Dataset Information

Empirical evidence of recruitment bias in a network study of people who inject drugs.

ABSTRACT: Background: Epidemiologic surveys of people who inject drugs (PWID) can be difficult to conduct because potential participants may fear exposure or legal repercussions. Respondent-driven sampling (RDS) is a procedure in which subjects recruit their eligible social contacts. The statistical validity of RDS surveys of PWID and other risk groups depends on subjects recruiting at random from among their network contacts. Objectives: We sought to develop and apply a rigorous definition and statistical tests for uniform network recruitment in an RDS survey. Methods: We undertook a detailed study of recruitment bias in a unique RDS study of PWID in Hartford, CT, the USA in which the network, individual-level covariates, and social link attributes were recorded. A total of n=527 participants (402 male, 123 female, and two individuals who did not specify their gender) within a network of 2626 PWID were recruited. Results: We found strong evidence of recruitment bias with respect to age, homelessness, and social relationship characteristics. In the discrete model, the estimated hazard ratios regarding the significant features of recruitment time and choice of recruitee were: alter's age 1.03 [1.02, 1.05], alter's crack-using status 0.70 [0.50, 1.00], homelessness difference 0.61 [0.43, 0.87], and sharing activities in drug preparation 2.82 [1.39, 5.72]. Under both the discrete and continuous-time recruitment regression models, we reject the null hypothesis of uniform recruitment. Conclusions: The results provide the evidence that for this study population of PWID, recruitment bias may significantly alter the sample composition, making results of RDS surveys less reliable. More broadly, RDS studies that fail to collect comprehensive network data may not be able to detect biased recruitment when it occurs.

SUBMITTER: Zeng L

PROVIDER: S-EPMC7680667 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Empirical evidence of recruitment bias in a network study of people who inject drugs.

Zeng Li L Li Jianghong J Crawford Forrest W FW

The American journal of drug and alcohol abuse 20190321 5

<b>Background</b>: Epidemiologic surveys of people who inject drugs (PWID) can be difficult to conduct because potential participants may fear exposure or legal repercussions. Respondent-driven sampling (RDS) is a procedure in which subjects recruit their eligible social contacts. The statistical validity of RDS surveys of PWID and other risk groups depends on subjects recruiting at random from among their network contacts. <b>Objectives</b>: We sought to develop and apply a rigorous definition ...[more]

PMID: 30896982

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Project description:BackgroundHepatitis C virus (HCV) treatment uptake among people who inject drugs (PWID), a population with disproportionately high rates of HCV, remains low. Peers have been shown to positively impact a broad range of health outcomes for PWID. There is, however, limited data on the impact of PWID social network members on HCV treatment.MethodsHCV-infected PWID enrolled in an ongoing community-based cohort were recruited as "indexes" to complete an egocentric social network survey. The survey elicited from the index PWID a list of their network members and the index's perception of network member characteristics. Logistic regression analyses were conducted to compare individual and network factors associated with HCV treatment in the index PWID.ResultsAmong 540 HCV-infected PWID, the mean age was 55.7 years and the majority were black (87.2%) and male (69.8%). PWID reported a mean of 4.4 (standard deviation [SD] 3.2) network members, most of whom were relatives (mean 2.2 [SD 1.5]). In multivariable analysis, increasing index age and HIV infection were positively associated with HCV treatment, while drug use and homelessness in the preceding 6 months were negatively associated with HCV treatment. From a network perspective, having at least one network member who regularly talked with the index about seeing their doctor for HIV care was associated with HCV treatment (Adjusted Odds Ratio [AOR] 2.7; 95% Confidence Interval (CI) [1.3, 5.6]). Conversely, PWID who had at least one network member who helped them understand their HCV care were less likely to have been HCV treated (AOR 0.2; CI [0.1, 0.6).ConclusionHCV treatment uptake in this group of PWID appeared to be positively influenced by discussions with network members living with HIV who were in care and negatively influenced by HCV information sharing within PWID networks. These findings underscore the influence of peers on health seeking behaviors of their network members and emphasizes the importance of well-informed peers.

Project description:IntroductionHIV testing programmes have struggled to reach the most marginalized populations at risk for HIV. Social network methods such as respondent-driven sampling (RDS) and peer-based active case-finding (ACF) may be effective in overcoming barriers to reaching these populations. We compared the client characteristics, proportion testing HIV positive (yield), and number of new cases found through two RDS strategies and an ACF approach to HIV case-finding among people who inject drugs (PWID) in Tajikistan.MethodsRoutine programme data from adult PWID recruited to testing under the HIV Flagship Project in Tajikistan were analysed to compare client demographic and clinical characteristics across the three approaches. We also compared the number of previously untested clients, the number of new HIV cases found, and the yield across the case-finding strategies, and evaluated predictors of new HIV diagnosis using fixed-effects logistic regression.ResultsFrom 24 October 2016 to 30 June 2017, Flagship tested 10,300 PWID for HIV, including 2143 under RDS with unrestricted waves (RDS1, yield: 1.5%), 3517 under restricted RDS (RDS2, yield: 2.6%), and 4640 under ACF (yield: 1.5%). Clients recruited under ACF were similar in age (35.8 vs. 36.8) and gender (91% vs. 90% male) to those recruited through RDS, though ACF clients were more likely to report being a first-time tester (85.1% vs. 68.3%, p < 0.001). After controlling for age, sex, previous testing history and accounting for clustering at the site level, we found that clients tested under both RDS1 (aOR: 1.74, 95% CI: 1.04 to 2.90) and RDS2 (aOR: 1.54, 95% CI: 1.11 to 2.15) had higher odds of testing newly positive for HIV relative to clients recruited through ACF. We did not find significant differences in the odds of new HIV infection between those recruited from RDS1 versus RDS2 (aOR: 1.12, 95% CI: 0.67 to 1.86).ConclusionsRDS-based interventions resulted in higher yields and overall case-finding, especially when recruitment was restricted. However, ACF identified a higher proportion of first-time testers. To find at least 90% of PWID living with HIV in Tajikistan, it may be necessary to implement multiple case-finding approaches concurrently to maximize testing coverage.

Dataset Information

Empirical evidence of recruitment bias in a network study of people who inject drugs.

Publications

Empirical evidence of recruitment bias in a network study of people who inject drugs.

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