[Agency name]

Social Network Strategy for

HIV Testing Recruitment
Standard Operating
Procedures
 Curated for the Centers for Disease Control and Prevention by
Capacity for Health, a program of the Asian & Pacific Islander American Health Forum
May 2018
Thanks to the Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Capacity
Building Branch, and Crescent Care, New Orleans, LA

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Table of Contents
What is Social Network Strategy (SNS) for HIV Testing Recruitment? .............................................. 3
What is the SNS for HIV Testing Recruitment Standard Operating Procedures Tool? ...................... 4
How Will Your Organization use SNS? ............................................................................................... 4

Procedure 1 Community and Target Population Engagement.......................................................... 5

Procedure 2 Recruiter Enlistment ..................................................................................................... 6
Recruiter Enlistment Procedure ........................................................................................................ 8

Procedure 3 Recruiter Engagement .................................................................................................. 9

Orientation Procedure ....................................................................................................................... 9
Coaching Session & Recruiter Follow-up Procedure ....................................................................... 10
Releasing Recruiters Procedure ....................................................................................................... 11

Procedure 4 Recruitment of Network Associates ........................................................................... 12

Recruiting Network Associates Procedure ...................................................................................... 12

Procedure 5 HIV Testing .................................................................................................................. 13

Tracking Linkage............................................................................................................................... 13
Providing Incentives Procedure ....................................................................................................... 13

Procedure 6 Inviting Network Associates to Become Recruiters .................................................... 14

Procedure 7 Ensuring Confidentiality for Social Network Strategy for HIV Testing Recruitment ... 15
Procedure 8 Potential Risks for Recruiters ...................................................................................... 16
Procedure 9 Data Collection and Program Monitoring ................................................................... 17
Data Collection Table ....................................................................................................................... 17
Analyzing Program Data................................................................................................................... 21

Procedure 10 Quality Assurance ..................................................................................................... 21

Quality Assurance Procedure........................................................................................................... 21

Appendices
Appendix A: Staffing Summary Template ........................................................................................ 23
Appendix B: Memorandum of Understanding ................................................................................ 24
Appendix C: Informed Consent & Agreement ................................................................................. 26
Appendix D: Orientation/Interview and Coaching Checklist ........................................................... 27
Appendix E: Social Networks Strategy for HIV Testing Recruitment Problem Indicator Tool ......... 28
Appendix F: Network Associate Incentive Log ................................................................................. 31
Appendix G: Social Network Strategy for HIV Testing Recruitment Coaching Guide ..................... 32

Bibliography .................................................................................................................................... 37

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What is Social Network Strategy for HIV Testing Recruitment?

The Social Network Strategy for HIV Testing Recruitment (SNS) 1 is an evidence-
supported approach to recruiting persons at high risk for HIV infection. SNS is based on the
underlying principles that people in the same social network share similar risks and risk behaviors
for HIV, and that people in the same social network can exert influence on each other because
they know and trust each other. The approach begins with identifying clients or peers who are
HIV positive or at high risk for HIV and enlisting them to become Recruiters. Recruiters are a
short-term role and require coaching to identify, engage, and direct Network Associates to HIV
testing services. Network Associates (NA) are people in the Recruiter’s social networks (e.g.,
friends, sex or drug partners, etc.) who are at risk for HIV.

The Centers for Disease Control and Prevention (CDC) estimates that approximately one in seven
people (15%) who have HIV do not know they have it. 2 SNS is a targeted and focused approach
that has successfully identified people with undiagnosed HIV infection and connected them to
HIV testing and other HIV prevention services. A two-year demonstration project funded by the
CDC showed that agencies using SNS had a 6% HIV positivity rate overall. 3 Agencies using the
targeted approach of Social Network Strategy may test fewer people and significantly increase
the project’s positivity rate because they will be testing the “right” people.

SNS builds on the existing trust among the members of a social network, as they are more likely
to respond positively to messages about HIV testing. Typically, Recruiters identify two to eight
Network Associates whom they believe would benefit from HIV testing. The Recruiters talk with
the Network Associates they identify and refer or direct them to a clinic where they can receive
HIV testing services.

There are Four Core Phases of the Social Network Strategy for HIV Testing:

1. Recruiter Enlistment: Who will you target? Where will you find them? How will you assess
and motivate them to participate in SNS?
2. Recruiter Engagement: Orientation, Identification of Network Associates, and Coaching
3. Recruitment of Network Associates
4. HIV Testing: When a Network Associate comes in for HIV testing, staff screen them to identify
new potential Recruiters. If the Network Associate is appropriate, the phases start over again.

1
Centers for Disease Control and Prevention, “Use of Social Networks: A Recruitment Strategy for Counseling,
Testing and Referral Services, Trainer’s Manual,” (STD/HIV Prevention Training Centers Part III, Atlanta, GA, July
2013).
2
Centers for Disease Control and Prevention, “HIV/AIDS Basic Statistics,” CDC, September 2017,
https://www.cdc.gov/hiv/basics/statistics.html.
3
Centers for Disease Control and Prevention, “Use of social networks to identify persons with undiagnosed HIV
infection,” Morbidity and Mortality Weekly Report 54, no. 24 (2005): 601.
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What is the Social Network Strategy for HIV Recruitment Standard
Operating Procedures Tool?
This tool is designed to assist your agency with implementing SNS. Standard operating
procedures describe in detail the processes and best practices for implementing a program. The
authors recommend editing this tool electronically and training all SNS staff and volunteers on it.
When you see text with the following format, [black, bold, underlined text in brackets], replace it
with information specific to your organization or SNS program. If you are new to SNS, we
encourage you to attend an in-person training of facilitators (see Effective Interventions Training
Calendar for upcoming dates), contact a capacity building assistance provider, or work closely
with colleagues or organizational partners who are familiar with the strategy.

Procedures align with the phases for completing SNS and processes for effective program
operation. This tool repeats information from the in-person SNS training of facilitators and
information available from the Effective Interventions website. We encourage you to work with
your SNS and HIV testing staff to tailor each procedure to the operations of your organization. If
you have standard operating procedures for HIV testing, we recommend using that document to
guide your SNS standard operating procedures.

If you need assistance completing this document, please contact your CDC project officer to
receive capacity building assistance.

How will your organization use SNS?

Below, describe how your organization will use SNS. Over time, this information may change. This
section is an opportunity for your program staff to think carefully about the way this strategy will
support overall program goals.

SNS RECRUITMENT GOAL

Describe the goal for using SNS to recruit potential clients for HIV testing. Use this goal to monitor
weekly and monthly program performance. You can use sample language below, or create your
own.

Sample language

To achieve [target percentage]% seropositivity by [target date] utilizing SNS to recruit persons
at elevated-HIV risk.

Our Goal: [goal for using SNS to recruit clients]

TARGET POPULATION
Describe target population(s) using demographic information (e.g., gender, age, and
race/ethnicity), risk behavior (e.g., condomless sex with a partner of unknown HIV status, person

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 who injects drugs), and geographic location (being as specific as possible regarding neighborhood,
city, or region).

Our target population: [SNS program target population].

SNS STAFFING SUMMARY

List the name(s) and title(s) of each employee who will support SNS (see Appendix A for a
template).

PROCEDURE 1
COMMUNITY AND TARGET POPULATION ENGAGEMENT

“Community involvement is an essential element in developing public health programs that

respond to local HIV prevention needs and priorities.” – Community Engagement for Data to Care
Program 4

Before you begin implementing SNS, engage members of the target population whom you seek to
reach. Members of the target population can help you plan, implement, and evaluate SNS.
Successfully engaging members of the target population will help create effective strategies for
identifying, recruiting, and training SNS Recruiters.

