Harlem Prevention Center, ICAP at Columbia University, New York, NY, USA.
Harlem Hospital Center, New York, NY, USA.
J Int AIDS Soc. 2018 Mar;21(3). doi: 10.1002/jia2.25091.
Black men who have sex with men and transgender women are at high risk for HIV infection, but are more likely to be unaware of their infection or not in care for diagnosed HIV compared to other races. Respondent driven sampling has been advanced as a method to reach stigmatized and hidden populations for HIV testing. We compared strategies to recruit black, substance-using men who have sex with men and transgender women to identify newly diagnosed HIV infection, or those previously diagnosed but not in care.
The STAR (Seek, Test, and Retain) study (ClinicalTrials.gov NCT01790360) used several recruitment strategies to identify black, substance-using men who have sex with men and transgender women with undiagnosed HIV infection or with previously diagnosed HIV infection but who were not in HIV care. Respondent-driven sampling, community-based recruitment and online advertising were used to recruit participants. Incentivized peer referral was integrated into all recruitment strategies. Participants completed interviewer-administered questionnaires and HIV testing. Demographic and HIV risk-related characteristics and recruitment strategy were summarized and stratified by HIV status. Associations were tested using Pearson's chi-squared, Fisher's exact, and Wilcoxon rank sum tests. Factors associated with HIV-positive diagnosis at p < 0.1 were included in a multivariable logistic regression model.
From July 2012 through October 2015, the study enrolled 1929 participants; 96.3% men who have sex with men and 3.7% transgender women. Behavioural risk factors included recent condomless anal sex (55.6%) and recent substance use during sex (73.1%). HIV prevalence was 8.7%. In multivariable analysis, significant associations with HIV infection included being transgender; non-Hispanic black; gay/homosexual orientation; not homeless; and less likely to have insufficient income for necessities. Among recruitment strategies, respondent driven sampling was least effective in identifying HIV-positive participants.
Integrating multiple recruitment strategies yielded a large sample of black men who have sex with men and transgender women at substantial risk for HIV. Respondent-driven sampling was less effective than other strategies at identifying men who have sex with men and transgender women with HIV.
男男性行为者和跨性别女性是感染 HIV 的高危人群，但与其他种族相比，他们更有可能不知道自己感染了 HIV，或者在感染 HIV 后没有得到治疗。应答者驱动抽样已被提出作为一种方法，用于对感染 HIV 的受歧视和隐蔽人群进行检测。我们比较了几种招募黑人、有吸毒行为的男男性行为者和跨性别女性的策略，以确定新诊断的 HIV 感染或以前诊断但未接受治疗的 HIV 感染。
STAR（寻找、检测和保留）研究（ClinicalTrials.gov NCT01790360）使用了几种招募策略来识别未确诊的 HIV 感染或以前诊断但未接受 HIV 治疗的黑人、有吸毒行为的男男性行为者和跨性别女性。应答者驱动抽样、基于社区的招募和在线广告被用来招募参与者。激励性同伴推荐被整合到所有招募策略中。参与者完成了访谈者管理的问卷和 HIV 检测。按 HIV 状况总结和分层了人口统计学和 HIV 风险相关特征以及招募策略。使用 Pearson's chi-squared、Fisher's exact 和 Wilcoxon rank sum 检验测试关联。将在 p<0.1 处与 HIV 阳性诊断相关的因素纳入多变量逻辑回归模型。
从 2012 年 7 月到 2015 年 10 月，该研究共招募了 1929 名参与者；96.3%是男男性行为者，3.7%是跨性别女性。行为风险因素包括最近无保护的肛交（55.6%）和最近性行为时使用毒品（73.1%）。HIV 流行率为 8.7%。在多变量分析中，与 HIV 感染显著相关的因素包括跨性别；非裔美国人；同性恋/同性恋取向；没有无家可归；和不太可能有足够的收入来满足必需品。在招募策略中，应答者驱动抽样在识别 HIV 阳性参与者方面效果最差。
整合多种招募策略可以获得大量的黑人男男性行为者和跨性别女性样本，这些人感染 HIV 的风险很高。与其他策略相比，应答者驱动抽样在识别 HIV 阳性男男性行为者和跨性别女性方面的效果较差。
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