse M. Women and substance use disorders. Mens Sana Monogr. 2009;7(1):50–62.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Raeside L. Attitudes of staff towards mothers affected by substance abuse. Br J Nurs. 2003;12(5):302–10.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research was funded by the National Institutes of Health Grants R01 DA020350 and P30 MH57226. We thank the FUNDASALVA research team for their invaluable dedication to the study, the staff at the community sites that served as the basis of study activities, and the support of the Universidad Jose Simeón Cañas de El Salvador.

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Authors and Affiliations

  1. Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N Summit Ave., Milwaukee, WI, USA

    Laura R. Glasman & Julia Dickson-Gomez

  2. Department of Psychology, University of Texas, El Paso, TX, USA

    Julia Lechuga

  3. Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA

    Sergey Tarima

  4. Departamento de Investigación, Fundación Antidrogas de El Salvador (FUNDASALVA), Santa Tecla, El Salvador

    Gloria Bodnar

  5. Department of Psychology, Universidad Centroamericana José Simeón Cañas, San Salvador, El Salvador

    Lorena Rivas de Mendoza

Authors
  1. Laura R. Glasman
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  2. Julia Dickson-Gomez
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  3. Julia Lechuga
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  4. Sergey Tarima
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  5. Gloria Bodnar
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  6. Lorena Rivas de Mendoza
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Correspondence to Laura R. Glasman.

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Glasman, L.R., Dickson-Gomez, J., Lechuga, J. et al. Using Peer-Referral Chains with Incentives to Promote HIV Testing and Identify Undiagnosed HIV Infections Among Crack Users in San Salvador. AIDS Behav 20, 1236–1243 (2016). https://doi.org/10.1007/s10461-015-1267-8

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  • DOI: https://doi.org/10.1007/s10461-015-1267-8

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