One way to involve the target population is through a program community advisory board (CAB).

“A Community Advisory Board (CAB) is a select group of community members who provide
recommendations regarding HIV prevention programs. A CAB can help by advising organizations
on the needs of the communities they serve as well as assist in identifying appropriate programs
to help meet those needs. This group of individuals can also provide input at various levels of a
program’s process (e.g., designing and implementing services, recruitment and retention of
clients). The main role of a CAB is to provide their expertise and guidance based on the group’s
knowledge and experience. However, a CAB cannot tell an agency how to run their programs.” 5

We encourage you to consider how a CAB may help you implement or improve your SNS
program.

4
Centers for Disease Control and Prevention, “Community Engagement for Data to Care Program. High Impact
Prevention,” CDC, 2017,
https://effectiveinterventions.cdc.gov/en/HighImpactPrevention/PublicHealthStrategies/DatatoCare/Communi
tyEngagement.aspx.
5
Shared Action, “Technical Bulletin: Community Advisory Board for an HIV Prevention Program,” AIDS Project
Los Angeles, 2010, http://www.sharedaction.org/pdf/CAB.pdf.
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 BEST PRACTICES FOR CREATING A CAB
1. CAB members should reflect the sociodemographics of the target recruitment population.
2. Recommendations from staff members and collaborators should inform CAB member
selection.
3. Your agency should assign a staff member to recruit, manage, and engage CAB members.

EXAMPLE CAB ACTIVITIES

The CAB should meet frequently (e.g., every two weeks) in the first three months of planning and
implementation. Once the program begins to operate smoothly, the CAB can meet less
frequently (e.g., monthly). The CAB may help conduct the following activities:

1. Develop marketing tools;

2. Design incentive protocol;
3. Assess program performance (key activity);
a. Review Recruiters’ activities;
b. Review HIV testing outcomes;
4. Suggest achievable changes to improve program performance; and,
5. Continuously promote the program in the target population.

PROCEDURE 2
RECRUITER ENLISTMENT

Recruiter Enlistment is the first phase of SNS. In this phase, you will determine who to target as a
potential Recruiter, where to find them, and how to screen them and ensure that they are
appropriate and interested. We refer to these individuals as potential Recruiters because they
have not yet agreed to participate in SNS.

There are three steps in Recruiter Enlistment. Each step will be covered in this procedure.

THE THREE STEPS OF RECRUITER ENLISTMENT (SNS PHASE 1):

Step 1: Step 2: Step 3:

Who are your Where to find Screen and motivate
potential Recruiters? potential Recruiters potential Recruiters

STEP 1: WHO ARE YOUR RECRUITERS?

The first step of Recruiter Enlistment is to identify who should be targeted as a potential
Recruiter. Choosing the right Recruiters is critical to SNS success. You will want people who will

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 help tap into the correct network and who will work well with Network Associates. When
determining who to target as potential Recruiters, consider the Recruiter’s responsibilities.

A Recruiter must be able to:

1. Identify people in their social, sexual, or drug networks who are also in the target
population(s);
2. Engage their Network Associates;
3. Discuss and recommend HIV testing to people in their networks; and,
4. Escort or refer Network Associates to HIV testing/agency. 6

Decide what personal qualities of Recruiters are important for your program’s success and
combine those qualities with information about your local HIV epidemic. (Review your state’s
most recent HIV surveillance report for local epidemic information.) Then, use this list of desirable
Recruiter qualities from the in-person SNS training to identify your potential Recruiters:

1. Well-connected to the social scene among members of the program’s HIV testing target
population;
2. Able and willing to recruit these persons and refer them for HIV testing;
3. Feels positively about the agency and program; and,
4. Believes HIV testing is beneficial.

STEP 2: WHERE TO FIND POTENTIAL RECRUITERS

The second step of Recruiter Enlistment is to determine where to locate potential Recruiters.
Once your SNS program begins identifying Network Associates, you can select potential
Recruiters from the Network Associates who access HIV testing. Before your SNS program begins,
you may want to search for potential Recruiters from the following sources: your clients, client
referrals, internal referrals, existing programs or services, and external referrals from partner
organizations. Some examples are: people living with HIV (PLHIV) peer support groups, behavioral
services, sexually transmitted infection (STI) screening and treatment visits, HIV testing sessions,
HIV treatment visits, Disease Intervention Specialist (DIS) visits, etc.

If you want a separate program or outside organization to refer potential Recruiters to your SNS
program, develop criteria to help your referring partners identify appropriate candidates and a
plan to help the potential Recruiters contact your SNS program. For example, a brochure may
help outside sources effectively refer potential Recruiters. Include the qualities you are looking

6
Centers for Disease Control and Prevention, “Use of Social Networks: A Recruitment Strategy for Counseling,
Testing and Referral Services, Trainer’s Manual,” (STD/HIV Prevention Training Centers Part III, Atlanta, GA, July
2013).
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 for (see Step 1), a description of the SNS program and its objectives, and SNS program contact
information.

STEP 3: SCREEN & MOTIVATE POTENTIAL RECRUITERS

The third and final step of Recruiter Enlistment is to assess and motivate potential Recruiters.
Develop a series of questions for the potential Recruiter or a checklist to ensure the potential
Recruiter fits the criteria for your SNS program (see Step 1). Next, create a short message to invite
and motivate the potential Recruiter to participate in SNS. This motivational message should
provide enough information to generate interest, but not so much information that the potential
Recruiter is overwhelmed. There will be a longer orientation after the potential Recruiter
expresses interest in supporting SNS.

Motivational Message Components:

1. Ensure potential Recruiter fits your Step 1 criteria;

2. Provide a summary of the project’s purpose;
3. Provide an overview of participation, specifying what you are asking the potential
Recruiter to do;
4. Provide an overview of benefits of the project for Recruiters;
5. Provide an overview of risks of the project for Recruiters; and,
6. Introduce incentives.

Recruiter Enlistment Procedure

On this page, record your strategy for enlisting Recruiters. Many programs identify SNS
Recruiters during HIV testing sessions. If SNS is new to your region or to your agency, several
different activities may be needed in order to identify Recruiters. Read the example activities
below and replace this text with your program’s Recruiter Enlistment Procedure.

To identify potential Recruiters, [agency name] will do the following:

1. Assess potential Recruiters during HIV testing sessions. Typically, HIV testing staff will
introduce SNS and screen for Recruiter eligibility after the test result has been given to
the client.
2. Go to [location names] in order to meet and assess potential Recruiters.
3. Collaborate with [SNS program collaborator names (e.g., other departments in your
agency, external organizations in your community, or other stakeholders)] and create
written agreements. One example of a collaborator might be a clinic where people
receive HIV medical care (see Appendix B for an example of a memorandum of
agreement).
4. Assess interest and capability of potential Recruiters by conducting its SNS potential
process: [detailed SNS Recruiter assessment process, including any checklists for
qualities and responsibilities] (see page 7).

