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Campbell MB, Ratnayake A, Gomes G, Stoecker C, Kissinger PJ. Effectiveness of Incentivized Peer Referral to Increase Enrollment in a Community-Based Chlamydia Screening and Treatment Study Among Young Black Men. J Racial Ethn Health Disparities 2024; 11:1173-1181. [PMID: 37095285 PMCID: PMC10124922 DOI: 10.1007/s40615-023-01595-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 04/01/2023] [Accepted: 04/04/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVES Young Black men are under-represented in sexual health services and research, a condition likely magnified during COVID-19 shutdowns due to disruption of STI screening and treatment services. We examined the effect of incentivized peer referral (IPR) increasing peer referral among young Black men in a community-based chlamydia screening program. METHODS Young Black men in New Orleans, LA, age 15-26 years enrolled in a chlamydia screening program between 3/2018 and 5/2021 were included. Enrollees were provided with recruitment materials to distribute to peers. Starting July 28, 2020, enrollees were also offered a $5 incentive for each peer enrolled. Enrollment was compared before and after the incentivize peer referral program (IPR) was implemented using multiple time series analysis (MTSA). RESULTS The percentage of men referred by a peer was higher during IPR compared to pre-IPR (45.7% vs. 19.7%, p < 0.001). After the COVID-19 shutdown was lifted, there were 2.007 more recruitments per week (p = 0.044, 95% CI (0.0515, 3.964)) for IPR, compared to pre-IPR. Overall, there was a trending increase in recruitments in the IPR era relative to the pre-IPR era (0.0174 recruitments/week, p = 0.285, 95% CI (- 0.0146, 0.0493)) with less recruitment decay during IPR compared to pre-IPR. CONCLUSIONS IPR may be an effective means of engaging young Black men in community-based STI research and prevention programs, particularly when clinic access is limited. CLINICAL TRIALS REGISTRY SITE AND NUMBER Clinicaltrials.gov identifier NCT03098329.
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Affiliation(s)
- Mary Beth Campbell
- Epidemiology Department, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 2000, New Orleans, LA, 70112, USA
| | - Aneeka Ratnayake
- Epidemiology Department, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 2000, New Orleans, LA, 70112, USA
| | - Gérard Gomes
- Epidemiology Department, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 2000, New Orleans, LA, 70112, USA
| | - Charles Stoecker
- Health Policy and Management Department, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., Suite 2000, New Orleans, LA, 70112, USA
| | - Patricia J Kissinger
- Epidemiology Department, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 2000, New Orleans, LA, 70112, USA.
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Yin Z, Du Y, Cheng W, Tang W. Digital Strategies Supporting Social Network Approaches to HIV Testing: A Scoping Review. Curr HIV/AIDS Rep 2024; 21:168-195. [PMID: 38733522 DOI: 10.1007/s11904-024-00699-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE OF REVIEW This review captured how digital strategies support social network approaches to promote HIV testing. RECENT FINDING Overall, 29 studies were identified by searching PubMed and Embase for studies published up to June 2023. Existing studies revealed three types of digital strategies (social media (n = 28), online information channels (n = 4), and multifunctional digital platforms (n = 4)) split into four major modes of digital strategy-supported social-network-based HIV testing promotion: 1) Online outreach and recruiting, 2) gathering and identifying key populations for HIV testing, 3) communicating and disseminating online HIV testing health interventions, and 4) assisting and facilitating HIV testing uptake and distribution. Social network approaches supported by digital strategies yielded advantages in HIV testing education and distribution, which increases HIV testing coverage among key populations. Studies are needed on how to facilitate the use of digital strategies for social network-based HIV testing, as well as how to integrate them with existing HIV testing approaches.
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Affiliation(s)
- Zhuoheng Yin
- Guangdong Second Provincial General Hospital, Guangzhou, China
- University of North Carolina Project China, Guangzhou, China
| | - Yumeng Du
- Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Weibin Cheng
- Guangdong Second Provincial General Hospital, Guangzhou, China
- Faculty of Health Sciences, City University of Macau, Macao, SAR, China
| | - Weiming Tang
- Guangdong Second Provincial General Hospital, Guangzhou, China.
