Completeness and Reliability of Location Data Collected on the Web: Assessing the Quality of Self-Reported Locations in an Internet Sample of Men Who Have Sex With Men

Longitudinal cohort of HIV-negative transgender women of colour in New York City: protocol for the TURNNT ('Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour') study

INTRODUCTION

In the USA, transgender women are among the most vulnerable to HIV. In particular, transgender women of colour face high rates of infection and low uptake of important HIV prevention tools, including pre-exposure prophylaxis (PrEP). This paper describes the design, sampling methods, data collection and analyses of the TURNNT ('Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour') study. In collaboration with communities of transgender women of colour, TURNNT aims to explore the complex social and environmental (ie, neighbourhood) structures that affect HIV prevention and other aspects of health in order to identify avenues for intervention.

METHODS AND ANALYSES

TURNNT is a prospective cohort study, which will recruit 300 transgender women of colour (150 Black/African American, 100 Latina and 50 Asian/Pacific Islander participants) in New York City. There will be three waves of data collection separated by 6 months. At each wave, participants will provide information on their relationships, social and sexual networks, and neighbourhoods. Global position system technology will be used to generate individual daily path areas in order to estimate neighbourhood-level exposures. Multivariate analyses will be conducted to assess cross-sectional and longitudinal, independent and synergistic associations of personal relationships (notably individual social capital), social and sexual networks, and neighbourhood factors (notably neighbourhood-level social cohesion) with PrEP uptake and discontinuation.

ETHICS AND DISSEMINATION

The TURNNT protocol was approved by the Columbia University Institutional Review Board (reference no. AAAS8164). This study will provide novel insights into the relationship, network and neighbourhood factors that influence HIV prevention behaviours among transgender women of colour and facilitate exploration of this population's health and well-being more broadly. Through community-based dissemination events and consultation with policy makers, this foundational work will be used to guide the development and implementation of future interventions with and for transgender women of colour.

Using Web-Based Pin-Drop Maps to Capture Activity Spaces Among Young Adults Who Use Drugs in Rural Areas: Cross-Sectional Survey

Background

Epicenters of harmful drug use are expanding to US rural areas, with rural young adults bearing a disproportionate burden. A large body of work suggests that place characteristics (eg, spatial access to health services) shape vulnerability to drug-related harms among urban residents. Research on the role of place characteristics in shaping these harms among rural residents is nascent, as are methods of gathering place-based data.

Objective

We (1) analyzed whether young rural adults who used drugs answered self-administered Web-based mapping items about locations where they engaged in risk behaviors and (2) determined the precision of mapped locations.

Methods

Eligible individuals had to report recently using opioids to get high; be aged between 18 and 35 years; and live in the 5-county rural Appalachian Kentucky study area. We used targeted outreach and peer-referral methods to recruit participants. The survey asked participants to drop a pin in interactive maps to mark where they completed the survey, and where they had slept most; used drugs most; and had sex most in the past 6 months. Precision was assessed by (1) determining whether mapped locations were within 100 m of a structure and (2) calculating the Euclidean distance between the pin-drop home location and the street address where participants reported sleeping most often. Measures of central tendency and dispersion were calculated for all variables; distributions of missingness for mapping items and for the Euclidean distance variable were explored across participant characteristics.

Results

Of the 151 participants, 88.7% (134/151) completed all mapping items, and ≥92.1% (>139/151) dropped a pin at each of the 4 locations queried. Missingness did not vary across most participant characteristics, except that lower percentages of full-time workers and peer-recruited participants mapped some locations. Two-thirds of the pin-drop sex and drug use locations were less than 100 m from a structure, as were 92.1% (139/151) of pin-drop home locations. The median distance between the pin-drop and street-address home locations was 2.0 miles (25th percentile=0.8 miles; 75th percentile=5.5 miles); distances were shorter for high-school graduates, staff-recruited participants, and participants reporting no technical difficulties completing the survey.