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 5. Deliver motivational messages to the potential Recruiter and invite the potential
Recruiter to participate in the program. If the potential Recruiter accepts, the potential
Recruiter moves to Procedure 3, Recruiter Engagement (see page 9).
6. Collect the potential Recruiter’s contact information (e.g., name, cell phone number, best
times to call) before the interaction with the potential Recruiter ends and save this
information in a protected location. 7

PROCEDURE 3
RECRUITER ENGAGEMENT

Engagement is the phase when the SNS staff member orients the potential Recruiter to SNS and
offers the opportunity to become a Recruiter. The Engagement phase has two steps:

1. Orientation. Review the SNS program in greater detail so the Recruiter can make a fully
informed decision about whether or not to commit to the role. Orientation varies across
programs. Design an orientation that will be effective yet not burdensome. We
recommend designing an orientation session that will last no longer than 10 minutes.
2. Coaching Session. First, the SNS staff member meets with Recruiter to identify and
prioritize members of the Recruiter’s social networks. Then, the staff member helps the
Recruiter plan a unique conversation about HIV testing tailored to each of their different
Network Associates.

Orientation Procedure
[Agency name] will use the following procedure to orient potential Recruiters to SNS:

1. [Staff member name(s)] will orient the Recruiter.

2. The orientation will be conducted by [orientation format] (possible formats could be
video, group orientation, or one-on-one meeting).
3. The orientation will include the following information.
a. [Staff member name(s)] will introduce themselves and describe role(s) at agency.
b. Our description of SNS: [agency SNS description].
c. Our description of Recruiter and Network Associate roles: [roles of a Recruiter and a
Network Associate].
d. Our explanation of our SNS program referral cards and referral tracking procedure:
[SNS program referral cards and referral tracking procedure].
e. Our description of how incentives are earned and any limits: [SNS program incentive
procedure].

7
A password protected electronic database or a notebook stored in a locked file cabinet are both examples of
places where personal information can be safely stored.
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 f. Contact information for program staff who can answer specific questions or resolve
specific problems: [staff names and contact information].
g. Review and gain consent from potential Recruiter using an Informed Consent &
Agreement Form (see Appendix C for a sample Informed Consent & Agreement
Form). This form includes a description of foreseeable risks and benefits to the
Recruiter, a statement that participation is voluntary, time-limited, and may be
discontinued, and a statement regarding confidentiality of records.
Promising Practices: (1) Because too much information can overwhelm potential Recruiters, we
recommend keeping the orientation as brief as possible. (2) Some programs combine orientation
and coaching into one meeting. Combining the two steps saves staff time and may better
accommodate Recruiter availability. For an example of a combined meeting, see Appendix D,
“Orientation/Interview and Coaching Checklist.”

Coaching Session & Recruiter Follow-Up Procedure

[Agency name] will use the following procedure to coach and follow-up with SNS Recruiters:

1. The following staff are responsible for coaching Recruiters: [staff name(s)].
2. Staff will record the following information during each coaching session:
a. Names and descriptions of Network Associates;
b. The Recruiter’s preferred contact information (phone, email, etc.); and,
c. The number of referral cards each Recruiter receives and the unique identifier
associated with each card. Programs should use referral cards to monitor
recruitment, Network Associates, and testing linkage success (see example referral
card on page 11).
3. Some programs conduct short coaching sessions in person and other programs conduct
sessions over the phone. Describe coaching session locations and format(s). Coaching
session will be held at [coaching session location(s)] via [coaching format(s)].
4. SNS staff should check in with Recruiters regularly. Describe the frequency and method(s)
(e.g., phone, text, in-person, etc.). [Staff name(s)] will with check in with Recruiters
[frequency] by [method(s)].
5. SNS staff will give Recruiters a sufficient supply of referral cards to help them successfully
refer Network Associates to HIV testing. Referral cards will include the HIV testing
location, name, hours of testing operation, and phone number.

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 EXAMPLE: THE MOVEMENT, NEW ORLEANS, LA

The Movement, an HIV prevention project of Crescent Care, equips SNS Recruiters with business
cards. (See images to the left. Top image is the front of the card. Bottom image is the back of the
card.) 8 The number “2001” at the top of the front image is a unique number assigned to a specific
Recruiter. Staff use the number to count the number of Network Associates successfully referred
to HIV testing by one Recruiter. This information indicates the level of incentive each Recruiter will
receive, tracks their effectiveness, and provides data to monitor program progress.

Releasing Recruiters Procedure

Programs should set criteria to determine when a Recruiter should be released. Criteria could
include: unreliable communication, the Recruiter has saturated all potential Network Associates,
or improper coercion of others (e.g., forcing/scheming people to become Network Associates for
incentive sharing).

Programs should determine how they inform a Recruiter that they are being released. Example
procedures for releasing a Recruiter: Over the phone or in person, have a direct conversation with
your Recruiter. Thank them for their participation in and support of your program, explain that
they have fulfilled their role, remind them that the service was time limited, and show
appreciation for their work.

8
Business card images created by The Movement, CrescentCare, New Orleans, LA. Permission for use in this
document granted on April 20, 2017.
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 [Agency name]'s criteria and process for releasing Recruiters includes the following: [criteria and
process for releasing Recruiters].

It is also important to decide and practice a potential message to give when releasing a Recruiter.

Sample Language

“When you began this project with us, we discussed that it would be for a limited time. You
have done a good job supporting your community and talking with your friends about HIV
testing. We hope this has been a positive experience for you. At this time, it appears that we
have gone about as far as we can. It is time to take a break from referring more people to the
program.” 9

[Agency name]'s suggested message for releasing a Recruiter includes the following language:
[language for releasing a Recruiter].

For more reasons to release Recruiters and example language, please refer to page 54 of CDC’s
“Use of Social Networks: A Recruitment Strategy for Counseling, Testing and Referral Services
Participant Manual.”

PROCEDURE 4
RECRUITMENT OF NETWORK ASSOCIATES

During Phase 4 of SNS, Recruiters locate and contact their Network Associates to recommend
HIV testing. The Recruiter verbally refers the Network Associate to an HIV testing site and hands
them a referral card with a unique code or name of the Recruiter on the referral card. Ideally, the
Recruiter accompanies the Network Associate to the HIV testing location.

An HIV testing referral card should include the testing location name, address, hours of testing
operation, phone number, and type of HIV test(s) offered (see example on page 11). The
Recruiter gives each Network Associate an HIV testing referral card and asks them to present it at
the testing location. The card will contain a code/name of the Recruiter. This code tells the SNS
program how many Network Associates each Recruiter successfully links to HIV testing. This code
also helps program staff monitor the seropositivity of the Recruiter’s network and correctly
administer incentives. Programs that successfully implement SNS use careful monitoring activities
(see Procedure 9 for more details about monitoring and evaluation).

9
Centers for Disease Control and Prevention, “Use of Social Networks: A Recruitment Strategy for Counseling,
Testing and Referral Services, Trainer’s Manual,” (STD/HIV Prevention Training Centers Part III, Atlanta, GA, July
2013), 172.
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Recruiting Network Associates Procedure
[Agency name] will use the following procedure for recruiting Network Associates:

1. The Recruiter approaches the Network Associate and informs them about HIV testing,
offers to accompany the person to the testing site, and provides a referral card. The
Recruiter carries the following materials:
a. A referral card;
b. Cell phone (in the event the Recruiter needs to contact a staff member); and
c. Condoms/lubricant (optional).
2. The Recruiter informs the Network Associate that they will receive [incentive] if they
complete an HIV test. The Recruiter also explains that the Network Associate could be
offered the opportunity to become a Recruiter to help people get tested, describing the
type of incentive used by your program in this step.
3. If the Recruiter needs support while recruiting Network Associates, [staff name] will be
available by [method(s)] during the following days and hours: [days and hours].
4. The Recruiter and the Network Associate will agree on a time and location where the
Network Associate will receive HIV testing. As optional support, the Recruiter may offer
to accompany the Network Associate to the testing location. This may help ensure the
Network Associate’s follow through, though it is not required. It is important that the
staff coach explore and determine if a Recruiter feels comfortable and can offer this
additional support to their Network Associate. Correspondingly, if the Recruiter offers
this, they should explore and determine that the Network Associate feels comfortable
whether accepting or declining the offer. A Network Associate may prefer to go alone.

