Assessment of a new web-based sexual concurrency measurement tool for men who have sex with men.
BACKGROUND
Men who have sex with men (MSM) are the most affected risk group in the United States' human immunodeficiency virus (HIV) epidemic. Sexual concurrency, the overlapping of partnerships in time, accelerates HIV transmission in populations and has been documented at high levels among MSM. However, concurrency is challenging to measure empirically and variations in assessment techniques used (primarily the date overlap and direct question approaches) and the outcomes derived from them have led to heterogeneity and questionable validity of estimates among MSM and other populations.


OBJECTIVE
The aim was to evaluate a novel Web-based and interactive partnership-timing module designed for measuring concurrency among MSM, and to compare outcomes measured by the partnership-timing module to those of typical approaches in an online study of MSM.


METHODS
In an online study of MSM aged ≥18 years, we assessed concurrency by using the direct question method and by gathering the dates of first and last sex, with enhanced programming logic, for each reported partner in the previous 6 months. From these methods, we computed multiple concurrency cumulative prevalence outcomes: direct question, day resolution / date overlap, and month resolution / date overlap including both 1-month ties and excluding ties. We additionally computed variants of the UNAIDS point prevalence outcome. The partnership-timing module was also administered. It uses an interactive month resolution calendar to improve recall and follow-up questions to resolve temporal ambiguities, combines elements of the direct question and date overlap approaches. The agreement between the partnership-timing module and other concurrency outcomes was assessed with percent agreement, kappa statistic (κ), and matched odds ratios at the individual, dyad, and triad levels of analysis.


RESULTS
Among 2737 MSM who completed the partnership section of the partnership-timing module, 41.07% (1124/2737) of individuals had concurrent partners in the previous 6 months. The partnership-timing module had the highest degree of agreement with the direct question. Agreement was lower with date overlap outcomes (agreement range 79%-81%, κ range .55-.59) and lowest with the UNAIDS outcome at 5 months before interview (65% agreement, κ=.14, 95% CI .12-.16). All agreements declined after excluding individuals with 1 sex partner (always classified as not engaging in concurrency), although the highest agreement was still observed with the direct question technique (81% agreement, κ=.59, 95% CI .55-.63). Similar patterns in agreement were observed with dyad- and triad-level outcomes.


CONCLUSIONS
The partnership-timing module showed strong concurrency detection ability and agreement with previous measures. These levels of agreement were greater than others have reported among previous measures. The partnership-timing module may be well suited to quantifying concurrency among MSM at multiple levels of analysis.
Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States. esrose2@emory.edu.
Eli S
http://orcid.org/0000-0002-1695-8075
ES
Rosenberg
Richard B
http://orcid.org/0000-0002-4968-6248
RB
Rothenberg
David G
http://orcid.org/0000-0002-6544-2972
DG
Kleinbaum
Rob B
http://orcid.org/0000-0001-6034-2019
RB
Stephenson
Patrick S
http://orcid.org/0000-0002-7728-0587
PS
Sullivan
D000328:Adult; D058872:Epidemics; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission*; D018451:Homosexuality, Male; D006801:Humans; D020407:Internet; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012725:Sexual Behavior; D012747:Sexual Partners; D013997:Time Factors; D014481:United States / Q000453:epidemiology
HIV; MSM; concurrency; online questionnaire; questionnaires; sexual network measurement; sexual networks