title: Study protocol for the recruitment of female sex workers and their non-commercial partners into couple-based HIV research.
abstract: BACKGROUND
  Researchers are increasingly recognizing the importance of addressing sexual and drug-related HIV risk within the context of intimate relationships rather than solely focusing on individual behaviors. Practical and effective methods are needed to recruit, screen, and enroll the high risk and hard-to-reach couples who would most benefit from HIV interventions, such as drug-using female sex workers (FSWs) and their intimate, non-commercial partners. This paper outlines a bi-national, multidisciplinary effort to develop and implement a study protocol for research on the social context and epidemiology of HIV, sexually transmitted infections (STI), and high risk behaviors among FSWs and their non-commercial male partners in Tijuana and Ciudad Juarez, Mexico. We provide an overview of our study and specifically focus on the sampling, recruitment, screening, and successful enrollment of high risk couples into a public health study in this context.
  
  
  METHODS
  We used targeted and snowball sampling to recruit couples through the female partner first and administered a primary screener to check her initial eligibility. Willing and eligible females then invited their primary male partners for couple-based screening using a couple verification screening (CVS) instrument adapted from previous studies. The CVS rechecked eligibility and separately asked each partner the same questions about their relationship to "test" if the couple was legitimate. We adapted the original protocol to consider issues of gender and power within the local cultural and socioeconomic context and expanded the question pool to create multiple versions of the CVS that were randomly administered to potential couples to determine eligibility and facilitate study enrollment.
  
  
  CONCLUSIONS
  The protocol successfully enrolled 214 high risk couples into a multi-site public health study. This work suggests the importance of collaborating to construct a study protocol, understanding the local population and context, and drawing on multiple sources of input to determine eligibility and verify the legitimacy of relationships. We provide a practical set of tools that other researchers should find helpful in the study of high risk couples in international settings, with particular relevance to studies of FSWs and their intimate partners.
authors.affiliation: Department of Anthropology, University of South Florida, 4202 East FowlerAvenue, SOC 107, Tampa, FL 33620-7200, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Syvertsen
authors.forename: Angela M
authors.initials: AM
authors.lastname: Robertson
authors.forename: Daniela
authors.initials: D
authors.lastname: Abramovitz
authors.forename: M Gudelia
authors.initials: MG
authors.lastname: Rangel
authors.forename: Gustavo
authors.initials: G
authors.lastname: Martinez
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
authors.forename: Monica D
authors.initials: MD
authors.lastname: Ulibarri
authors.forename: Alicia
authors.initials: A
authors.lastname: Vera
authors.forename: Nabila
authors.initials: N
authors.lastname: El-Bassel
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
mesh_terms: D002985:Clinical Protocols; D003955:Diagnostic Tests, Routine / Q000379:methods; D004608:Eligibility Determination; D005191:Family Characteristics; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008800:Mexico / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D011159:Population Surveillance / Q000379:methods*; D011446:Prospective Studies; D036301:Qualitative Research; D012309:Risk-Taking; D018401:Sample Size; D060386:Sex Workers / Q000523:psychology / Q000706:statistics & numerical data; D012725:Sexual Behavior; D012747:Sexual Partners / Q000523:psychology; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000523:psychology; D015813:Substance Abuse Detection / Q000706:statistics & numerical data