PROCEDURE 5
HIV TESTING

When the Network Associate links to HIV testing, there are two key procedures: (1) Tracking
linkage, and (2) Providing any incentive(s) to the Recruiter and Network Associate.

Tracking Linkage
The HIV testing site may have an existing tracking system to monitor all persons who access
testing. If so, the agency should add a data field “SNS Recruiter” to the testing tracking system
and fill in the unique ID as it appears on the HIV testing referral card. Programs should track the
test result, date of test, and Recruiter’s unique ID (see example in Appendix F).

Providing Incentives Procedure

Evidence demonstrates that SNS is effective based on incentivized recruitment. The SNS
demonstration project sites and many subsequent programs provide Recruiter and the Network
Associate incentives. A Recruiter should be incentivized based on the number of Network
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 Associates who test for HIV. A Network Associate who is recruited and follows through with HIV
testing and receives their results should be incentivized for completion.

Staff should determine appropriate and meaningful incentives for your SNS program. Promising
practices to inform this determination include the following: consulting with your program’s
Community Advisory Board; conducting surveys, focus groups, and/or key informant interviews
with target population members; exploring what incentives are provided in similar internal and
external programs; exploring low cost/no-cost and donated incentives; and, ascertaining your
program’s budget line item for incentives.

We recommend developing a procedure around incentives. Your incentive procedure should

include a description of who receives the incentives (e.g., Recruiters and Network Associates), at
what stage the incentive is given, a description of the incentive, how incentives are
documented/monitored, and who is tasked with dispensing and monitoring incentives. Add a
data field in your tracking sheet to monitor the dates of providing incentives, and the quantity
provided to each Recruiter and Network Associate.

[Agency name]’s Incentive Procedure

Use the information above and fill in the field below to create your agency’s incentive procedure.

1. [Recruiters and Network Associates] are eligible to receive incentives.

2. Incentives are distributed to [recipients] when they [phases/steps in your SNS program].
Repeat line as necessary.
3. The incentive for [recipient] completing [step/task] is [incentive] (e.g., cash, giveaways,
transportation vouchers, chain store gift certificates). Repeat line as necessary.
4. [Agency name] documents and monitors incentives by the following process:
[documentation and monitoring process].
5. An employee of your organization must be responsible for dispensing and monitoring
incentives. [Staff names] are responsible for dispensing and monitoring incentives.

PROCEDURE 6
INVITING NETWORK ASSOCIATES TO BECOME RECRUITERS

Regular identification and recruitment of potential Recruiters are important features of a

successful SNS program. Previous Network Associates are a good source of potential Recruiters
because they understand the program and may tap deeper into the social networks of the
Recruiter who identified them in the first place. Each Network Associate should be considered
and approached as a potential Recruiter if they fit the target population and risk profile, and meet
the desired Recruiter characteristics. HIV testing staff and volunteers should be trained to
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 describe the SNS program and refer potential Recruiters to your enlistment staff. Commonly, HIV
testing staff are co-trained to enlist and recruit Recruiters, which improves program efficiency.

If the Network Associate is not interested in participating as a Recruiter, HIV testing staff could
ask whether someone in their social network might like to become a Recruiter. Recruiters can
also be identified through other means, such as through existing peer support groups, behavioral
services, STI screening and treatment visits, etc. (see Procedure 2, page 7).

Describe how your program will invite Network Associates to become Recruiters. This procedure
may require training staff who are not familiar with SNS. [Agency’s procedure to invite Network
Associates to become Recruiters].

WHAT MIGHT YOU SAY TO A NETWORK ASSOCIATE ABOUT BECOMING A RECRUITER

AFTER TESTING?
Sample language

“We’re so glad you came in to take an HIV test today. Now that you’ve received your result,
you are in a position to help others access HIV testing – just like the way your friend helped
you access the test today. We’re offering incentives to Recruiters who invite their friends and
family who they think could be at risk of HIV and would benefit from receiving an HIV test.
What do you think?”

[Agency]’s suggested message to a Network Associate about becoming a Recruiter after testing:
[language for suggesting a Network Associate become a Recruiter].

PROCEDURE 7
ENSURING CONFIDENTIALITY

To protect the privacy and confidentiality of clients accessing your SNS program, ensure that your
policy is aligned with the privacy and protection standards for health information within your
organization, and your local county and state. Sample privacy and confidentiality procedures
appear below and can be adapted: 10

1. [Name of agency] staff must never disclose to Recruiters their Network Associates’ test
results.

10
CDC. (2011). Data security and confidentiality guidelines for HIV, viral hepatitis, sexually transmitted
disease, and tuberculosis programs: standards to facilitate sharing and use of surveillance data for public
health action. http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf.
Accessed May 24, 2017.

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 2. All staff with access to confidential information must sign a confidentiality statement
acknowledging the legal requirements not to disclose HIV information.
3. All services, whether in the office or clinic or in the field, must be provided in spaces that
maintain the client’s privacy.
4. Staff must carry out efforts to contact and communicate with clients, Network Associates,
partners, and spouses in a manner that preserves the confidentiality and privacy of all
involved.
5. [Name of agency] and its staff must keep client records in a locked office or file room
when not being used to provide services. Similarly, computers with access to electronic
client records must be kept in locked offices.
6. [Name of agency] must limit access to client records to designated staff. The following
staff are designated to have access to SNS program client information: [staff name(s)].
7. Designated staff named above must retain control of and not leave records visible or
accessible to unauthorized persons when they are being used outside of the room
designated for file storage.
8. [Name of agency] must password-protect databases containing electronic client records
and these must never be left open and visible on unattended computers.
9. [Name of agency] and its staff must not release or disclose client information—including
whether or not an individual even is a client—to other persons, agencies, or organizations
without written informed consent from the client, or their legally designated
representative.
10. Policies and procedures regarding release of client information to other persons,
agencies, or organizations must comply with all applicable requirements related to the
Health Insurance Portability and Accountability Act (HIPAA).

PROCEDURE 8
POTENTIAL RISKS FOR RECRUITERS

[Agency name] will take any step necessary to provide a positive experience for their SNS
Recruiters. It is suggested, but not required, that each Recruiter signs an Informed Consent Form.
(see Appendix C for an example Informed Consent Form).

Potential risks for Recruiters include:

1. Feeling the pressure to disclose their HIV status. There is no necessity to disclose one’s
status, or the status of a Recruiter or Network Associate, to take part in SNS recruitment.
Remember, disclosing one’s HIV status is a personal choice.

2. Unpredictable responses from the Network Associate when the topic of HIV is addressed
in conversation. Responses could include and are not limited to anger, fear, apathy,
sadness, denial, or physical violence.

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 3. Temporary or permanent damage to the relationship between Recruiter and Network
Associate.

Remember, HIV testing is voluntary and requires informed consent. This means that not all
Network Associates will agree to test for HIV.

PROCEDURE 9
DATA COLLECTION & PROGRAM MONITORING

Efficient systems for accurately collecting program information are critical for evaluating SNS.
Reviewing program information on a weekly and monthly basis is important to understanding
what is working and what is not working.

