Copen Casey E, Rushmore Julie, De Voux Alex, Kirkcaldy Robert D, Fakile Yetunde F, Tilchin Carla, Duchen Jessica, Jennings Jacky M, Spahnie Morgan, Norris Turner Abigail, Miller William C, Novak Richard M, Schneider John A, Trotter Andrew B, Bernstein Kyle T
Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, GA, United States.
JMIR Res Protoc. 2022 Nov 4;11(11):e40095. doi: 10.2196/40095.
In the United States, the rates of primary and secondary syphilis have increased more rapidly among men who have sex with men (MSM) than among any other subpopulation. Rising syphilis rates among MSM reflect changes in both individual behaviors and the role of sexual networks (eg, persons linked directly or indirectly by sexual contact) in the spread of the infection. Decades of research examined how sexual networks influence sexually transmitted infections (STIs) among MSM; however, few longitudinal data sources focusing on syphilis have collected network characteristics. The Centers for Disease Control and Prevention, in collaboration with 3 sites, enrolled a prospective cohort of MSM in 3 US cities to longitudinally study sexual behaviors and STIs, including HIV, for up to 24 months.
The Network Epidemiology of Syphilis Transmission (NEST) study aimed to collect data on the factors related to syphilis transmission and acquisition among MSM.
The NEST study was a prospective cohort study that enrolled 748 MSM in Baltimore, Maryland; Chicago, Illinois; and Columbus, Ohio. NEST recruitment used a combination of convenience sampling, venue-based recruitment, and respondent-driven sampling approaches. At quarterly visits, participants completed a behavioral questionnaire and were tested for syphilis, HIV, gonorrhea, and chlamydia. The participants also provided a list of their sexual partners and described their 3 most recent partners in greater detail.
The NEST participants were enrolled in the study from July 2018 to December 2021. At baseline, the mean age of the participants was 31.5 (SD 9.1) years. More than half (396/727. 54.5%) of the participants were non-Hispanic Black, 29.8% (217/727) were non-Hispanic White, and 8.8% (64/727) were Hispanic or Latino. Multiple recruitment strategies across the 3 study locations, including respondent-driven sampling, clinic referrals, flyers, and social media advertisements, strengthened NEST participation. Upon the completion of follow-up visits in March 2022, the mean number of visits per participant was 5.1 (SD 3.2; range 1-9) in Baltimore, 2.2 (SD 1.6; range 1-8) in Chicago, and 7.2 (SD 2.9; range 1-9) in Columbus. Using a community-based participatory research approach, site-specific staff were able to draw upon collaborations with local communities to address stigma concerning STIs, particularly syphilis, among potential NEST participants. Community-led efforts also provided a forum for staff to describe the NEST study objectives and plans for research dissemination to the target audience. Strategies to bolster data collection during the COVID-19 pandemic included telehealth visits (all sites) and adaptation to self-collection of STI specimens (Baltimore only).
Data from NEST will be used to address important questions regarding individual and partnership-based sexual risk behaviors among MSM, with the goal of informing interventions to prevent syphilis in high-burden areas.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/40095.
在美国，男男性行为者（MSM）中一期和二期梅毒的发病率增速高于其他任何亚人群。MSM中梅毒发病率的上升反映了个体行为以及性网络（如通过性接触直接或间接联系的人）在感染传播中作用的变化。数十年来的研究探讨了性网络如何影响MSM中的性传播感染（STI）；然而，很少有专注于梅毒的纵向数据源收集网络特征。疾病控制与预防中心与3个地点合作，于2018年在美国3个城市招募了一组MSM前瞻性队列，对其性行为和包括艾滋病毒在内的性传播感染进行长达24个月的纵向研究。
梅毒传播网络流行病学（NEST）研究旨在收集与MSM中梅毒传播和感染相关因素的数据。
NEST研究是一项前瞻性队列研究，在马里兰州巴尔的摩、伊利诺伊州芝加哥和俄亥俄州哥伦布招募了748名MSM。NEST招募采用了便利抽样、基于场所的招募和应答驱动抽样方法相结合的方式。在季度随访中，参与者完成一份行为问卷，并接受梅毒、艾滋病毒、淋病和衣原体检测。参与者还提供了他们性伴侣的名单，并更详细地描述了他们最近的3个伴侣。
NEST参与者于2018年7月至2021年12月纳入研究。基线时，参与者的平均年龄为31.5（标准差9.1）岁。超过一半（396/727，54.5%）的参与者为非西班牙裔黑人，29.8%（217/727）为非西班牙裔白人，8.8%（64/727）为西班牙裔或拉丁裔。3个研究地点的多种招募策略，包括应答驱动抽样、诊所转诊、传单和社交媒体广告，增强了NEST的参与度。在2022年3月完成随访时，巴尔的摩每位参与者的平均随访次数为5.1（标准差3.2；范围1 - 9）次，芝加哥为2.2（标准差1.6；范围1 - 8）次，哥伦布为7.2（标准差2.9；范围1 - 9）次。采用基于社区的参与性研究方法，各地点的工作人员能够利用与当地社区的合作，解决潜在NEST参与者对性传播感染，特别是梅毒的污名化问题。社区主导的努力还为工作人员提供了一个论坛，向目标受众描述NEST研究目标和研究传播计划。在2019冠状病毒病大流行期间加强数据收集的策略包括远程医疗问诊（所有地点）和适应性传播感染标本的自我采集（仅巴尔的摩）。
NEST的数据将用于解决有关MSM中基于个体和伴侣的性风险行为的重要问题，目标是为高负担地区预防梅毒的干预措施提供信息。
国际注册报告标识符（IRRID）：RR1 - 10.2196/40095。
