title: Respondent-driven sampling as a recruitment method for men who have sex with men in southern sub-Saharan Africa: a cross-sectional analysis by wave.
abstract: Respondent-driven sampling (RDS) is a popular method for recruiting men who have sex with men (MSM). Our objective is to describe the ability of RDS to reach MSM for HIV testing in three southern African nations.
  
  
  
  Data collected via RDS among MSM in Lesotho (N=318), Swaziland (N=310) and Malawi (N=334) were analysed by wave in order to characterise differences in sample characteristics. Seeds were recruited from MSM-affiliated community-based organisations. Men were interviewed during a single study visit and tested for HIV. χ(2) tests for trend were used to examine differences in the proportions across wave category.
  
  
  
  A maximum of 13-19 recruitment waves were achieved in each study site. The percentage of those who identified as gay/homosexual decreased as waves increased in Lesotho (49% to 27%, p<0.01). In Swaziland and Lesotho, knowledge that anal sex was the riskiest type of sex for HIV transmission decreased across waves (39% to 23%, p<0.05, and 37% to 19%, p<0.05). The percentage of participants who had ever received more than one HIV test decreased across waves in Malawi (31% to 12%, p<0.01). In Lesotho and Malawi, the prevalence of testing positive for HIV decreased across waves (48% to 15%, p<0.01 and 23% to 11%, p<0.05). Among those living with HIV, the proportion of those unaware of their status increased across waves in all study sites although this finding was not statistically significant.
  
  
  
  RDS that extends deeper into recruitment waves may be a promising method of reaching MSM with varying levels of HIV prevention needs.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, Maryland, USA.
authors.forename: Shauna
authors.identifier: 0000-0003-2861-7734
authors.initials: S
authors.lastname: Stahlman
authors.affiliation: Department of Global Health Sciences, University of California San Francisco, San Francisco, California, USA.
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Johnston
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, Maryland, USA Department of Biochemistry and Microbiology, Nelson Mandela Metropolitan University, South Africa.
authors.forename: Clarence
authors.initials: C
authors.lastname: Yah
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, Maryland, USA.
authors.forename: Sosthenes
authors.initials: S
authors.lastname: Ketende
authors.affiliation: Rock of Hope, Manzini, Swaziland.
authors.forename: Sibusiso
authors.initials: S
authors.lastname: Maziya
authors.affiliation: Center for the Development of People, Blantyre, Malawi.
authors.forename: Gift
authors.initials: G
authors.lastname: Trapence
authors.affiliation: Malawi College of Medicine, Blantyre, Malawi Centre for Global Health, Trinity College, Dublin, Ireland.
authors.forename: Vincent
authors.initials: V
authors.lastname: Jumbe
authors.affiliation: Rock of Hope, Mbabane, Swaziland.
authors.forename: Bhekie
authors.initials: B
authors.lastname: Sithole
authors.affiliation: Rock of Hope, Mbabane, Swaziland.
authors.forename: Tampose
authors.initials: T
authors.lastname: Mothopeng
authors.affiliation: Ministry of Health, Mbabane, Swaziland.
authors.forename: Zandile
authors.initials: Z
authors.lastname: Mnisi
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, Maryland, USA.
authors.forename: Stefan
authors.initials: S
authors.lastname: Baral
mesh_terms: D000328:Adult; D044383:Black People; D003430:Cross-Sectional Studies; D013541:Eswatini / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male; D006801:Humans; D007927:Lesotho / Q000453:epidemiology; D008295:Malawi / Q000453:epidemiology; D008297:Male; D018579:Patient Selection; D015995:Prevalence; D012494:Sampling Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: AFRICA; GAY MEN; HIV; IMPLEMENTATION SCIENCE; PREVENTION