Crowdsourcing to expand HIV testing among men who have sex with men in China

A closed cohort stepped wedge cluster randomized controlled trial

Weiming Tang, Chongyi Wei, Bolin Cao, Dan Wu, Katherine T. Li, Haidong Lu, Wei Ma, Dianmin Kang, Haochu Li, Meizhen Liao, Katie R. Mollan, Michael G. Hudgens, Chuncheng Liu, Wenting Huang, Aifeng Liu, Ye Zhang, M. Kumi Smith, Kate M. Mitchell, Jason J. Ong, Hongyun Fu & 6 others Peter Vickerman, Ligang Yang, Cheng Wang, Heping Zheng, Bin Yang, Joseph D. Tucker

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: HIV testing rates are suboptimal among at-risk men. Crowdsourcing may be a useful tool for designing innovative, community-based HIV testing strategies to increase HIV testing. The purpose of this study was to use a stepped wedge cluster randomized controlled trial (RCT) to evaluate the effect of a crowdsourced HIV intervention on HIV testing uptake among men who have sex with men (MSM) in eight Chinese cities. Methods and findings: An HIV testing intervention was developed through a national image contest, a regional strategy designathon, and local message contests. The final intervention included a multimedia HIV testing campaign, an online HIV testing service, and local testing promotion campaigns tailored for MSM. This intervention was evaluated using a closed cohort stepped wedge cluster RCT in eight Chinese cities (Guangzhou, Shenzhen, Zhuhai, and Jiangmen in Guangdong province; Jinan, Qingdao, Yantai, and Jining in Shandong province) from August 2016 to August 2017. MSM were recruited through Blued, a social networking mobile application for MSM, from July 29 to August 21 of 2016. The primary outcome was self-reported HIV testing in the past 3 months. Secondary outcomes included HIV self-testing, facility-based HIV testing, condom use, and syphilis testing. Generalized linear mixed models (GLMMs) were used to analyze primary and secondary outcomes. We enrolled a total of 1,381 MSM. Most were ≤30 years old (82%), unmarried (86%), and had a college degree or higher (65%). The proportion of individuals receiving an HIV test during the intervention periods within a city was 8.9% (95% confidence interval [CI] 2.2–15.5) greater than during the control periods. In addition, the intention-to-treat analysis showed a higher probability of receiving an HIV test during the intervention periods as compared to the control periods (estimated risk ratio [RR] = 1.43, 95% CI 1.19–1.73). The intervention also increased HIV self-testing (RR = 1.89, 95% CI 1.50–2.38). There was no effect on facility-based HIV testing (RR = 1.00, 95% CI 0.79–1.26), condom use (RR = 1.00, 95% CI 0.86–1.17), or syphilis testing (RR = 0.92, 95% CI 0.70–1.21). A total of 48.6% (593/1,219) of participants reported that they received HIV self-testing. Among men who received two HIV tests, 32 individuals seroconverted during the 1-year study period. Study limitations include the use of self-reported HIV testing data among a subset of men and non-completion of the final survey by 23% of participants. Our study population was a young online group in urban China and the relevance of our findings to other populations will require further investigation. Conclusions: In this setting, crowdsourcing was effective for developing and strengthening community-based HIV testing services for MSM. Crowdsourced interventions may be an important tool for the scale-up of HIV testing services among MSM in low- and middle-income countries (LMIC). Trial registration: ClinicalTrials.gov NCT02796963.

Original languageEnglish
Article numbere1002645
Number of pages19
JournalPLoS Medicine
Volume15
Issue number8
DOIs
Publication statusPublished - 1 Aug 2018
Externally publishedYes