This section of your operating procedures should describe what type of information is collected,
who is collecting the information, and how the information is used. The following four pages
provide a table to guide you. Integrate your data collection activities for SNS with those in place
to monitor other program deliverables. The SNS participant training manual contains a complete
list of data that should be collected in each phase of the recruitment strategy on pages 60-65.
Design your program’s data collection tools to align with the recommendations from the training.

Data Collection Table

The following table describes the type of data you may consider collecting in each phase of SNS,
who is responsible for collecting it, and how it is used. Some of this information is a priority to
collect, while other information is only helpful to track if your program has the capacity to collect
and use. The SNS coordinator and the SNS coaches are the primary data collectors (position titles
will vary by program). Review this table and indicate who will collect each piece of data.

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 Program Phase Type of Information Who collects the data How to use the data

Phase 1: Recruiter Sources of Recruiters SNS program coordinator Use these data to identify
Enlistment (e.g., internal program, [staff name] successful/unsuccessful
external agency, etc.) sources for Recruiter
enlistment.

Number of potential SNS program coordinator Use these data to monitor time
Recruiters screened [staff name] spent screening potential
Recruiters. Use data to monitor
ratio of Recruiters accepted to
Recruiters screened.

Number of people SNS program coordinator Use these data to determine

recruited who are [staff name] eligibility characteristics among
referred to an orientation persons screened, as well as
session total number of referrals made.

Recruiter age, gender, SNS program coordinator Use these data to describe the
race/ethnicity, [staff name] characteristics of your
HIV status (optional) Recruiters.

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 Program Phase Type of Information
Phase 2: Recruiter Number of orientation
Engagement sessions
Length of sessions
Number of people
oriented
Number of people who
agree to become SNS
Recruiters
Number of coaching
sessions conducted
Number of Network
Associates identified (per
Recruiter and cumulative)
Recruiter name
Recruiter age, gender,
race/ethnicity*
HIV status (optional)
*May be captured in Phase 1.
Recruiter contact
information (phone)
Recruiter city, state of
residence, and zip code
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Who collects the data How to use the data
SNS program coordinator Use these data to monitor time
[staff name] spent motivating potential
Recruiters into SNS Recruiters.
SNS program coordinator Use these data to monitor time
[staff name] spent converting potential
Recruiters into SNS Recruiters.
SNS program coordinator Use these data to monitor time
[staff name] spent converting potential
Recruiters into SNS Recruiters.
SNS program coordinator Use these data to monitor how
[staff name] many Recruiters are active at a
given time.
SNS program coordinator Use these data to monitor time
or coach [staff name] spent coaching Recruiters. Link
these data to a Recruiter ID.
Too much time coaching an
individual Recruiter could be
grounds for dismissing the
Recruiter.
SNS program coordinator Compare this information to
or coach [staff name] the number of Network
Associates who come in for HIV
testing in Phase 4. Use these
data to monitor an individual
Recruiter’s effectiveness.
SNS program coordinator For internal use only. Ensure
or coach [staff name] privacy of this information.
SNS program coordinator Use these data to describe the
or coach [staff name] characteristics of your
Recruiters.
SNS program coordinator Use these data to follow-up
or coach [staff name] with the Recruiter.
SNS program coordinator Use these data to describe your
or coach [staff name] Recruiters.
19
 Date orientation SNS program coordinator Use these data to indicate
completed or coach [staff name] completion status of a program
step.

Staff name person who is SNS program coordinator If an SNS program relies on
the primary contact of a or coach [staff name] multiple staff to motivate and
Recruiter monitor a Recruiter, this
information will help staff
communicate

Network Associate name SNS program coordinator Use these data to remind and
or coach [staff name] motivate Recruiters and
monitor whether or not a
Network Associate completes
an HIV test.

Network Associate age, SNS Program Coordinator Use these data to describe the
gender, race/ethnicity or coach [staff name] characteristics of your Network
Associates.

Network Associate city SNS program coordinator Use these data to describe the
and state of residence or coach [staff name] characteristics of your Network
Associates.

Reason(s) Network SNS program coordinator Use these data to describe the
Associate is or coach [staff name] characteristics of your Network
recommended for HIV Associates.
testing

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 Program Phase Type of Information Who collects the data How to use the data

Phase 3: Number of follow-up SNS program coordinator Use these data to monitor time
Recruitment of coaching sessions or coach [staff name] spent coaching Recruiters. Link
Network Associates completed this data to a Recruiter ID. Too
much time coaching an
individual Recruiter could be
grounds for dismissing the
Recruiter.

Date Recruiter names SNS program coordinator Use these data with the date
Network Associate or coach [staff name] Network Associate receives an
HIV test to compute the time
between naming and testing.

Date Network Associate SNS program coordinator Use these data with the date
receives an HIV test or coach [staff name] Recruiter names Network
Associate to compute the time
between naming and testing.

Time between Recruiter [staff name] computes Use these data to monitor time
naming Network this figure by counting the Recruiters spend motivating
Associate and Network days between “date Network Associates.
Associate receiving HIV Recruiter names Network
test. (This indicator is a Associate” and “date
computation of the two Network Associate
indicators above.) receives an HIV test”

Number of follow-up SNS program coordinator Use these data to monitor time
contacts initiated by or coach [staff name] spent preparing Recruiters to
program staff to bring in Network Associates.
encourage Recruiter

How the Recruiter helps SNS program coordinator Use these data to understand
the Network Associate or coach [staff name] what type of support from a
connect to HIV testing Recruiter results in a Network
(referral, accompanies Associate completing an HIV
Network Associate to test.
agency, coordinates HIV
testing time, etc.)

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 Program Phase Type of Information Who collects the data How to use the data

Phase 4: HIV Testing Number of Network
Associates who complete an
HIV test
SNS program coordinator
or HIV testing staff [staff
name]
Connect this data to the
unique Recruiter ID. This data
will help you understand how
many Network Associates are
testing.

Create a unique ID for

Network Associates to
support monitoring.

Use this data to monitor

effectiveness of SNS strategy.

HIV test results for Network SNS program coordinator These data are only for
Associates (# of negatives or HIV testing staff [staff internal use to maintain
and # of positives) name] confidentiality.

Connect these data to the

unique ID for Network
Associates and Recruiters.

Use these data to monitor

effectiveness of SNS strategy.

Number of Network SNS program coordinator Use these data to monitor

Associates who are in the or HIV testing staff [staff effectiveness of SNS strategy.
target population name]

Analyzing Program Data and Use of the Social Networks Problem Indicator Tool
Report program data according to the standards set by your SNS program funder to improve
program performance.

In Appendix E you will find a copy of the Social Networks Problem Indicator Tool. 11 Use this tool
to identify reasons why your program is not performing the way you intended. Follow the tool’s
recommendations to improve your program processes or activities.

Capacity building assistance providers can help improve your program’s performance. Contact
your CDC project officer or local health department to learn what services are available for your
program.

11
The Social Networks Problem Indicator Tool is on pages 63-65 of the July 2013 SNS Participant Manual.
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PROCEDURE 10
QUALITY ASSURANCE

Quality assurance procedures, regular quality program monitoring, and standard operating
procedures will ensure successful implementation of SNS.

