In 2000, Springfield, Mass., a city of 150,000, was second to greater Boston in HIV prevalence in the state. Springfield's Brightwood Health Center had an established HIV counseling and testing site offering standard blood testing. Education Development Center Inc. of Newton, Mass., and the Massachusetts Department of Public Health, Brightwood's funder, asked the health center to collaborate on a pilot study to increase the volume of testing and to target high-risk heterosexual adults.

The authors designed an evaluation study to compare testing volume and test takers' risk profiles at Brightwood with those of clients at a comparison site -- another publicly funded, community health center anonymous test site in an area with similar racial, ethnic and socioeconomic demographics.

Brightwood's intervention included the OraSure noninvasive HIV test and used high-risk women to recruit peers for testing. OraSure is an established, easy-to-use HIV testing method that uses oral-mucosal samples and offers 99.9 percent sensitivity and specificity, comparable to blood testing. The comparison site offered only standard blood testing and no peer recruitment. During an 11-month intervention period, both sites collected anonymous information on test takers' risk profiles.

A pool of high-risk women -- identified by a previous HIV prevention intervention at Brightwood -- were invited to become peer recruiters and encourage members of their social networks to be tested. Peer recruiters completed a 30-minute training session that demonstrated the test kit and reviewed HIV transmission modes. Recruiters brainstormed objections people might raise to being tested and developed responses to counter them. Recruiters would earn a $10 grocery-store coupon for recruiting 3 or more test takers; the test takers would earn a $5 coupon.

The pilot test succeeded in reaching a greater proportion of high-risk individuals with risk profiles similar to the peer recruiters: people at high risk because of multiple heterosexual partners. Over 11 months, the total number of test takers at Brightwood increased from 166 to 285 (a 71.7 percent increase), while overall testing remained stable at the comparison site (a 0.4 percent decrease). At Brightwood, the proportion of test takers reporting the risk factor of heterosexual sex increased 24.2 percent; the proportion reporting multiple sex partners increased 19.5 percent; and the proportion of women increased 4.6 percent. By contrast, the proportion of test takers at the comparison site reporting heterosexual sex as a risk factor decreased 42.5 percent; the proportion reporting multiple sex partners decreased 21.8 percent; and the proportion of women decreased 8.9 percent.

The investigators measured the number of active recruiters, defined as "active" for the 2 months following training, and the total number of test takers during each month of the intervention. They found a strong positive correlation between the number of active recruiters and testers. In addition, anecdotal reports and data from clients indicated that test takers were learning about Brightwood's services through peer-based channels. "Although this does not account for the entire increase in test takers from year 1 to year 2, it does suggest that social networks played a strong role," the authors noted. "However, a larger-scale trial testing the 2 components individually is needed to establish their relative effectiveness."

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