Cite this

Tang, Weiming ; Wei, Chongyi ; Cao, Bolin ; Wu, Dan ; Li, Katherine T. ; Lu, Haidong ; Ma, Wei ; Kang, Dianmin ; Li, Haochu ; Liao, Meizhen ; Mollan, Katie R. ; Hudgens, Michael G. ; Liu, Chuncheng ; Huang, Wenting ; Liu, Aifeng ; Zhang, Ye ; Smith, M. Kumi ; Mitchell, Kate M. ; Ong, Jason J. ; Fu, Hongyun ; Vickerman, Peter ; Yang, Ligang ; Wang, Cheng ; Zheng, Heping ; Yang, Bin ; Tucker, Joseph D. / Crowdsourcing to expand HIV testing among men who have sex with men in China : A closed cohort stepped wedge cluster randomized controlled trial. In: PLoS Medicine. 2018 ; Vol. 15, No. 8.
@article{221ed785d7ff404fa0e94331987b3e9f,
title = "Crowdsourcing to expand HIV testing among men who have sex with men in China: A closed cohort stepped wedge cluster randomized controlled trial",
abstract = "Background: HIV testing rates are suboptimal among at-risk men. Crowdsourcing may be a useful tool for designing innovative, community-based HIV testing strategies to increase HIV testing. The purpose of this study was to use a stepped wedge cluster randomized controlled trial (RCT) to evaluate the effect of a crowdsourced HIV intervention on HIV testing uptake among men who have sex with men (MSM) in eight Chinese cities. Methods and findings: An HIV testing intervention was developed through a national image contest, a regional strategy designathon, and local message contests. The final intervention included a multimedia HIV testing campaign, an online HIV testing service, and local testing promotion campaigns tailored for MSM. This intervention was evaluated using a closed cohort stepped wedge cluster RCT in eight Chinese cities (Guangzhou, Shenzhen, Zhuhai, and Jiangmen in Guangdong province; Jinan, Qingdao, Yantai, and Jining in Shandong province) from August 2016 to August 2017. MSM were recruited through Blued, a social networking mobile application for MSM, from July 29 to August 21 of 2016. The primary outcome was self-reported HIV testing in the past 3 months. Secondary outcomes included HIV self-testing, facility-based HIV testing, condom use, and syphilis testing. Generalized linear mixed models (GLMMs) were used to analyze primary and secondary outcomes. We enrolled a total of 1,381 MSM. Most were ≤30 years old (82{\%}), unmarried (86{\%}), and had a college degree or higher (65{\%}). The proportion of individuals receiving an HIV test during the intervention periods within a city was 8.9{\%} (95{\%} confidence interval [CI] 2.2–15.5) greater than during the control periods. In addition, the intention-to-treat analysis showed a higher probability of receiving an HIV test during the intervention periods as compared to the control periods (estimated risk ratio [RR] = 1.43, 95{\%} CI 1.19–1.73). The intervention also increased HIV self-testing (RR = 1.89, 95{\%} CI 1.50–2.38). There was no effect on facility-based HIV testing (RR = 1.00, 95{\%} CI 0.79–1.26), condom use (RR = 1.00, 95{\%} CI 0.86–1.17), or syphilis testing (RR = 0.92, 95{\%} CI 0.70–1.21). A total of 48.6{\%} (593/1,219) of participants reported that they received HIV self-testing. Among men who received two HIV tests, 32 individuals seroconverted during the 1-year study period. Study limitations include the use of self-reported HIV testing data among a subset of men and non-completion of the final survey by 23{\%} of participants. Our study population was a young online group in urban China and the relevance of our findings to other populations will require further investigation. Conclusions: In this setting, crowdsourcing was effective for developing and strengthening community-based HIV testing services for MSM. Crowdsourced interventions may be an important tool for the scale-up of HIV testing services among MSM in low- and middle-income countries (LMIC). Trial registration: ClinicalTrials.gov NCT02796963.",
author = "Weiming Tang and Chongyi Wei and Bolin Cao and Dan Wu and Li, {Katherine T.} and Haidong Lu and Wei Ma and Dianmin Kang and Haochu Li and Meizhen Liao and Mollan, {Katie R.} and Hudgens, {Michael G.} and Chuncheng Liu and Wenting Huang and Aifeng Liu and Ye Zhang and Smith, {M. Kumi} and Mitchell, {Kate M.} and Ong, {Jason J.} and Hongyun Fu and Peter Vickerman and Ligang Yang and Cheng Wang and Heping Zheng and Bin Yang and Tucker, {Joseph D.}",
year = "2018",
month = "8",
day = "1",
doi = "10.1371/journal.pmed.1002645",
language = "English",
volume = "15",
journal = "PLoS Medicine",
issn = "1549-1676",
publisher = "Public Library of Science",
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}

