*Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, JHSPH, Baltimore, MD; †ICARH, Abuja, Nigeria; ‡Improving Men's Health Initiative, Abuja, Nigeria; §US Military HIV Research Project, Silver Spring, MD; ‖US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD; and ¶Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland, Baltimore, MD.
J Acquir Immune Defic Syndr. 2015 Mar 1;68 Suppl 2(0 2):S107-13. doi: 10.1097/QAI.0000000000000438.
The TRUST model based on experimental and observational data posits that integration of HIV prevention and universal coverage of antiretroviral treatment at a trusted community venue provides a framework for achieving effective reduction in HIV-related morbidity and mortality among men who have sex with men (MSM) living with HIV, as well as reducing HIV incidence. The analyses presented here evaluate the utility of respondent-driven sampling as an implementation tool for engaging MSM in the TRUST intervention.
The TRUST integrated prevention and treatment model was established at a trusted community center serving MSM in Abuja, Nigeria. Five seeds have resulted in 3-26 waves of accrual between March 2013 and August 2014, with results presented here characterizing HIV burden and engagement in HIV care for 722 men across study recruitment waves. For analytic purposes, the waves were collapsed into 5 groups: 4 equally spaced (0-4, 5-9, 10-14, and 15-19) and 1 ranging from the 20th to the 26th wave with significance assessed using Pearson χ2 test.
In earlier waves, MSM were more likely to have reported testing for HIV (82.9% in waves 0-4, 47.7% in waves 20-26; P < 0.01). In addition, biologically confirmed HIV prevalence decreased from an average of 59.1% to 42.9% (P < 0.05) in later waves. In earlier waves, about 80% of participants correctly reported their HIV status as compared with less than 25% in the later waves (P < 0.01). Finally, participants reporting being on ART decreased from 50% to 22.2% in later waves (P < 0.01).
Implementation science studies focused on demonstrating impact of universal HIV treatment programs among people living with HIV necessitate different accrual methods than those focused on preventing HIV acquisition. Here, respondent-driven sampling was shown to be an efficient method for reaching marginalized populations of MSM living with HIV in Nigeria, and engaging them in universal HIV treatment services.
基于实验和观察数据的 TRUST 模型提出，在受信任的社区场所将艾滋病毒预防和普遍覆盖抗逆转录病毒治疗相结合，为实现艾滋病毒相关发病率和死亡率的有效降低提供了框架，同时也降低了艾滋病毒的发病率。这里呈现的分析评估了使用应答者驱动抽样作为参与 TRUST 干预的实施工具的效用。
TRUST 综合预防和治疗模式在阿布贾的一个服务男男性接触者（MSM）的受信任社区中心建立。五个种子在 2013 年 3 月至 2014 年 8 月期间产生了 3-26 波招募，这里呈现的结果描述了 722 名男性在研究招募波次中的艾滋病毒负担和参与艾滋病毒护理情况。为了分析目的，波次被分为 5 组：4 个均等间隔的波次（0-4、5-9、10-14 和 15-19）和 1 个从第 20 波到第 26 波的范围，使用 Pearson χ2 检验评估显著性。
在早期波次中，MSM 更有可能报告进行了艾滋病毒检测（波次 0-4 中为 82.9%，波次 20-26 中为 47.7%；P < 0.01）。此外，在后期波次中，生物确证的艾滋病毒流行率从平均 59.1%下降到 42.9%（P < 0.05）。在早期波次中，约 80%的参与者正确报告了自己的艾滋病毒状况，而在后期波次中不到 25%的参与者正确报告（P < 0.01）。最后，报告正在接受抗逆转录病毒治疗的参与者从 50%下降到了后期波次中的 22.2%（P < 0.01）。
实施科学研究侧重于展示普及艾滋病毒治疗方案对艾滋病毒感染者的影响，这需要与侧重于预防艾滋病毒感染的研究采用不同的招募方法。在这里，应答者驱动抽样被证明是在尼日利亚接触感染艾滋病毒的边缘化男男性接触者并使他们参与普及艾滋病毒治疗服务的有效方法。