- University of North Carolina Project China, Guangzhou, China.
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Ni Y, Lu Y, Jing F, Wang Q, Xie Y, He X, Wu D, Tan RKJ, Tucker JD, Yan X, Ong JJ, Zhang Q, Jiang H, Dai W, Huang L, Mei W, Zhou Y, Tang W. A Machine Learning Model for Identifying Sexual Health Influencers to Promote the Secondary Distribution of HIV Self-Testing Among Gay, Bisexual, and Other Men Who Have Sex With Men in China: Quasi-Experimental Study. JMIR Public Health Surveill 2024; 10:e50656. [PMID: 38656769 PMCID: PMC11079758 DOI: 10.2196/50656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/27/2023] [Accepted: 02/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Sexual health influencers (SHIs) are individuals actively sharing sexual health information with their peers, and they play an important role in promoting HIV care services, including the secondary distribution of HIV self-testing (SD-HIVST). Previous studies used a 6-item empirical leadership scale to identify SHIs. However, this approach may be biased as it does not consider individuals' social networks. OBJECTIVE This study used a quasi-experimental study design to evaluate how well a newly developed machine learning (ML) model identifies SHIs in promoting SD-HIVST compared to SHIs identified by a scale whose validity had been tested before. METHODS We recruited participants from BlueD, the largest social networking app for gay men in China. Based on their responses to the baseline survey, the ML model and scale were used to identify SHIs, respectively. This study consisted of 2 rounds, differing in the upper limit of the number of HIVST kits and peer-referral links that SHIs could order and distribute (first round ≤5 and second round ≤10). Consented SHIs could order multiple HIV self-testing (HIVST) kits and generate personalized peer-referral links through a web-based platform managed by a partnered gay-friendly community-based organization. SHIs were encouraged to share additional kits and peer-referral links with their social contacts (defined as "alters"). SHIs would receive US $3 incentives when their corresponding alters uploaded valid photographic testing results to the same platform. Our primary outcomes included (1) the number of alters who conducted HIVST in each group and (2) the number of newly tested alters who conducted HIVST in each. We used negative binomial regression to examine group differences during the first round (February-June 2021), the second round (June-November 2021), and the combined first and second rounds, respectively. RESULTS In January 2021, a total of 1828 men who have sex with men (MSM) completed the survey. Overall, 393 SHIs (scale=195 and ML model=198) agreed to participate in SD-HIVST. Among them, 229 SHIs (scale=116 and ML model=113) ordered HIVST on the web. Compared with the scale group, SHIs in the ML model group motivated more alters to conduct HIVST (mean difference [MD] 0.88, 95% CI 0.02-2.22; adjusted incidence risk ratio [aIRR] 1.77, 95% CI 1.07-2.95) when we combined the first and second rounds. Although the mean number of newly tested alters was slightly higher in the ML model group than in the scale group, the group difference was insignificant (MD 0.35, 95% CI -0.17 to -0.99; aIRR 1.49, 95% CI 0.74-3.02). CONCLUSIONS Among Chinese MSM, SHIs identified by the ML model can motivate more individuals to conduct HIVST than those identified by the scale. Future research can focus on how to adapt the ML model to encourage newly tested individuals to conduct HIVST. TRIAL REGISTRATION Chinese Clinical Trials Registry ChiCTR2000039632; https://www.chictr.org.cn/showprojEN.html?proj=63068. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12889-021-11817-2.