Tang, W, Wei, C, Cao, B, Wu, D, Li, KT, Lu, H, Ma, W, Kang, D, Li, H, Liao, M, Mollan, KR, Hudgens, MG, Liu, C, Huang, W, Liu, A, Zhang, Y, Smith, MK, Mitchell, KM, Ong, JJ, Fu, H, Vickerman, P, Yang, L, Wang, C, Zheng, H, Yang, B & Tucker, JD 2018, 'Crowdsourcing to expand HIV testing among men who have sex with men in China: A closed cohort stepped wedge cluster randomized controlled trial', PLoS Medicine, vol. 15, no. 8, e1002645. https://doi.org/10.1371/journal.pmed.1002645

Crowdsourcing to expand HIV testing among men who have sex with men in China : A closed cohort stepped wedge cluster randomized controlled trial. / Tang, Weiming; Wei, Chongyi; Cao, Bolin; Wu, Dan; Li, Katherine T.; Lu, Haidong; Ma, Wei; Kang, Dianmin; Li, Haochu; Liao, Meizhen; Mollan, Katie R.; Hudgens, Michael G.; Liu, Chuncheng; Huang, Wenting; Liu, Aifeng; Zhang, Ye; Smith, M. Kumi; Mitchell, Kate M.; Ong, Jason J.; Fu, Hongyun; Vickerman, Peter; Yang, Ligang; Wang, Cheng; Zheng, Heping; Yang, Bin; Tucker, Joseph D.

In: PLoS Medicine, Vol. 15, No. 8, e1002645, 01.08.2018.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Crowdsourcing to expand HIV testing among men who have sex with men in China

T2 - A closed cohort stepped wedge cluster randomized controlled trial

AU - Tang, Weiming

AU - Wei, Chongyi

AU - Cao, Bolin

AU - Wu, Dan

AU - Li, Katherine T.

AU - Lu, Haidong

AU - Ma, Wei

AU - Kang, Dianmin

AU - Li, Haochu

AU - Liao, Meizhen

AU - Mollan, Katie R.

AU - Hudgens, Michael G.

AU - Liu, Chuncheng

AU - Huang, Wenting

AU - Liu, Aifeng

AU - Zhang, Ye

AU - Smith, M. Kumi

AU - Mitchell, Kate M.

AU - Ong, Jason J.

AU - Fu, Hongyun

AU - Vickerman, Peter

AU - Yang, Ligang

AU - Wang, Cheng

AU - Zheng, Heping

AU - Yang, Bin

AU - Tucker, Joseph D.

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Background: HIV testing rates are suboptimal among at-risk men. Crowdsourcing may be a useful tool for designing innovative, community-based HIV testing strategies to increase HIV testing. The purpose of this study was to use a stepped wedge cluster randomized controlled trial (RCT) to evaluate the effect of a crowdsourced HIV intervention on HIV testing uptake among men who have sex with men (MSM) in eight Chinese cities. Methods and findings: An HIV testing intervention was developed through a national image contest, a regional strategy designathon, and local message contests. The final intervention included a multimedia HIV testing campaign, an online HIV testing service, and local testing promotion campaigns tailored for MSM. This intervention was evaluated using a closed cohort stepped wedge cluster RCT in eight Chinese cities (Guangzhou, Shenzhen, Zhuhai, and Jiangmen in Guangdong province; Jinan, Qingdao, Yantai, and Jining in Shandong province) from August 2016 to August 2017. MSM were recruited through Blued, a social networking mobile application for MSM, from July 29 to August 21 of 2016. The primary outcome was self-reported HIV testing in the past 3 months. Secondary outcomes included HIV self-testing, facility-based HIV testing, condom use, and syphilis testing. Generalized linear mixed models (GLMMs) were used to analyze primary and secondary outcomes. We enrolled a total of 1,381 MSM. Most were ≤30 years old (82%), unmarried (86%), and had a college degree or higher (65%). The proportion of individuals receiving an HIV test during the intervention periods within a city was 8.9% (95% confidence interval [CI] 2.2–15.5) greater than during the control periods. In addition, the intention-to-treat analysis showed a higher probability of receiving an HIV test during the intervention periods as compared to the control periods (estimated risk ratio [RR] = 1.43, 95% CI 1.19–1.73). The intervention also increased HIV self-testing (RR = 1.89, 95% CI 1.50–2.38). There was no effect on facility-based HIV testing (RR = 1.00, 95% CI 0.79–1.26), condom use (RR = 1.00, 95% CI 0.86–1.17), or syphilis testing (RR = 0.92, 95% CI 0.70–1.21). A total of 48.6% (593/1,219) of participants reported that they received HIV self-testing. Among men who received two HIV tests, 32 individuals seroconverted during the 1-year study period. Study limitations include the use of self-reported HIV testing data among a subset of men and non-completion of the final survey by 23% of participants. Our study population was a young online group in urban China and the relevance of our findings to other populations will require further investigation. Conclusions: In this setting, crowdsourcing was effective for developing and strengthening community-based HIV testing services for MSM. Crowdsourced interventions may be an important tool for the scale-up of HIV testing services among MSM in low- and middle-income countries (LMIC). Trial registration: ClinicalTrials.gov NCT02796963.

