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Welcome to the BATLab’s Weekly Lit Review, where every week we post peer-reviewed papers relevant to our research projects.

This week, take a look at this interesting paper published in JMIR in 2015:

Key words: human immunodeficiency virushuman immunodeficiency virus preventionhuman immunodeficiency virus testingracial/ethnic minoritiescommunity-based organizationsHigh-Impact Prevention


Background: Recent studies have demonstrated that high human immunodeficiency virus (HIV) prevalence (2.1%) rates exist in “high-risk areas” of US cities that are comparable to rates in developing nations. Community-based interventions (CBIs) have demonstrated potential for improving HIV testing in these areas, thereby facilitating early entry and engagement in the HIV continuum of care. By encouraging neighborhood-based community participation through an organized community coalition, Project LINK sought to demonstrate the potential of the CBI concept to improve widespread HIV testing and referral in an area characterized by high poverty and HIV prevalence with few existing HIV-related services.

Objective: This study examines the influence of Project LINK to improve linkage-to-care and HIV engagement among residents of its target neighborhoods.

Methods: Using a venue-based sampling strategy, survey participants were selected from among all adult participants aged 18 years or more at Project LINK community events (n=547). We explored multilevel factors influencing continuum-of-care outcomes (linkage to HIV testing and CBI network referral) through combined geospatial-survey analyses utilizing hierarchical linear model methodologies and random-intercept models that adjusted for baseline effect differences among zip codes. The study specifically examined participant CBI utilization and engagement in relation to individual and psychosocial factors, as well as neighborhood characteristics including the availability of HIV testing services, and the extent of local prevention, education, and clinical support services.

Results: Study participants indicated strong mean intention to test for HIV using CBI agencies (mean 8.66 on 10-point scale [SD 2.51]) and to facilitate referrals to the program (mean 8.81 on 10-point scale [SD 1.86]). Individual-level effects were consistent across simple multiple regression and random-effects models, as well as multilevel models. Participants with lower income expressed greater intentions to obtain HIV tests through LINK (P<.01 across models). HIV testing and CBI referral intention were associated with neighborhood-level factors, including reduced availability of support services (testing P<.001), greater proportion of black/African Americans (testing and referral P<.001), and reduced socioeconomic capital (testing P=.017 and referral P<.001). Across models, participants expressing positive attitudes toward the CBI exhibited greater likelihood of engaging in routine HIV testing (P<.01) and referring others to HIV care (P<.01). Transgender individuals indicated greater intent to refer others to the CBI (P<.05). These outcomes were broadly influenced by distal community-level factors including availability of neighborhood HIV support organizations, population composition socioeconomic status, and high HIV prevalence.

Conclusions: Project LINK demonstrated its potential as a geotargeted CBI by evidencing greater individual intention to engage in HIV testing, care, and personal referrals to its coalition partner organizations. This study highlights important socioecological effects of US-based CBIs to improve HIV testing and initiate acceptable mechanisms for prompt referral to care among a vulnerable population.

This article was written by Paula M Frew1,2, MA, MPH, PhD Matthew Archibald3, PhD Jay Schamel1, BS Diane Saint-Victor1, MPH Elizabeth Fox1 Neena Smith-Bankhead4, MS Dazon Dixon Diallo5, MPH Marcia M Holstad6, PhD, FNP-BC, FAAN, FAANP Carlos del Rio1,2, MD 

Contributors are from:

1Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States

2Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States

3Department of Sociology, Colby College, Waterville, ME, United States

4AID Atlanta, Atlanta, GA, United States

5SisterLove, Inc., Atlanta, GA, United States

6Emory University School of Nursing, Atlanta, GA, United States

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