Quality Assurance Procedure

1. Prior to SNS implementation, [agency name] will assess current HIV testing standard
operating procedures and program monitoring procedures. Sample assessment questions
include the following: Does the agency have the capacity to implement SNS? Is SNS
appropriate for the target population(s)? What systems are in place for tracking the
relationship between Recruiters and Network Associates?
2. [Agency name] will develop training plans for all staff and collaborators to ensure all
parties are at greatest capacity to achieve SNS purpose and goals. Training needs will be
assessed every 6 months.
3. [Agency name] will collect, assess and review indicators to monitor the quality of the
program.

Table of sample indicators:

Indicator Purpose Indicator Performance Measure Potential Data

Source
Accessibility to The ease with which Period of time All HIV testing types and Testing logs
testing a Network Associate between being confirmatory blood
can access HIV Recruiter’s contact draw must be available
testing with Network
Associate and that
Network Associate
completing HIV test

Appropriateness of The degree to which Number of Network Complaints and Complaints lodged,
Recruiter the Recruiter can Associates testing productivity logs testing logs
relate to potential
Network Associates

Safety The degree to which Number of reported Monthly incident Review of internal
the Recruiter feels issues by Recruiter reports and coaching documentation
comfortable to sessions
recruit Network
Associate

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APPENDIX A
STAFFING SUMMARY TEMPLATE

SNS Project Manager, [staff name(s)]. Responsible for planning and executing program activities,
coordinating staff, monitoring and evaluating all program activities and deliverables, and
reporting progress to CDC and agency leadership. Monitor incentive supplies and logs. SNS
Phases: 1 – 4.

HIV Testing Project Manager, [staff name(s)]. Responsible for overseeing all HIV testing activities
for SNS Network Associates and ensuring that any Network Associates who test positive for HIV
are connected to follow-up services. The HIV testing project manager will effectively monitor
when SNS Network Associates are tested and communicate progress and outcomes to the SNS
project manager. Distribute SNS incentives to Network Associates. SNS Phases: 3 & 4.

SNS Coach, [staff name(s)]. Responsible for motivating and encouraging SNS Recruiters to refer
and/or accompany their Network Associates to HIV testing. Distribute SNS incentives to
Recruiters once their Network Associates have completed an HIV test. SNS Phases 2 & 3.

SNS Recruiter Enlistment, [staff name(s)]. Responsible for identifying potential Recruiters who
are active in other prevention department activities, approaching the potential Recruiter to
assess interest, and making a warm referral for SNS to SNS project manager. SNS Phases 1 & 4.

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APPENDIX B
MEMORANDUM OF UNDERSTANDING
between
[agency name]
and
[collaborating agency name]

This memorandum of understanding (MOU) serves as evidence that [agency name] will collaborate with
[collaborating agency name], (hereinafter referred to as the “Collaborating Agency”).

COLLABORATING AGENCIES
The mission of [agency name] is to [agency mission statement].

The mission of the Collaborating Agency is to [collaborating agency mission statement].

OBJECTIVE OF THE MOU

To formalize, define, and implement the working relationship between [agency name] and the
Collaborating Agency in the Social Network Strategy (SNS) for HIV Testing Recruitment program,
“[SNS program name]” targeting [description of target population].

SCOPE
A. Responsibilities of [agency name]:

[agency name] will orient, train, and support SNS Recruiters to refer and/or accompany
Network Associates to HIV testing.
[agency name] will refer clients to the Collaborating Agency for [name of specific
programs at collaborating agency].

B. Responsibilities of the Collaborating Agency:

[collaborating agency name] will train staff to identify potential Recruiters for the SNS
recruitment program at [agency name].
[collaborating agency name] will refer potential Recruiters to [agency name] by phone,
email, or a referral card.

PROCESS OF COORDINATION
Staff from both [agency name] and [collaborating agency name] will facilitate communication
between the two entities. They will also advise each other in any changes in relevant staff at their
agencies. As such, the contact persons are:

[Agency name]
1. [staff name, phone number]
2. [staff supervisor name, phone number]

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 [Collaborating agency name]
1. [collaborating agency staff name, phone number]
2. [collaborating agency staff supervisor name, phone number]

Staff from both [agency name] and the Collaborating Agency will consult on a regular basis in
order to assess the effectiveness of the collaborative relationship, address any barriers that are
identified, and to discuss implementation changes that are needed. Meetings will be called on an
as-needed basis.

This MOU will be effective beginning from [date] until [date]. Any changes or addenda to this
MOU must be communicated in writing and signed by both parties. Either party may terminate
or modify this agreement, giving at least two weeks’ notice, at any time during this period.

Signed:

________________________ ________________________
[authorized signatory name] [authorized signatory name]

[title] [title]

[agency name] [collaborating agency name]

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APPENDIX C
INFORMED CONSENT & AGREEMENT BETWEEN
[AGENCY NAME] & SOCIAL NETWORK STRATEGY (SNS) RECRUITER

[date]: [agency name]

[SNS Recruiter name]

Social Network Strategy is a recruitment technique to engage a set of individuals linked by one or more
specific types of relationships to HIV testing. [Agency name] is using social network strategy and you have
been recommended as a Recruiter.

I agree to participate in a volunteer social networking program that asks the following:
1. Identify people you hang around with who you think may participate in activities that put
them at risk for HIV.
2. When you see them next, try to tell them where they can get a free HIV test. Only give this
information to people you know.
3. Bring them to the HIV testing site (ideal) or give them a card telling them where the nearest
HIV testing site is located.

Anyone you bring or send for HIV testing from your social network will be referred to as a “Network
Associate” and if they get tested it will result in your receiving a [incentive] as an incentive. You will
receive incentives [time frame (e.g., weekly, as Network Associates present for HIV testing)] as long as
the following criteria are met:
1. The Network Associate must be listed on your social network worksheet.
2. The Network Associate must have been referred and received an HIV test.

Someone from [agency name] will be available to you to discuss problems or issues that may arise from
conversations about HIV testing with people who are in your social network.

My signature below indicates that I understand the following:

1. I know that talking about HIV/AIDS may make some people uncomfortable.
2. If I feel uncomfortable, [staff name] will be available to help me.
3. I do NOT have to tell anyone about my HIV status, but I may choose to disclose my status.
4. I will NOT know the HIV test results of people I bring in for testing.
5. I will NOT have access to written or electronic files of those I refer for testing.
6. I know that I can choose not to be a part of this program or if I participate and wish to stop I
can do so without any impact on my services at [agency name].

Recruiter Signature: Date:

Agency Staff Signature: Date:

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APPENDIX D
ORIENTATION/INTERVIEW AND COACHING CHECKLIST

Expectations of Recruiter

Identify individuals within their social network (people with whom the Recruiter has an existing
relationship) who are at high risk for HIV infection and who currently do not know their HIV status.

May escort their Network Associates to testing, but in the event the person does not want to be
escorted, provide them with a referral card to the testing site.

Complete Participant Registration Form, Participant Data Forms, and Interview Log.

Follow-up with the Social Network Strategy coordinator to receive incentive(s) for Network
Associates who successfully complete an HIV test.

Ask Recruiter if they have questions about the information provided above. Make sure they have
a good understanding of expectations.

Benefits of Being a Recruiter

Assisting friends and associates who do not know their HIV status to now know their HIV status.

Receive an incentive as appreciation for connecting the agency to Network Associates.

Ask Recruiter if they have questions about the information provided above. Make sure they have
a good understanding of expectations.

Brief Overview of the Social Network Strategy project

The purpose of the Social Network Strategy project is to identify individuals who do not know
their HIV status and who are at risk for infection, and to connect them to HIV testing services.

Ask Recruiter if they have questions about the information provided above. Make sure they have
a good understanding of expectations.

