Tracing Risk Networks to Identify More Undiagnosed Individuals With HIV

By now, every health care practitioner is aware of the 90-90-90 targets set by the United Nation’s Program on HIV/AIDS, and the first objective calls for 90% those living with the virus to be aware of their status. Locating and identifying undiagnosed but infected individuals is crucial, not only to achieve the targets, but in order to prevent more individuals from getting the virus.

To this end, a recent study has found that tracing the risk networks of patients who have been recently diagnosed with HIV can help locate additional patients who are unknowingly infected with the virus.

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, the study consisted of 3 projects which looked at populations in Odessa, a large city in southern 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 individuals than there are in networks of individuals who have been infected longer-term.

TRIP consisted of an intervention arm comprised of risk network members traced from recently-infected “seeds,” which the authors define as “people recruited as potentially recently infected who were interviewed and had specimens taken and whose network members were eligible for TRIP.”

Risk networks entailed patients’ sex partners, individuals who shared injection drugs with the patient, those present for either drug use or sex, and individuals recruited from locations where participants engaged in either activity. All of those identified as risk network members were at least 18 years old.

The recently infected seeds were compared with an 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, a site of high injection drug use and a previous HIV epidemic in the 1990s.

Dr. Friedman and his team originally set out to find recently infected HIV patients, not undiagnosed patients. But he told our sister publication, MD Magazine^® that it was a serendipitous venture — undiagnosed patients were uncovered in the analysis.

“It’s not totally unexpected, obviously,” Dr. Friedman explained. “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,” Dr. Friedman said. Although 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 has been more commonly practiced by sexually-transmitted disease researchers rather those specifically in the field of HIV, Dr. 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,” Dr. Friedman explained. “That means viruses can spread more rapidly.”

Dr. Friedman hopes to bring the TRIP intervention into mainstream diagnostic HIV test measures and to expand studies into areas with urgent HIV rates, such as South Africa. However, 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.

“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 as well moving forward.

“The entire global age strategy focuses on getting undiagnosed patients into treatment,” Dr. Friedman said. “Anything that makes that more effective is a byproduct.”

A previous version of this article was posted on MDMagazine.com.