title: TOGETHER Project to Increase Understanding of the HIV Epidemic Among Sub-Saharan African Migrants: Protocol of Community-Based Participatory Mixed-Method Studies.
abstract: BACKGROUND
  Sub-Saharan African Migrants (SAM) are the second largest group affected by HIV/AIDS in Belgium and the rest of Western Europe. Increasing evidence shows that, more than previously thought, SAM are acquiring HIV in their host countries. This calls for a renewed focus on primary prevention. Yet, knowledge on the magnitude of the HIV epidemic among SAM (HIV prevalence estimates and proportions of undiagnosed HIV infections) and underlying drivers are scarce and limit the development of such interventions.
  
  
  OBJECTIVE
  By applying a community-based participatory and mixed-methods approach, the TOGETHER project aims to deepen our understanding of HIV transmission dynamics, as well as inform future primary prevention interventions for this target group.
  
  
  METHODS
  The TOGETHER project consists of a cross-sectional study to assess HIV prevalence and risk factors among SAM visiting community settings in Antwerp city, Belgium, and links an anonymous electronic self-reported questionnaire to oral fluid samples. Three formative studies informed this method: (1) a social mapping of community settings using an adaptation of the PLACE method; (2) a multiple case study aiming to identify factors that increase risk and vulnerability for HIV infection by triangulating data from life history interviews, lifelines, and patient files; and (3) an acceptability and feasibility study of oral fluid sampling in community settings using participant observations.
  
  
  RESULTS
  Results have been obtained from 4 interlinked studies and will be described in future research.
  
  
  CONCLUSIONS
  Combining empirically tested and innovative epidemiological and social science methods, this project provides the first HIV prevalence estimates for a representative sample of SAM residing in a West European city. By triangulating qualitative and quantitative insights, the project will generate an in-depth understanding of the factors that increase risk and vulnerability for HIV infection among SAM. Based on this knowledge, the project will identify priority subgroups within SAM communities and places for HIV prevention. Adopting a community-based participatory approach throughout the full research process should increase community ownership, investment, and mobilization for HIV prevention.
authors.affiliation: HIV and Sexual Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium. jloos@itg.be.
authors.forename: Jasna
authors.identifier: http://orcid.org/0000-0002-3081-5409
authors.initials: J
authors.lastname: Loos
authors.forename: Bea
authors.identifier: http://orcid.org/0000-0003-0514-4372
authors.initials: B
authors.lastname: Vuylsteke
authors.forename: Lazare
authors.identifier: http://orcid.org/0000-0002-4162-4210
authors.initials: L
authors.lastname: Manirankunda
authors.forename: Jessika
authors.identifier: http://orcid.org/0000-0002-8989-0091
authors.initials: J
authors.lastname: Deblonde
authors.forename: Ilse
authors.identifier: http://orcid.org/0000-0003-3179-7510
authors.initials: I
authors.lastname: Kint
authors.forename: Fiona
authors.identifier: http://orcid.org/0000-0002-6983-2185
authors.initials: F
authors.lastname: Namanya
authors.forename: Katrien
authors.identifier: http://orcid.org/0000-0003-2127-4599
authors.initials: K
authors.lastname: Fransen
authors.forename: Robert
authors.identifier: http://orcid.org/0000-0002-1919-1340
authors.initials: R
authors.lastname: Colebunders
authors.forename: Marie
authors.identifier: http://orcid.org/0000-0002-3567-000X
authors.initials: M
authors.lastname: Laga
authors.forename: Dorothy
authors.identifier: http://orcid.org/0000-0002-0131-7742
authors.initials: D
authors.lastname: Adobea
authors.forename: Christiana
authors.identifier: http://orcid.org/0000-0001-9031-8503
authors.initials: C
authors.lastname: Nöstlinger
keywords: HIV; HIV prevalence; HIV prevention; HIV risk factors; community-based participatory research; electronic questionnaire; mixed methods; oral fluid; sub-Saharan African migrants; surveys and questionnaires