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Affiliation(s)
- Yuxin Ni
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Ying Lu
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Fengshi Jing
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
- Faculty of Data Science, City University of Macau, Macao SAR, China
| | - Qianyun Wang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Department of Social Welfare, University of California, Los Angeles, CA, United States
| | - Yewei Xie
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Health Service and System Research Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Xi He
- Zhuhai Xutong Voluntary Services Center, Zhuhai, China
| | - Dan Wu
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Rayner Kay Jin Tan
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Joseph D Tucker
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Xumeng Yan
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA, United States
| | - Jason J Ong
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Central Clinical School, Monash University, Melbourne, Australia
| | - Qingpeng Zhang
- Musketeers Foundation Institute of Data Science, The University of Hong Kong, Hong Kong, China (Hong Kong)
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Wencan Dai
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Liqun Huang
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Wenhua Mei
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Yi Zhou
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
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Jing F, Ye Y, Zhou Y, Ni Y, Yan X, Lu Y, Ong J, Tucker JD, Wu D, Xiong Y, Xu C, He X, Huang S, Li X, Jiang H, Wang C, Dai W, Huang L, Mei W, Cheng W, Zhang Q, Tang W. Identification of Key Influencers for Secondary Distribution of HIV Self-Testing Kits Among Chinese Men Who Have Sex With Men: Development of an Ensemble Machine Learning Approach. J Med Internet Res 2023; 25:e37719. [PMID: 37995110 PMCID: PMC10704319 DOI: 10.2196/37719] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 12/30/2022] [Accepted: 10/11/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND HIV self-testing (HIVST) has been rapidly scaled up and additional strategies further expand testing uptake. Secondary distribution involves people (defined as "indexes") applying for multiple kits and subsequently sharing them with people (defined as "alters") in their social networks. However, identifying key influencers is difficult. OBJECTIVE This study aimed to develop an innovative ensemble machine learning approach to identify key influencers among Chinese men who have sex with men (MSM) for secondary distribution of HIVST kits. METHODS We defined three types of key influencers: (1) key distributors who can distribute more kits, (2) key promoters who can contribute to finding first-time testing alters, and (3) key detectors who can help to find positive alters. Four machine learning models (logistic regression, support vector machine, decision tree, and random forest) were trained to identify key influencers. An ensemble learning algorithm was adopted to combine these 4 models. For comparison with our machine learning models, self-evaluated leadership scales were used as the human identification approach. Four metrics for performance evaluation, including accuracy, precision, recall, and F1-score, were used to evaluate the machine learning models and the human identification approach. Simulation experiments were carried out to validate our approach. RESULTS We included 309 indexes (our sample size) who were eligible and applied for multiple test kits; they distributed these kits to 269 alters. We compared the performance of the machine learning classification and ensemble learning models with that of the human identification approach based on leadership self-evaluated scales in terms of the 2 nearest cutoffs. Our approach outperformed human identification (based on the cutoff of the self-reported scales), exceeding by an average accuracy of 11.0%, could distribute 18.2% (95% CI 9.9%-26.5%) more kits, and find 13.6% (95% CI 1.9%-25.3%) more first-time testing alters and 12.0% (95% CI -14.7% to 38.7%) more positive-testing alters. Our approach could also increase the simulated intervention's efficiency by 17.7% (95% CI -3.5% to 38.8%) compared to that of human identification. CONCLUSIONS We built machine learning models to identify key influencers among Chinese MSM who were more likely to engage in secondary distribution of HIVST kits. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR) ChiCTR1900025433; https://www.chictr.org.cn/showproj.html?proj=42001.