Conclusions

Missingness for mapping items was low and unlikely to introduce bias, given that it varied across few participant characteristics. Precision results were mixed. In a rural study area of 1378 square miles, most pin-drop home addresses were near a structure; it is unsurprising that fewer drug and sex locations were near structures because most participants reported engaging in these activities outside at times. The error in pin-drop home locations, however, might be too large for some purposes. We offer several recommendations to strengthen future research, including gathering metadata on the extent to which participants zoom in on each map and recruiting participants via trusted staff.

A Web-Based Study of HIV Prevention in the Era of Pre-Exposure Prophylaxis Among Vulnerable HIV-Negative Gay and Bisexual Men, Transmen, and Transwomen Who Have Sex With Men: Protocol for an Observational Cohort Study

Background

Gay, bisexual, and other men who have sex with men continue to bear a large burden of the HIV epidemic in the United States and are among the only populations with increasing incidence in recent years.

Objective

The Together 5000 (T5K) Study aimed to enroll a US-based, racially diverse sample of HIV-negative men, transmen, and transwomen who are not on pre-exposure prophylaxis (PrEP) into an observational cohort to inform the design, implementation, scale-up, and evaluation of HIV prevention programs.

Methods

We used internet-based strategies to enroll a large, racially diverse national sample of HIV-negative men, transmen, and transwomen aged 16 to 49 years at high risk of HIV acquisition via sexual networking apps. Study participants are contacted every 6 months (in between annual surveys) for a brief survey on HIV testing, HIV diagnosis, and PrEP use (ie, attempts to access, PrEP initiation, and PrEP discontinuation). Participants complete annual self-administered at-home HIV testing and Web-based surveys. Using baseline serologic data and self-reported HIV testing history, we reconstructed a cohort of persons who were HIV negative at 12 months before baseline to estimate HIV incidence leading up to cohort enrollment.

Results

The study sample included 8777 participants from all 50 US states, Puerto Rico, and Guam; 50.91% (4468/8777) were persons of color and 25.30% (2221/8777) were young individuals aged 16 to 24 years. Per eligibility criteria, all T5K participants reported having sex with >2 male partners in the 90 days before enrollment, self-reported not having been diagnosed with HIV, and were not actively taking PrEP. In addition, 79.39% (6968/8777) reported >2 insertive condomless anal sex (CAS) acts, 61.02% (5356/8777) reported >1 receptive CAS acts in the past 90 days. Furthermore, most (7525/8777, 85.74%) reported never having taken PrEP. In total, 70.25% (6166/8777) were sent a self-administered at-home HIV test kit and 82.29% (5074/6166) of those sent a kit returned a sample for testing. The HIV incidence rate during the 12-month period leading up to enrollment was estimated to be 2.41 (95% CI 2.02-2.90) per 100 person-years.

Conclusions

A large, national, and racially diverse fully Web-based cohort of HIV-negative men, transmen, and transwomen at high risk for HIV seroconversion has successfully been recruited into longitudinal follow-up. This cohort is at high risk for HIV acquisition and can provide important insights related to the real-world uptake, impact, and equity of HIV prevention interventions in the United States. Participants can be invited to participate in trials aimed at testing strategies to improve the uptake of and engagement in these interventions.

International Registered Report Identifier (IRRID)

RR1-10.2196/13715

Obtaining contextually relevant geographic data using Facebook recruitment in public health studies

INTRODUCTION

Online participant recruitment for public health research studies has increased dramatically in recent years, particularly as traditional recruitment strategies have waned in efficiency. The emergence of e-epidemiology offers possibilities for reaching understudied populations as well as conducting large-scale studies.

METHODS

We conducted a cross-sectional survey focused on self-reported neighborhood characteristics, perceived stress, and feasibility of obtaining work/residential addresses via online recruitment in St. Louis, Missouri, USA from February 2017 to December 2017. We report the process of using Facebook recruitment and demonstrate how this strategy can enhance collection of geospatial data to better understand context and spatial patterns of disease.

