Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Am J Epidemiol. 2013 Jul 15;178(2):260-7. doi: 10.1093/aje/kws432. Epub 2013 Jun 25.
We are now in the fourth decade of the human immunodeficiency virus (HIV) pandemic. Several novel prevention tools have been identified, and prevalence and incidence have declined in many settings. A remaining challenge is the delivery of preventive interventions to hard-to-reach populations, including men who have sex with men and injection drug users. Leaders in the field of HIV have called for a new focus on implementation science, which requires a shift in thinking from individual randomized controlled trials to cluster-randomized trials. Multiple challenges need to be addressed in the conduct of cluster-randomized trials, including: 1) generalizability of the study population to the target population, 2) potential contamination through overlap/exchange of members of control and intervention clusters, and 3) evaluation of effectiveness at multiple levels of influence. To address these key challenges, we propose a novel application of respondent-driven sampling-a chain-referral strategy commonly used for surveillance-in the recruitment of participants for the evaluation of a cluster-randomized trial of a community intervention. We illustrate this application with an empirical example of a cluster-randomized trial that is currently under way to assess the effectiveness of men's wellness centers in improving utilization of HIV counseling and testing among men who have sex with men in India.
我们正处于人类免疫缺陷病毒（HIV）流行的第四个十年。已经确定了几种新的预防工具，并且在许多环境中，流行率和发病率都有所下降。仍然存在的挑战是向难以接触到的人群提供预防干预措施，包括男男性行为者和注射毒品使用者。HIV 领域的领导者呼吁将重点转向实施科学，这需要从个体随机对照试验转变为整群随机试验。在进行整群随机试验时需要解决多个挑战，包括：1）研究人群对目标人群的可推广性，2）通过控制和干预群成员的重叠/交换而产生的潜在污染，以及 3）在多个影响层面评估效果。为了解决这些关键挑战，我们提出了一种新的应用，即应答驱动抽样——一种常用于监测的连锁referral 策略——在评估社区干预的整群随机试验中招募参与者。我们用一个正在进行的整群随机试验的实证例子来说明这种应用，该试验旨在评估男性健康中心在提高男男性行为者接受 HIV 咨询和检测方面的效果。
