Background: Healthcare settings screen broadly for HIV. Public health settings use social
network and partner testing (“Transmission Network Targeting (TNT)”) to select high-risk individuals
based on their contacts. HIV screening and TNT systems are not integrated, and healthcare
settings have not implemented TNT.
Objective: The study aimed to evaluate pilot implementation of multi-component, multi-venue TNT
in conjunction with HIV screening by a healthcare setting.
Methods: Our urban, academic health center implemented a TNT program in collaboration with the
local health department for five months during 2011. High-risk or HIV positive patients of the infectious
diseases clinic and emergency department HIV screening program were recruited to access social
and partner networks via compensated peer-referral, testing of companions present with them,
and partner notification services. Contacts became the next-generation index cases in a snowball recruitment
Results: The pilot TNT program yielded 485 HIV tests for 482 individuals through eight generations
of recruitment with five (1.0%; 95% CI = 0.4%, 2.3%) new diagnoses. Of these, 246 (51.0%;
95% CI = 46.6%, 55.5%) reported that they had not been tested for HIV within the last 12 months
and 383 (79.5%; 95% CI = 75.7%, 82.9%) had not been tested by the existing ED screening program
within the last five years.
Conclusion: TNT complements population screening by more directly targeting high-risk individuals
and by expanding the population receiving testing. Information from existing healthcare services
could be used to seed TNT programs, or TNT could be implemented within healthcare settings. Research
evaluating multi-component, multi-venue HIV detection is necessary to maximize complementary
approaches while minimizing redundancy.