Venue-Based Recruitment of Women at Elevated Risk for HIV: An HIV Prevention Trials Network Study

Background: The challenge of identifying and recruiting U.S. women at elevated risk for HIV acquisition impedes prevention studies and services. HIV Prevention Trials Network (HPTN) 064 was a U.S. multisite, longitudinal cohort study designed to estimate HIV incidence among women living in communities with prevalent HIV and poverty. Venue-based sampling (VBS) methodologies and participant and venue characteristics are described. Methods: Eligible women were recruited from 10 U.S. communities with prevalent HIV and poverty using VBS. Participant eligibility criteria included age 18–44 years, residing in a designated census tract/zip code, and self-report of at least one high-risk personal and/or male sexual partner characteristic associated with HIV acquisition (e.g., incarceration history). Ethnography was conducted to finalize recruitment areas and venues. Results: Eight thousand twenty-nine women were screened and 2,099 women were enrolled (88% black, median age 29 years) over 14 months. The majority of participants were recruited from outdoor venues (58%), retail spaces (18%), and social service organizations (13%). The proportion of women recruited per venue category varied by site. Most participants (73%) had both individual and partner characteristics that qualified them for the study; 14% were eligible based on partner risk only. Conclusion: VBS is a feasible and effective approach to rapidly recruit a population of women at enhanced risk for HIV in the United States. Such a recruitment approach is needed in order to engage women most at risk and requires strong community engagement

Estimating Design Effect and Calculating Sample Size for Respondent-Driven Sampling Studies of Injection Drug Users in the United States

Respondent-driven sampling (RDS) has become increasingly popular for sampling hidden populations, including injecting drug users (IDU). However, RDS data are unique and require specialized analysis techniques, many of which remain underdeveloped. RDS sample size estimation requires knowing design effect (DE), which can only be calculated post hoc. Few studies have analyzed RDS DE using real world empirical data. We analyze estimated DE from 43 samples of IDU collected using a standardized protocol. We find the previous recommendation that sample size be at least doubled, consistent with DE = 2, underestimates true DE and recommend researchers use DE = 4 as an alternate estimate when calculating sample size. A formula for calculating sample size for RDS studies among IDU is presented. Researchers faced with limited resources may wish to accept slightly higher standard errors to keep sample size requirements low. Our results highlight dangers of ignoring sampling design in analysis

Sexually transmitted infection diagnoses among Hispanic immigrant and migrant men who have sex with men in the United States

Hispanic immigrant/migrant men who have sex with men (MSM) should be at higher risk for sexually transmitted infections/human immunodeficiency virus (STIs/HIV) given individual-level factors associated with the migration process that have been theorised to increase susceptibility to STIs/HIV among migrant populations. However, relatively little is known if these individual level factors are actually associated with the STI prevalence among this population. During 2005–2007, 2576 men and women foreign-born Hispanics were surveyed at three community-based organisations offering services to immigrant/migrant communities in the US. We analysed demographic characteristics, sexual risk behaviours, migration patterns, and factors associated with STI diagnoses (syphilis, chlamydia, and gonorrhoea) in the past 12 months among Hispanic immigrant/migrant MSM. Of 1482 Hispanic immigrant/migrant men surveyed who reported having sex in the past 12 months, 353 (24%) reported sex with a man, and of these, 302 answered questions regarding whether or not they had been diagnosed with a bacterial STI in the past year. Of these 302 men, 25% reported being married; 42% self-identified as being heterosexual and 20% as bisexual. Twenty-nine (9.6%) men reported that they had received an STI diagnosis in the past year. In the multivariate logistic regression model, men who reported receiving money or goods for sex had increased odds of a self-reported STI diagnosis. The prevalence of bacterial STIs among Hispanic immigrant/migrant MSM is lower than the prevalence of bacterial STIs among other MSM in the United States. Nevertheless, receiving money or goods for sex was significantly associated with a self-reported STI diagnosis among Hispanic immigrant/migrant MSM. It is important to understand factors contributing to participation in exchange sex among this population. HIV/STI prevention interventions tailored to non-gay identifying MSM are important for Hispanic immigrant/migrant MSM. </jats:p

Estimating Gains in HIV Testing by Expanding HIV Screening at Routine Checkups

Objectives. To estimate gains in the prevalence of individuals who had ever been tested for HIV overall and by subpopulations from increases in the percentage of persons who had a routine checkup and were tested. Methods. We used data from the 2019 Behavioral Risk Factor Surveillance System to determine the prevalence of individuals who were ever tested for HIV and the prevalence of missed opportunities for HIV testing among those never tested in the United States. We assessed the effect of absolute percentage increases in having ever been tested among those who had a past-year routine checkup on increasing the overall prevalence of having ever been tested. Results. In 2019, 49.5% of US adults had ever been tested for HIV; 34.5% had a missed opportunity. A 50% increase in testing at routine checkups would increase the prevalence of having ever been tested to 84.0%. Increases in the prevalence of having ever been tested (≥ 85%) was highest among persons aged 35 to 54 years, Black persons, persons who were female at birth, persons with health insurance, and persons reporting HIV risk behaviors. Conclusions. Fully incorporating HIV screening into primary care would greatly increase the proportion of US adults who have been tested for HIV. Public Health Implications. Continued efforts to promote HIV testing, including implementing routine screening in clinical settings, will help ensure that all US adults know their HIV status. </jats:p