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Affiliation(s)
- Fengshi Jing
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
- Faculty of Data Science, City University of Macau, Macao Special Administrative Region, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- School of Data Science, City University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yang Ye
- School of Data Science, City University of Hong Kong, Hong Kong Special Administrative Region, China
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Yi Zhou
- Department of HIV Prevention, Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Yuxin Ni
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- School of Public Health, Boston University, Boston, MA, United States
| | - Xumeng Yan
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
| | - Ying Lu
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Jason Ong
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Melbourne Sexual Health Centre, Melbourne, Australia
| | - Joseph D Tucker
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Dan Wu
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yuan Xiong
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- School of Social Work, Michigan State University, East Lansing, MI, United States
| | - Chen Xu
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Xi He
- Zhuhai Xutong Voluntary Services Center, Zhuhai, China
| | - Shanzi Huang
- Department of HIV Prevention, Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Xiaofeng Li
- Department of HIV Prevention, Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Wencan Dai
- Department of HIV Prevention, Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Liqun Huang
- Department of HIV Prevention, Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Wenhua Mei
- Department of HIV Prevention, Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Weibin Cheng
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
- School of Data Science, City University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Qingpeng Zhang
- Institute of Data Science and Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Weiming Tang
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Hu S, Jing F, Fan C, Dai Y, Xie Y, Zhou Y, Lv H, He X, Wu D, Tucker JD, Tang W. Social Network Strategies to Distribute HIV Self-testing Kits: A Global Systematic Review and Network Meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.05.23298135. [PMID: 37986939 PMCID: PMC10659482 DOI: 10.1101/2023.11.05.23298135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Introduction Social network strategies, in which social networks are utilized to influence individuals or communities, are increasingly being used to deliver human immunodeficiency virus (HIV) interventions to key populations. We summarized and critically assessed existing research on the effectiveness of social network strategies in promoting HIV self-testing (HIVST). Methods Using search terms related to social network interventions and HIVST, we searched five databases for trials published between January 1st, 2010, and June 30th, 2023. Outcomes included uptake of HIV testing, HIV seroconversion, and linkage to antiretroviral therapy (ART) or HIV Care. We used network meta-analysis to assess the uptake of HIV testing through social network strategies compared with control methods. A pairwise meta-analysis of studies with a comparison arm that reported outcomes was performed to assess relative risks (RR) and their corresponding 95% confidence intervals (CI). Results and discussion Among the 3,745 manuscripts identified, 33 studies fulfilled the inclusion criteria, including one quasi-experimental study, 17 RCTs and 15 observational studies. Networks HIVST testing was organized by peers (distributed to known peers, 15 studies), partners (distributed to their sexual partners, 10 studies), and peer educators (distributed to unknown peers, 8 studies). The results showed that all of the three social network distribution strategies enhanced the uptake of HIV testing compared to standard facility-based testing. Among social networks, peer distribution had the highest uptake of HIV testing (79% probability, SUCRA 0.92), followed by partner distribution (72% probability, SUCRA 0.71), and peer educator distribution (66% probability, SUCRA 0.29). Pairwise meta-analysis showed that peer distribution (RR 2.29, 95% CI 1.54-3.39, 5 studies) and partner distribution (RR 1.45, 95% CI 1.05-2.02, 7 studies) also increased the probability of detecting HIV reactivity during testing within the key population when compared to the control. Linkage to ART or HIV Care remained comparable to facility-based testing across the three HIVST distribution strategies. Conclusions Network-based HIVST distribution is considered effective in augmenting HIV testing rates and reaching marginalized populations compared to facility-based testing. These strategies can be integrated with the existing HIV care services, to fill the testing gap among key populations globally.PROSPERO Number: CRD42022361782.
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Affiliation(s)
- Siyue Hu
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- School of Public Health, Southern Medical University, Guangzhou, China
- University of North Carolina Project – China, Guangzhou, China
| | - Fengshi Jing
- Faculty of Data Science, City University of Macau, Taipa, Macao SAR, China
| | - Chengxin Fan
- University of North Carolina Project – China, Guangzhou, China
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yifan Dai
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- School of Public Health, Southern Medical University, Guangzhou, China
- University of North Carolina Project – China, Guangzhou, China
| | - Yewei Xie
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Yi Zhou
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Hang Lv
