Golden, M. R., Gift, T. L., Brewer, D. D., Fleming, M., Hogben, M., St. Lawrence, J. S., Thiede, H., & Handsfield, H. H. (2006). Peer referral for HIV case-finding among men who have sex with men. AIDS, 20, 1961-1968.
Objective: To evaluate the effectiveness and cost-effectiveness of a health department-based peer referral program for identifying previously undiagnosed cases of HIV among men who have sex with men (MSM).
Design and methods: Between 2002 and 2005, 283 MSM peer recruiters were enrolled in a public health program in King County, Washington, USA. Peer recruiters were enrolled from a sexually transmitted disease (STD) clinic, an HIV clinic, via media advertisements and through collaboration with community-based organizations (CBO). The peer recruiters underwent a brief training and were then paid US$ 20 for each peer they referred to be tested for HIV, STD and viral hepatitis. Peers were paid US$ 20 for being tested. The main outcome measure was the number of new cases of HIV identified and cost per case of HIV identified.
Results: Recruiters referred 498 peers for HIV, STD and hepatitis testing. Among 438 peers not previously diagnosed with HIV, 22 (5%) were HIV positive, of whom 18 received their HIV test results. Other infections were variably prevalent among tested peers: gonorrhea [23/307 (8%)], chlamydia [6/285 (2%)], syphilis [1/445 (0.2%)], hepatitis C [61/198 (31%)], surface antigen positive hepatitis B [8/314 (3%)]. Excluding the costs of testing for viral hepatitis and STDs other than HIV, the cost per new HIV case identified was US$ 4929. During the same period, the cost per new case of HIV detected through bathhouse-based HIV testing and through the county's largest CBO-based HIV testing program were US$ 8250 and US$ 11 481, respectively.
Conclusions: Peer referral is an effective means of identifying new cases of HIV among MSM.
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