Increasing HIV detection with incentive-based, peer-referral approach known as Risk Tracing Snowball Approach

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Cambodia has achieved measurable success in its fight against HIV. Prevalence has dropped more than 60% from 1998 to 2015, and the number of new HIV cases fell more than 80% over the same period. However, as in many countries, going the last mile to fully eliminate the AIDS epidemic requires innovative approaches to reach individuals unaware of their HIV status – especially among hard-to-reach key populations – and link them to treatment to achieve viral load suppression.

A consortium comprised of three NGOs – KHANA, FHI 360, and Population Services International (PSI) – working with the HIV/AIDS Flagship Project funded by USAID came up with an intervention study idea. Would we detect more newly identified HIV cases if we asked people that walked-in for HIV testing (presumably high-risk) to refer their peers whom they think are at risk for HIV infection for testing? We hypothesized yes. If we were right, it would be brilliant and we could help Cambodia’s National Centre for HIV/AIDS, Dermatology and STD (NCHADS) scale-up the intervention and avert hundreds of new infections every year. The same Risk Tracing Snowball Approach (RTSA) had proven to be successful among high-risk heterosexuals in the United States, among drug users in Greece, and heterosexual couples in China. We set out to determine if it would work in Cambodia, and I describe our intervention design and evaluation outcomes in this blog post.