AB - Background: HIV testing rates are suboptimal among at-risk men. Crowdsourcing may be a useful tool for designing innovative, community-based HIV testing strategies to increase HIV testing. The purpose of this study was to use a stepped wedge cluster randomized controlled trial (RCT) to evaluate the effect of a crowdsourced HIV intervention on HIV testing uptake among men who have sex with men (MSM) in eight Chinese cities. Methods and findings: An HIV testing intervention was developed through a national image contest, a regional strategy designathon, and local message contests. The final intervention included a multimedia HIV testing campaign, an online HIV testing service, and local testing promotion campaigns tailored for MSM. This intervention was evaluated using a closed cohort stepped wedge cluster RCT in eight Chinese cities (Guangzhou, Shenzhen, Zhuhai, and Jiangmen in Guangdong province; Jinan, Qingdao, Yantai, and Jining in Shandong province) from August 2016 to August 2017. MSM were recruited through Blued, a social networking mobile application for MSM, from July 29 to August 21 of 2016. The primary outcome was self-reported HIV testing in the past 3 months. Secondary outcomes included HIV self-testing, facility-based HIV testing, condom use, and syphilis testing. Generalized linear mixed models (GLMMs) were used to analyze primary and secondary outcomes. We enrolled a total of 1,381 MSM. Most were ≤30 years old (82%), unmarried (86%), and had a college degree or higher (65%). The proportion of individuals receiving an HIV test during the intervention periods within a city was 8.9% (95% confidence interval [CI] 2.2–15.5) greater than during the control periods. In addition, the intention-to-treat analysis showed a higher probability of receiving an HIV test during the intervention periods as compared to the control periods (estimated risk ratio [RR] = 1.43, 95% CI 1.19–1.73). The intervention also increased HIV self-testing (RR = 1.89, 95% CI 1.50–2.38). There was no effect on facility-based HIV testing (RR = 1.00, 95% CI 0.79–1.26), condom use (RR = 1.00, 95% CI 0.86–1.17), or syphilis testing (RR = 0.92, 95% CI 0.70–1.21). A total of 48.6% (593/1,219) of participants reported that they received HIV self-testing. Among men who received two HIV tests, 32 individuals seroconverted during the 1-year study period. Study limitations include the use of self-reported HIV testing data among a subset of men and non-completion of the final survey by 23% of participants. Our study population was a young online group in urban China and the relevance of our findings to other populations will require further investigation. Conclusions: In this setting, crowdsourcing was effective for developing and strengthening community-based HIV testing services for MSM. Crowdsourced interventions may be an important tool for the scale-up of HIV testing services among MSM in low- and middle-income countries (LMIC). Trial registration: ClinicalTrials.gov NCT02796963.

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U2 - 10.1371/journal.pmed.1002645

DO - 10.1371/journal.pmed.1002645

M3 - Article

VL - 15

JO - PLoS Medicine

JF - PLoS Medicine

SN - 1549-1676

IS - 8

M1 - e1002645

ER -