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Xi He
- Zhuhai Xutong Voluntary Services Center, Zhuhai, China
| | - Dan Wu
- University of North Carolina Project – China, Guangzhou, China
- School of Public Health, Nanjing Medical University, Nanjing, China
- London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph D. Tucker
- University of North Carolina Project – China, Guangzhou, China
- London School of Hygiene and Tropical Medicine, London, UK
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina Project – China, Guangzhou, China
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Li JS, Gu YZ, Hou FS, Lu YH, Fan XR, Qiu JL, Yang QL, Gu J, Li JH, Xu DR, Hao C. Delivery of WeChat-Based HIV Result e-Reports in Social Networks for Recruitment of High-Risk Population: Baseline Data From a Cluster Randomized Controlled Trial. J Med Internet Res 2023; 25:e46793. [PMID: 37318850 PMCID: PMC10337306 DOI: 10.2196/46793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/20/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Disclosure of infectious disease status to social network peers can facilitate reaching and early detection among high-risk populations. In this era of social media, globally, HIV/AIDS represents a high burden of infectious disease. Thus, delivery of an HIV result e-report via social media presents a new approach that has the potential to improve contact with and enrollment of the high-risk population in research studies and routine practice. OBJECTIVE This study explores the effectiveness and associated factors of a recruitment strategy (ie, WeChat-based HIV e-report delivery in social networks) on the enrollment of men who have sex with men (MSM) for an HIV testing intervention study. METHODS This was an enrollment result analysis of an ongoing cluster randomized controlled trial (RCT) aiming to promote HIV testing among MSM. Recruitment of potential participants was based on the unit of an egocentric social network, which includes 1 core member (an offline tested ego as the recruiter) and several network members (online alters as network associates). Alters' enrollment and alters' transformation to ego-recruiters (alter-ego) were measured as outcomes. Recruitment outcomes were compared between the exchangeable and regular e-report groups of the RCT. Associated factors of both outcomes were also investigated, including sociodemographic characteristics, health behaviors, social network characteristics, e-report types, and online delivery information. Binary outcomes were modeled using logistic models, with Firth correction for rare events. Qualitative interviews were conducted to understand facilitators and barriers in detail for alter-ego as the subsequent wave's recruiter. RESULTS The e-report of 1157 egos who tested offline were delivered to 5165 alters in 3 recruitment waves; eventually, 1162 eligible alters enrolled in this RCT (response rate: 22.5%). In the exchangeable e-report group, 544 egos recruited 467 alters, of which 35 alters transformed to alter-egos (7.5%), whereas in the regular e-report group, 613 egos recruited 695 alters, of which 40 alters transformed to alter-egos (5.8%). Alters' enrollment at first wave was associated with a higher number of e-reports being forwarded by the egos. Alters' transformation to alter-egos for the subsequent wave was associated with the exchangeable e-report, higher income, being a Guangzhou resident, unprotected anal intercourse, preferring self-testing, and viewing senders' e-reports frequently. Qualitative interviews revealed that the lack of awareness of e-reports' function and inadequate access to e-reports at offline testing facilities were major barriers to alters' transformation to offline ego-recruiters. CONCLUSIONS The delivery of e-report was feasible in MSM social network, and the success and sustainability of online recruitment depended on high levels of familiarity among MSM with the digital tool. The HIV e-report exchange mechanism might promote MSM to test HIV offline to get their own e-report for exchange in the community. The e-report provides an innovative recruitment method with great potential to trace direct contacts for infectious diseases studies.
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Affiliation(s)
- Ju-Shuang Li
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat-Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| | - Yu-Zhou Gu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Feng-Su Hou
- Sun Yat-Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, China
| | - Yong-Heng Lu
- Guangzhou Lingnan Community Support Center, Guangzhou, China
- Kangyuan Community Support Center of Yuexiu District, Guangzhou, China
| | - Xiao-Ru Fan
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat-Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| | - Jia-Ling Qiu
- Department of Public Health, Guangdong Women and Children Hospital, Guangzhou, China
| | - Qing-Ling Yang
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat-Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat-Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| | - Jing-Hua Li
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat-Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| | - Dong Roman Xu
- Center for World Health Organization Studies, School of Health Management, Southern Medical University, Guangzhou, China
- Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Research, Southern Medical University Institute for Global Health, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Chun Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat-Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
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7