Complete forms and provide the Recruiter with:

Referral cards Referral tracking procedure

Recruiter Signature: Date:

Agency Staff Signature: Date:

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APPENDIX E
SOCIAL NETWORKS PROBLEM INDICATOR TOOL

This tool comes from the July 2013 SNS Participant Manual (p. 63-65).

Problem
Potential Problems Potential Causes Potential Solutions Phase
Indicator
1. No Recruiters Staff not screening Screening criteria Modify screening Recruiter
enlisted in 30 potential Recruiters may be too criteria Enlistment
days New staff person structured Provide
assigned Staff not training/orientation
Recruiters not trained/oriented on Train/orient all
accepting invitations screening criteria assigned staff on
to participate Staff may not be screening criteria and
delivering the correct observe screening
message sessions
2. Recruiters Staff’s lack of Staff not Train/orient all Recruiter
from the wrong understanding of the trained/oriented for assigned staff for Enlistment
target profile of potential screening criteria screening criteria and
population are Recruiters observe screening
enlisted New staff person sessions
assigned Modify screening
criteria
3. No Network No Network Staff not providing Train/Orient staff for Recruiter
Associates being Associates accepted the correct message screening criteria for Enlistment
enlisted as invitation to become a to potential potential Recruiters
Recruiters Recruiter Recruiters (e.g., previously and
No Network Staff unaware or lack newly diagnosed
Associates being of understanding of HIV+ persons, and
screened to become screening Network high risk persons
Recruiters Associates to tested as Network
become Recruiters Associates)
4. Recruiters are Orientation too long Too much Develop checklist to Engagement
not completing Orientation not information included discuss most (Orientation)
orientation in the orientation important
convenient for
Orientation dates information to
Recruiter
and times are potential Recruiters
Wrong type of
orientation for inflexible Provide individual
orientation for
individual Recruiter
Recruiters at times
most convenient to
them
Conduct individual or
group orientation

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 Problem
Potential Problems Potential Causes Potential Solutions Phase
Indicator
5. Recruiters not Recruiters do not Confidentiality not Clarify Engagement
providing names understand clearly discussed misunderstanding (Interview)
of Network confidentiality of with Recruiters in the about confidentiality
Associates information Recruiter Enlistment Coach Recruiters on
Recruiters do not phase the procedure for
want to provide network elicitation
names of Network and discuss other
Associates means for providing
information, e.g., first
names, initials,
nicknames, etc.
6. No follow-up Recruiters are not Recruiters not fully Close out Recruiter Engagement
with Recruiters responsive to follow- participating or not records after _____ (Coaching/Follow-
up attempts available number of attempts up)
No follow-up attempts Staff not recording Train staff on
are being made follow-up attempts. importance of
progress notes.
7. No Network Recruiters conducting Lack of Coach Recruiters on Recruitment of
Associates outreach referrals to understanding about message to give to Network Associates
tested in 30 persons not in their referrals and Network Associates if
days personal networks incentives they lose their HIV
Network associates Network Associate(s) test referral card
are not coming in for lost HIV Testing Recruiters escort
testing referral card their Network
Recruiters are not Need additional Associates to testing
referring support from Coach Recruiters on
Recruiter to navigate procedures for
the testing system participation in
project, assess
All Network
Associates in network referrals,
close out records
network have been
tested or refused after ____ number of
follow-ups
testing
8. Previous Seeking incentives Incorrect information Follow-up and coach HIV Testing
positives are offered to testers about testing being Recruiters on
being tested circulated in referring persons
networks unaware of their HIV
status for testing

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 Problem
Potential Problems Potential Causes Potential Solutions Phase
Indicator
9. No HIV Recruiters referring Recruiters lack of Coach Recruiters and HIV Testing
positive persons Network Associates understanding of review Network
identified for testing who are high risk Associates (sexual,
not at high risk for HIV Staff not assessing social, drug-using)
Core of network not referred for testing
network testing
identified or and discuss their risks
previously identified Conduct discussions
with staff to gain
skills in assessing
networks.
10. No referrals Staff not making Staff not trained to Train/orient staff on HIV Testing
to prevention referrals make and track referral tracking
and care Staff not tracking referrals systems and their
services Referral tracking roles.
referrals
system not in place Create/modify
or not functional referral tracking
system

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APPENDIX F
NETWORK ASSOCIATE INCENTIVE LOG

We recommend creating a spreadsheet based on the sample table below. You may include as many
coupons as you need. This table is based on an internationally used example from CDC.

First Last Participant Date $ Paid # Coupon # 1 Coupon # 2 Notes

Name Name ID Tested for Coup.
Testing Given

Coupon $ for Coupon $ for

ID Recruit ID Recruit

Alex Agron 0001 8/9/18 $2 5 1001 $2 1002

Bo Barrera 0002 8/10/18 $2 5 1011 1012
Chi Chi Connors 1001 8/11/18 $2 3 1016 1017
Danny Deng 1003 8/12/18 $2 3 1021 1022
Eva Edwards 1015 8/13/18 $2 3 1026 1027

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APPENDIX G
SNS COACHING GUIDE

Note: This coaching guide is intended to provide a coach with the rationale behind a coaching session.
Coach Name:
Coaching Session Date:
Recruiter Name:
Recruiter Contact Information:

Introduce the Coaching Session

1. What is your understanding of what I am asking you to do?
At this point, the Recruiter has completed orientation.
This question is asked because the coach wants to assess whether the Recruiter has a clear
understanding of what they are being asked to do.
If there is a clear and complete understanding, the coach can move forward. If not, the coach
should correct misunderstandings and provide vital information.
Following this, the coach should ask: “Is this still something you’re interested in doing?”
2. Let’s talk about confidentiality. None of the information you have provided me with will be shared
with any other person. The notes I have taken will be kept in a locked file cabinet and will be used
only as a reminder on what the plan was for each person.
Identify Network Associates
3. Next, I’d like for us to talk about someone you know who you think should test for HIV and you’d
be willing to have a conversation with.
Consider ways to help identify appropriate Network Associates.
4. What would you like to call this person?
The intent of asking this question is to get the Recruiter to identify a specific person. The coach
wants the Recruiter to offer a name, a nickname, a fictitious name, or initials so that the person
can be referred to in the coaching session. This helps the coach to keep the Recruiter focused on
developing a plan for a specific person.
5. How would you describe your relationship to this person?
This is an open-ended question that assesses how well the Recruiter knows the Network Associate.
The Recruiter may or may not disclose information about having engaged in risk behavior with the
Network Associate. It is not necessary to do so and the coach should be careful about asking since
disclosure may be a sensitive topic.
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6. Please describe this person. (As necessary, do probes to get information on age, gender, etc.)
If the person described their relationship to the Network Associate, skip this question.
This is an open-ended question that the coach asks mainly to assess how well the Recruiter knows
the Network Associate and to get the Recruiter more comfortable in talking about their Network
Associate. The amount of information provided may vary from person to person and may describe
gender, age, and other characteristics. If the Recruiter describes their relationship to the Network
Associate, skip question 9.
7. Why do you think this person could be at risk for HIV?
In this question, the coach is assessing how well the Recruiter knows the Network Associate and
whether the Recruiter has a clear understanding of why testing may be appropriate. If the
Recruiter does not provide any information indicating risk, it may be necessary to review what risk
behavior is and try to determine whether the Recruiter believes the Network Associate is at risk for
transmission of or exposure to HIV. If no risk can be determined, it is not necessary to continue.
8. Do you believe this person has ever tested for HIV before?
“No” or “I don’t know” are acceptable answers to this question. If the Recruiter answers with a
“yes”, the coach should ask the Recruiter if he/she knows what the result was. If the Recruiter
indicates that the Network Associate is HIV positive, the coach should point out that the testing
program in for people of unknown status.
Coach – Develop a Plan
9. When and where would you bring up the subject of HIV testing?
Try to get the Recruiter to be specific about the time or timing and location of the conversation.
The coach can bring up the importance of choosing a location where a confidential conversation
can take place without distractions.
10. How would you bring up the subject of testing for HIV with this person? What will you say about
it?
The coach can ask about the conversation that would lead up to asking the Network Associate if
they would be willing to test. A simple role play exercise might be appropriate if the Recruiter is
uncertain.
11. How do you think this person would react to you bringing up the subject of testing for HIV?
The point of this question is to get the Recruiter to anticipate some of the likely responses to
bringing up the topic of testing so that the Recruiter can prepare for offering appropriate
responses. If the Recruiter is uncertain, the coach may ask some probing questions such as “Do
you think they may ask you why you thing they should test?”
12. How would you respond to those reactions?

