Reaching and enrolling drug users for HIV prevention: a multi-site analysis

Since 1994, several sites have participated in a NIDA Cooperative Agreement for AIDS Community-based Outreach/Intervention Research Program to examine rates of HIV risk behaviors and evaluate HIV risk reduction interventions among out-of-treatment drug injection and crack cocaine and heroin smokers. We studied the process and outcome of community outreach for recruitment o f drug users in AIDS research and education projects in three metropolitan areas: St. Louis, MO; San Antonio, TX, and Durham and Wake Counties, NC. Th ere were two primary areas of focus: (1) the level of accuracy among commun ity health outreach workers (CHOWs) in identifying potentially eligible per sons for HIV prevention, and (2) overall effectiveness in recruiting and en rolling persons in formal assessment and intervention studies. We found cro ss-site and within-site differences in levels of accuracy and in recruitmen t and enrollment yields. Drug users who had never been in treatment and dru g users who had never been tested for HIV infection were underrepresented a t all sites. We discuss the factors which may have contributed to cross-sit e and within-site differences. The findings suggest a need for continued st udy, refinement, and evaluation of community outreach strategies in order t o enroll a broad spectrum of vulnerable groups in HIV prevention activities . (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.