Successes and challenges to door-to-door recruitment of homeless persons living with HIV/AIDS residing in single room occupancy shelters in New York City

Background: Recruitment of transient homeless populations and chronic substance users in longitudinal studies is uniquely challenging. Homeless persons living with HIV/AIDS (PLWHA) in New York City (NYC), many with co-occurring substance use issues, were recruited into a one-year longitudinal study evaluating the effectiveness of a housing placement program.

Methods: Participants were recruited directly from HIV emergency shelters in which they were living and enrolled through one-hour baseline interviews. A door-to-door recruitment strategy was used to increase engagement with residents, and teams returned to each shelter multiple times to increase response rates. Rooms were ranked and approached in order to ensure random assignment into study arms. Participants were given $20 food vouchers at enrollment. We employed recruitment strategies to enhance success, and adapted along the way as the study team learned and implemented best practices based on experiences.

Results: Between April 2012—2013, homeless PLWHA were recruited from 22 different HIV emergency shelters. There were 2,026 attempts made to 1,103 unique rooms; we received 605 responses and enrolled 236 persons. Effective strategies at engaging and retaining participants included elements promoting sensitivity to individuals such as limiting number of recruiters in the building, giving participants needed breaks throughout the one-hour baseline interview, and interviewing in places where participants felt comfortable; as well as structural elements like varying time and day of week and month to better match shelter residents’ patterns.

Conclusions: These fluid and evolving recruitment strategies allowed the study team to reach recruitment goals and achieve a 55% response rate with a difficult-to-engage population.