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 This question is asked to get the Recruiter to anticipate reactions and attempt to respond
appropriately.
13. Do you think there is any possibility your Network Associate would react in a violent way?
If the response to this question is affirmative or uncertainty, explore whether it is appropriate to
bring up the subject of testing with this Network Associate.
14. Do you think the person will ask you about your HIV status? If so, how would you respond?
Avoid making recommendations about disclosure.
15. How would you disclose your HIV status? How comfortable are you with disclosing your status and
your decision to test? Discuss approaches for disclosing their own HIV status to Network
Associates, should they choose to do so.
Discuss approaches for disclosing HIV status if they choose to do so. Start by asking the Recruiter
how they would disclose their HIV status. If they are HIV positive and choose to disclose, ask
whether they would feel comfortable in explaining how they made the decision to test.
16. If you are not comfortable disclosing your status, how can you discuss (the importance of) testing
without revealing your HIV test results/status? Discuss approaches to raising the topic of HIV
testing to Network Associates without revealing their own status.
Discuss approaches to raising the topic of HIV testing without revealing their own status. Ask the
Recruiter how they would talk about the importance of testing without revealing their HIV status.
17. We can provide the following types of testing: aaa or bbb. Which of these do you think this person
is most likely to accept?
This question is based on the recognition that some people are more likely to test with some
testing technologies than others.
18. Here are the locations where we can provide testing: aaa, bbb, ccc. Where do you think this
person is most likely to test?
This question is based on the recognition that some people are more likely to test in some
locations than others.
19. Do you prefer to refer the Network Associate to testing (refer), come in with them (escort), or meet
in an agreed upon location where testing can be provided (coordinate)?
If the Recruiter prefers to escort the Network Associate to the testing site or coordinate a meeting
between the person doing the counseling and testing and the Network Associate, and the Network
Associate is comfortable and accepts the offer, the Recruiter should have the information and
ability to work out the details.
If the Recruiter chooses to refer to testing, provide information on how the referral cards work.
Provide the Recruiter with referral cards. Cards for each Recruiter should have a unique identifier
so that the card can be associated with the Recruiter when the Network Associates come for
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 testing. Explain that the Network Associate should surrender the card when appearing for a test.
(Those cards may be redeemed for incentives as well.)
20. Let’s talk a minute about how the incentive program works. What questions do you have about it?
How will you explain it to your friends?
If there is an incentive program, provide information on how it works.
The Recruiter should be made aware that there is an incentive program from the orientation.
They should understand what the incentive is and under what conditions it is offered. Explain how
and where the incentive can be redeemed. If a referral testing option is chosen, further explain
referral cards that can be redeemed for incentives.
21. Let’s talk about how to respond to any additional questions from Network Associates about HIV
transmission risks, available support services, confidentiality protections, or any other
issues/questions your friends may have.
Keep it simple.

• If someone has engaged in unprotected sex or shared injection drug equipment, they are
at risk.
• More information on support services can be obtained at the testing site.
• The right to confidentially is protected by law.
Summarize and Close Your Plan with the Recruiter
22. Let me summarize your plan for your Network Associate(s).
This summary should focus on who will be approached, when and where the conversation will
take place, how the topic will be brought up, and whether the Recruiter will refer or escort the
Network Associate to the testing location.
23. What, if anything, about this plan that makes you uncomfortable?
If there is something about the plan that makes the Recruiter uncomfortable, they are less likely to
carry it out. In such a case, the coach should identify what in the plan makes the Recruiter
uncomfortable and attempt to modify the plan or reframe the Recruiter’s thinking.
24. How confident do you feel that you can carry out this plan with your Network Associate?
If the Recruiter is not confident about any part of the plan, the coach should attempt to determine
what aspect of the plan the Recruiter is not confident about and either work on strengthening the
plan or reframing the Recruiter’s thinking.
25. I will want to follow up with you to see how things went with your Network Associates. Let’s talk
about OUR plan for that follow up: How will we touch base again: face-to-face, text, e-mail, or by
phone?
How often should we schedule our meetings/calls?

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 Let me tell you what we will discuss during our follow up.
Arrange for follow-up between you, the coach, and Recruiter in order to problem solve, reinforce,
support and identify additional Network Associates. It is recommended that the follow up with
the Recruiter take place as soon as possible after the Recruiter’s planned testing conversation with
the Network Associate.
26. What final questions or concerns do you have?
If there are questions, attempt to answer them. If there are concerns, attempt to address them.
Notes:
1. The wording for the questions statements provide a guide, but may be changed to make the
process feel more natural for the coach and more appropriate for the Recruiter. Review this
document and make any appropriate changes before using it. After using the document, review it
again and revise if appropriate.
2. Coaches should practice coaching sessions using this guide before actually engaging a potential
Recruiter. This can be easily done through a role-playing exercise.
3. A coach should progress through this guidance with a Recruiter for one Network Associate at the
time. A Recruiter plan for engaging a Network Associate may differ from one Network Associate
to another.
4. The intent of a coaching session is to get the Recruiter to identify a specific person, for the coach
to determine whether the person identified is a likely candidate for the program, and to assist the
Recruiter in planning a conversation with a Network Associate that will result in providing an HIV
test for a high-risk person of unknown HIV serostatus. The entire exercise is based on the
principle that the more specific a person is with their plan, the more likely they will succeed.

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Bibliography

Centers for Disease Control and Prevention. “Community Engagement for Data to Care Program. High
Impact Prevention.” Centers for Disease Control and Prevention. 2017. Community Engagement for
Data to Care Program.

Centers for Disease Control and Prevention. “HIV/AIDS Basic Statistics.” Centers for Disease Control and
Prevention. September 2017. HIV/AIDS Basic Statistics.

Centers for Disease Control and Prevention. “Use of Social Networks: A Recruitment Strategy for
Counseling, Testing and Referral Services, Trainer’s Manual.” STD/HIV Prevention Training Centers
Part III. Atlanta, GA, July 2013.

Centers for Disease Control and Prevention. “Use of social networks to identify persons with undiagnosed
HIV infection.” Morbidity and Mortality Weekly Report 54, no. 24 (2005): 601.

Shared Action. “Technical Bulletin: Community Advisory Board for an HIV Prevention Program.” AIDS
Project Los Angeles. 2010. Technical Bulletin: Community Advisory Board for an HIV Prevention
Program.

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