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Hu S, Lu Y, He X, Zhou Y, Wu D, Tucker JD, Yang B, Tang W. Effectiveness of the secondary distribution of HIV self-testing with and without monetary incentives among men who have sex with men living with HIV in China: study protocol for a randomized controlled trial. BMC Infect Dis 2023; 23:160. [PMID: 36918824 PMCID: PMC10013267 DOI: 10.1186/s12879-023-08062-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/07/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The HIV epidemic is still expanding among men who have sex with men (MSM) in China, but HIV testing rates remain suboptimal. Network-based interventions, such as secondary distribution, have shown promise to expand HIV self-testing (HIVST) among partners of MSM living with HIV (MLWH) but have not been widely implemented. Monetary incentives could enhance the secondary distribution of HIVST in some settings. We will conduct a randomized controlled trial to examine the effectiveness of monetary incentives in expanding the secondary distribution of HIVST among MLWH in China. METHODS We will recruit 200 eligible participants at three antiretroviral therapy (ART) clinics in China. Participants are eligible if they are 18 years of age or over, assigned as male at birth, have had anal sex with men, are living with HIV, are willing to apply for the HIVST kit at ART clinics, and are willing to provide personal contact information for follow-up. Eligible participants will be randomly assigned in a 1:1 ratio to one of two groups: standard secondary distribution group and secondary distribution group with monetary incentives. Participants (defined as "index") will distribute the HIVST kits to members of their social network (defined as "alter") and will be required to complete a baseline survey and a 3-month follow-up survey. All alters will be encouraged to report their testing results by taking photos of used kits and completing an online survey. The primary study outcomes will compare the mean number of alters and newly-tested alters motivated by each index participant in each group. Secondary study outcomes will include the mean number of alters who tested positive, the cost per person tested, and the cost per HIV diagnosed for each group. DISCUSSION Few studies have evaluated interventions to enhance the implementation of secondary distribution. Our study will provide information on the effectiveness of monetary incentives in expanding HIVST secondary distribution among MLWH. The findings of this trial will contribute to implementing HIVST secondary distribution services among MLWH in China and facilitating HIV case identifications. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200064517; http://www.chictr.org.cn/showproj.aspx?proj=177896 . Registered on 10th October 2022.
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Affiliation(s)
- Siyue Hu
- School of Public Health, Southern Medical University, Guangzhou, China.,Dermatology Hospital of Southern Medical University, Guangzhou, China.,University of North Carolina Project - China, Guangzhou, China
| | - Ying Lu
- University of North Carolina Project - China, Guangzhou, China
| | - Xi He
- Zhuhai Xutong Voluntary Services Center, Zhuhai, China
| | - Yi Zhou
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Dan Wu
- University of North Carolina Project - China, Guangzhou, China.,London School of Hygiene and Tropical Medicine, London, UK.,West China School of Public Health, Sichuan University, Chengdu, China
| | - Joseph D Tucker
- University of North Carolina Project - China, Guangzhou, China.,London School of Hygiene and Tropical Medicine, London, UK
| | - Bin Yang
- School of Public Health, Southern Medical University, Guangzhou, China. .,Dermatology Hospital of Southern Medical University, Guangzhou, China.
| | - Weiming Tang
- School of Public Health, Southern Medical University, Guangzhou, China. .,Dermatology Hospital of Southern Medical University, Guangzhou, China. .,University of North Carolina Project - China, Guangzhou, China.
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Wang Y, Zhang W, Gong X, Ong JJ, Marks M, Zhao P, Tucker JD, Tang W, Wu D, Wang C. Optimizing Peer Distribution of Syphilis Self-Testing Among Men Who Have Sex with Men in China: A Multi-City Pragmatic Randomized Controlled Trial. ARCHIVES OF SEXUAL BEHAVIOR 2023:1-12. [PMID: 36626071 PMCID: PMC9831370 DOI: 10.1007/s10508-022-02507-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/01/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Syphilis testing uptake is low among men who have sex with men (MSM) around the world. Syphilis self-testing (SST) may complement facility-based testing; the distribution model is yet to be explored. This study aimed to investigate the effectiveness of peer distribution of syphilis self-testing on promoting syphilis testing. We conducted a three-arm, unblinded, parallel individually randomized controlled trial among MSM in three cities in Guangdong, China. Inclusion criteria were: men who were born biologically male, aged 18 or above, have ever had sex with a man, will refer the interventions to peers, and will take the three-month follow-up survey. Enrolled indexes were randomly assigned in a 1:1:1 ratio into standard-of-care arm (SOC arm), standard SST delivery arm (S-SST arm), and a web-based referral link SST delivery arm (RL-SST arm). The primary outcome was the number of returned photograph-verified syphilis testing results per index. A total number of 300 indexes were enrolled, with 100 indexes in each arm. The number of verified syphilis tests per index conducted by alters was 0.05 in the control arm, 0.51 in the S-SST arm, and 0.31 in the RL-SST arm. The cost per alter tested was $760.60 for SOC, $83.78 for S-SST, and $93.10 for RL-SST. Minimal adverse event was reported among both indexes and alters during the study. This study showed that peer distribution of SST could improve syphilis testing uptake among MSM in China compared to facility-based testing. This approach warrants further consideration as part of expanding syphilis self-testing.
