Evaluating respondent-driven sampling as an implementation tool for universal coverage of antiretroviral studies among men who have sex with men living with HIV.
BACKGROUND
The TRUST model based on experimental and observational data posits that integration of HIV prevention and universal coverage of antiretroviral treatment at a trusted community venue provides a framework for achieving effective reduction in HIV-related morbidity and mortality among men who have sex with men (MSM) living with HIV, as well as reducing HIV incidence. The analyses presented here evaluate the utility of respondent-driven sampling as an implementation tool for engaging MSM in the TRUST intervention.


METHODS
The TRUST integrated prevention and treatment model was established at a trusted community center serving MSM in Abuja, Nigeria. Five seeds have resulted in 3-26 waves of accrual between March 2013 and August 2014, with results presented here characterizing HIV burden and engagement in HIV care for 722 men across study recruitment waves. For analytic purposes, the waves were collapsed into 5 groups: 4 equally spaced (0-4, 5-9, 10-14, and 15-19) and 1 ranging from the 20th to the 26th wave with significance assessed using Pearson χ2 test.


RESULTS
In earlier waves, MSM were more likely to have reported testing for HIV (82.9% in waves 0-4, 47.7% in waves 20-26; P < 0.01). In addition, biologically confirmed HIV prevalence decreased from an average of 59.1% to 42.9% (P < 0.05) in later waves. In earlier waves, about 80% of participants correctly reported their HIV status as compared with less than 25% in the later waves (P < 0.01). Finally, participants reporting being on ART decreased from 50% to 22.2% in later waves (P < 0.01).


CONCLUSIONS
Implementation science studies focused on demonstrating impact of universal HIV treatment programs among people living with HIV necessitate different accrual methods than those focused on preventing HIV acquisition. Here, respondent-driven sampling was shown to be an efficient method for reaching marginalized populations of MSM living with HIV in Nigeria, and engaging them in universal HIV treatment services.
*Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, JHSPH, Baltimore, MD; †ICARH, Abuja, Nigeria; ‡Improving Men's Health Initiative, Abuja, Nigeria; §US Military HIV Research Project, Silver Spring, MD; ‖US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD; and ¶Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland, Baltimore, MD.
Stefan D
SD
Baral
Sosthenes
S
Ketende
Sheree
S
Schwartz
Ifeanyi
I
Orazulike
Kelechi
K
Ugoh
Sheila A
SA
Peel
Julie
J
Ake
William
W
Blattner
Manhattan
M
Charurat
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003625:Data Collection / Q000379:methods*; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D055815:Young Adult
D019380:Anti-HIV Agents