RESULTS

A total of 425 participants were recruited via Facebook advertisements. All participants reported their residential and work ZIP codes, though only 64.7% and 45.6% provided their complete residential and work street addresses, respectively. Those who reported their complete residential street addresses were more likely to be female (69.8% vs. 56.1% of males, χ² = 7.89, 1 df, p = 0.005), though no differences were observed by race, age, or employment status.

DISCUSSION

These findings indicate that valuable location data can be successfully collected via Facebook recruitment - data that could potentially include residential history or prospective follow-up time or be combined with other emerging technologies for geographic data in order to better understand the context and the effects of place on health outcomes.

CONCLUSIONS

Facebook recruitment may be an underutilized resource for obtaining accurate geospatial and contextually relevant health data and should be considered as a means for finding participants due to the cost-effectiveness, efficiency and flexibility of this recruitment approach.

Correlates of recent HIV infection among men who have sex with men recruited through the internet in Huzhou City, Eastern China

OBJECTIVE

To identify factors associated with recent HIV infection among men who have sex with men (MSM) in Huzhou City, Eastern China, who seek sexual partners via the internet.

METHODS

Adult members of Tencent QQ instant messaging software, who completed a face-to-face interview questionnaire and serological HIV testing at baseline, were enrolled into this prospective cohort study. Questionnaires and serological testing were also completed at 6 and 12 months. Cox proportional hazards was used for initial bivariate analyses of differences between participants with or without recent HIV infection, and for subsequent forward stepwise multiple regression of statistically significant variables.

RESULTS

Out of 415 baseline participants, 283 completed the 12-month follow-up (25 with recent HIV infection and 258 without; recent HIV infection rate, 8.20 per 100 person-years). Recent HIV infection was shown to be significantly associated with ≤ high school education (versus college/university), registered residence outside Huzhou City (versus within Huzhou City), having ≥ two male sexual partners, and syphilis infection.

CONCLUSIONS

Improving education levels, treating syphilis promptly, and reducing the number of male sexual partners may reduce HIV transmission among MSM in Eastern China.

The association between monetary and sexual delay discounting and risky sexual behavior in an online sample of men who have sex with men

Delay discounting is a measure of impulsivity that has been found to be associated with numerous health-related outcomes. To the extent that delay discounting is associated with sexual risk-taking, it might serve as a marker for HIV risk or as the basis for novel HIV prevention interventions. The goal of the current study was to examine the association between monetary and sexual delay discounting and condomless anal intercourse (CAI) in a cross-sectional sample of men who have sex with men. Based on previous findings, we examined whether these associations were age-dependent. Sexual, but not monetary, delay discounting was found to be associated with CAI in the past 12 months. These results suggest that delay discounting is associated with sexual risk-taking. More high risk sexual behaviors and their associations with delay discounting should be investigated in the future.

Activity spaces of men who have sex with men: An initial exploration of geographic variation in locations of routine, potential sexual risk, and prevention behaviors

Theory and research on HIV and among men who have sex with men (MSM) have long suggested the importance of non-residential locations in defining structural exposures. Despite this, most studies within these fields define place as a residential context, neglecting the potential influence of non-residential locations on HIV-related outcomes. The concept of activity spaces, defined as a set of locations to which an individual is routinely exposed, represents one theoretical basis for addressing this potential imbalance. Using a one-time online survey to collect demographic, behavioral, and spatial data from MSM, this paper describes activity spaces and examines correlates of this spatial variation. We used latent class analysis to identify categories of activity spaces using spatial data on home, routine, potential sexual risk, and HIV prevention locations. We then assessed individual and area-level covariates for their associations with these categories. Classes were distinguished by the degree of spatial variation in routine and prevention behaviors (which were the same within each class) and in sexual risk behaviors (i.e., sex locations and locations of meeting sex partners). Partner type (e.g. casual or main) represented a key correlate of the activity space. In this early examination of activity spaces in an online sample of MSM, patterns of spatial behavior represent further evidence of significant spatial variation in locations of routine, potential HIV sexual risk, and HIV prevention behaviors among MSM. Although prevention behaviors tend to have similar geographic variation as routine behaviors, locations where men engage in potentially high-risk behaviors may be more spatially focused for some MSM than for others.