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Affiliation(s)
- Yajie Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, 510091, China
- Southern Medical University Institute for Global Health, Guangzhou, Guangdong, China
- Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, Guangdong, China
| | - Wei Zhang
- University of North Carolina at Chapel Hill, Project-China, Guangzhou, Guangdong, China
| | - Xiao Gong
- Department of Biostatistics, Guangzhou Jeeyor Medical Research Co., Ltd, Guangzhou, Guangdong, China
| | - Jason J Ong
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Hospital for Tropical Diseases, London, UK
| | - Peizhen Zhao
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, 510091, China
- Southern Medical University Institute for Global Health, Guangzhou, Guangdong, China
- Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, Guangdong, China
| | - Joseph D Tucker
- University of North Carolina at Chapel Hill, Project-China, Guangzhou, Guangdong, China
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, 510091, China
- University of North Carolina at Chapel Hill, Project-China, Guangzhou, Guangdong, China
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dan Wu
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, 510091, China.
- Southern Medical University Institute for Global Health, Guangzhou, Guangdong, China.
- Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, Guangdong, China.
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Xiu X, Qin Y, Bao Y, Chen Y, Wu H, Huang X, Wang L. The Practice and Potential Role of HIV Self-testing in China: Systematic Review and Meta-analysis. JMIR Public Health Surveill 2022; 8:e41125. [PMID: 36459393 PMCID: PMC9758640 DOI: 10.2196/41125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/15/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND HIV self-testing (HIVST) is recommended by the World Health Organization as a valid approach to routine HIV testing services. The scale of HIVST use has gradually been expanded in China over the past 5 years. To take a closer look at the role of HIVST in China, we reviewed the promotion and application of HIVST within China. OBJECTIVE The main objective of this study was to systematically analyze the proportion of past use and actual uptake of HIVST within China. Moreover, we aimed to quantify the effect of HIVST on HIV prevention and treatment. METHODS In all, 5 medical databases and 2 registration systems, including PubMed, Web of Science, MEDLINE, WanFang, China National Knowledge Internet, ClinicalTrials.gov, and the Chinese Clinical Trial Registry were systematically searched for studies reporting the prevalence of HIVST use from January 1, 2010, to December 25, 2021. Meta-analyses of the pooled proportion estimates were carried out by the meta-package in R software (version 4.1.2). Statistical heterogeneity among the studies was estimated using Cochran Q test and the inconsistency index (I2). RESULTS A total of 50 studies were included in our systematic review. The estimated pooled prevalence of HIVST use in China was 29.9% (95% CI 22.5%-37.9%). Among individuals who have ever used HIVST, 47.5% (95% CI 37.2%-57.8%) were tested for HIV for the first time. The pooled reactive rate of HIVST was 4.2% (95% CI 3.1%-5.8%). When HIVST revealed a reactive result, 81.3% (95% CI 70.9%-91.6%) of individuals sought medical care. CONCLUSIONS In recent times, HIVST has become a valuable tool for HIV prevention in China. The widespread use of HIVST in non-men who have sex with men populations needs to be endorsed and promoted. The long-term applications of HIVST and the potential consequences of self-financing of HIVST in China have yet to be explored. TRIAL REGISTRATION PROSPERO CRD42022304846; https://tinyurl.com/54d9pxy8.
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Affiliation(s)
- Xiangfei Xiu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuanyuan Qin
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Yugang Bao
- AIDS Healthcare Foundation, Beijing, China
| | - Yaokai Chen
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Hao Wu
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiaojie Huang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Lu Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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