University of North Carolina Project-China, Guangzhou, China.
Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China.
PLoS Med. 2018 Aug 28;15(8):e1002645. doi: 10.1371/journal.pmed.1002645. eCollection 2018 Aug.
HIV testing rates are suboptimal among at-risk men. Crowdsourcing may be a useful tool for designing innovative, community-based HIV testing strategies to increase HIV testing. The purpose of this study was to use a stepped wedge cluster randomized controlled trial (RCT) to evaluate the effect of a crowdsourced HIV intervention on HIV testing uptake among men who have sex with men (MSM) in eight Chinese cities.
An HIV testing intervention was developed through a national image contest, a regional strategy designathon, and local message contests. The final intervention included a multimedia HIV testing campaign, an online HIV testing service, and local testing promotion campaigns tailored for MSM. This intervention was evaluated using a closed cohort stepped wedge cluster RCT in eight Chinese cities (Guangzhou, Shenzhen, Zhuhai, and Jiangmen in Guangdong province; Jinan, Qingdao, Yantai, and Jining in Shandong province) from August 2016 to August 2017. MSM were recruited through Blued, a social networking mobile application for MSM, from July 29 to August 21 of 2016. The primary outcome was self-reported HIV testing in the past 3 months. Secondary outcomes included HIV self-testing, facility-based HIV testing, condom use, and syphilis testing. Generalized linear mixed models (GLMMs) were used to analyze primary and secondary outcomes. We enrolled a total of 1,381 MSM. Most were ≤30 years old (82%), unmarried (86%), and had a college degree or higher (65%). The proportion of individuals receiving an HIV test during the intervention periods within a city was 8.9% (95% confidence interval [CI] 2.2-15.5) greater than during the control periods. In addition, the intention-to-treat analysis showed a higher probability of receiving an HIV test during the intervention periods as compared to the control periods (estimated risk ratio [RR] = 1.43, 95% CI 1.19-1.73). The intervention also increased HIV self-testing (RR = 1.89, 95% CI 1.50-2.38). There was no effect on facility-based HIV testing (RR = 1.00, 95% CI 0.79-1.26), condom use (RR = 1.00, 95% CI 0.86-1.17), or syphilis testing (RR = 0.92, 95% CI 0.70-1.21). A total of 48.6% (593/1,219) of participants reported that they received HIV self-testing. Among men who received two HIV tests, 32 individuals seroconverted during the 1-year study period. Study limitations include the use of self-reported HIV testing data among a subset of men and non-completion of the final survey by 23% of participants. Our study population was a young online group in urban China and the relevance of our findings to other populations will require further investigation.
In this setting, crowdsourcing was effective for developing and strengthening community-based HIV testing services for MSM. Crowdsourced interventions may be an important tool for the scale-up of HIV testing services among MSM in low- and middle-income countries (LMIC).
ClinicalTrials.gov NCT02796963.
高危男性的 HIV 检测率不理想。众包可能是设计创新的基于社区的 HIV 检测策略的有用工具，以增加 HIV 检测。本研究旨在使用阶梯式楔形集群随机对照试验（RCT）评估一项众包 HIV 干预措施对中国八个城市男男性行为者（MSM）中 HIV 检测率的影响。
通过全国形象大赛、区域战略设计大赛和当地信息竞赛，开发了一项 HIV 检测干预措施。最终的干预措施包括多媒体 HIV 检测运动、在线 HIV 检测服务以及针对 MSM 的当地检测推广活动。这项干预措施在中国八个城市（广东的广州、深圳、珠海和江门；山东的济南、青岛、烟台和济宁）进行了封闭队列阶梯式楔形集群 RCT 评估，时间为 2016 年 8 月至 2017 年 8 月。MSM 通过 Blued（一款专为 MSM 设计的社交网络移动应用程序）招募，招募时间为 2016 年 7 月 29 日至 8 月 21 日。主要结局是过去 3 个月内自我报告的 HIV 检测。次要结局包括 HIV 自检、医疗机构 HIV 检测、安全套使用和梅毒检测。采用广义线性混合模型（GLMM）分析主要和次要结局。我们共招募了 1381 名 MSM。大多数人年龄在 30 岁以下（82%）、未婚（86%）、拥有大学学历或更高学历（65%）。与对照期相比，城市内干预期内接受 HIV 检测的比例高 8.9%（95%置信区间 [CI] 2.2-15.5）。此外，意向治疗分析显示，与对照期相比，干预期接受 HIV 检测的可能性更高（估计风险比 [RR] = 1.43，95%CI 1.19-1.73）。该干预措施还增加了 HIV 自检（RR = 1.89，95%CI 1.50-2.38）。但对医疗机构 HIV 检测（RR = 1.00，95%CI 0.79-1.26）、安全套使用（RR = 1.00，95%CI 0.86-1.17）或梅毒检测（RR = 0.92，95%CI 0.70-1.21）没有影响。共有 48.6%（593/1219）的参与者报告他们接受了 HIV 自检。在接受两次 HIV 检测的男性中，有 32 人在 1 年研究期间出现血清转化。研究的局限性包括在一小部分男性中使用自我报告的 HIV 检测数据，以及 23%的参与者没有完成最终调查。我们的研究人群是中国城市中年轻的在线群体，因此我们的研究结果与其他人群的相关性还需要进一步研究。
在这种情况下，众包在开发和加强 MSM 的基于社区的 HIV 检测服务方面非常有效。众包干预措施可能是在中低收入国家（LMIC）扩大 MSM 的 HIV 检测服务的重要工具。
ClinicalTrials.gov NCT02796963。
