More difficult-to-get infections may be tracked better through social and risk networks.
Samuel R. Friedman, PhD
An international research team is finding that targeting the social and risk networks of patients recently diagnosed with HIV is leading them to more patients unknowingly infected with the virus.
The study, led by Samuel R. Friedman, PhD, of the National Development Research Institutes (NDRI) and the Center for Drug Use and HIV/HCV Research (CDUHR) at New York University Rory Meyers College of Nursing, is a 3-site project that has just recently published results from its analysis of populations in Odessa, Ukraine.
Through 3 tracking programs — The Transmission Reduction Intervention Project (TRIP), integrated biobehavioral surveillance, and outreach testing — the researchers found there are more undiagnosed HIV patients in networks of recently-infected people than there in networks of longer-term infected people.
TRIP consisted of an intervention arm consisting of risk network members traced from recently-infected “seeds” — or, recruited and interviewed people who were potentially recently infected with HIV. Risk networks entailed patients’ sex partners, people who shared injection drugs with the patient, people present for either drug use or sex, and people recruited from locations where participants engaged in either activity. All risk network members were at least 18 years old.
The intervention arm was divided into 2, with a comparison arm consisting of seeds with longer-term HIV infections. In recent seeds, 735 were tested for HIV, with 184 reporting positive results. Of those positive tests, 120 (16.3%) were newly diagnosed.
In the comparison longer-term HIV seeds, 517 were tested for HIV. Of them, 145 reported positive results, but just 63 (12.2%) were newly diagnosed.
The study could become a more efficient HIV practice in high-risk regions such as in Odessa, where funding is dedicated to considerably more testing that ends with negative results. The city is the site of high injection drug use and a previous HIV epidemic in the 1990s.
Friedman and his team originally set out to find recently infected HIV patients, not undiagnosed patients. But he told MD Magazine that it was a serendipitous venture — undiagnosed patients were uncovered in the analysis.
“It’s not totally unexpected, obviously,” Friedman said. “Because when you look at the networks of the recently infected, you’re likely to find people who have been recently infected and not tested, and therefore undiagnosed.”
The findings are based on both “social and epidemiologic causes,” Friedman said. Though it wasn’t the basis of the study, researchers observed correlations in patients’ networks and their engagement in unsafe behavior that may leave them at-risk for HIV.
Network tracking research — while important in any injection or sexually-transmitted infections — has been more commonly practiced by sexually-transmitted disease researchers that those in the field of HIV, Friedman said. That’s an issue, if not just because of the varied means by which someone can spread HIV.
“The injection networks are slightly different from sexual networks, because a single user has more partners,” Friedman said. “That means viruses can spread more rapidly.”
Friedman hopes to bring the TRIP intervention into mainstream diagnostic HIV test measures, and to expand studies into areas of urgent HIV rates such as South Africa. But he also speculated that some of the more difficult infections to get, such as HIV, could rely on networks to be stronger predictors of transmission.
“So where there’s lower prevalence in an environment, behavioral study is more important,” Friedman said.
He added that it may become an important practice for hepatitis C and other infectious disease researchers moving forward.
“The entire global age strategy focuses on getting undiagnosed patients into treatment,” Friedman said. “Anything that makes that more effective is a byproduct.”
The study, "Risk network approaches to locating undiagnosed HIV cases in Odessa, Ukraine," was published online in the Journal of the International AIDS Society this week.
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