© 2013 Denver Health

Evaluation of the National HIV Behavioral Surveillance System Among Men Who Have Sex With Men in Denver, ColoradoKathryn DeYoung, MS1, Arthur Davidson, MD, MS1, Alia Al-Tayyib PhD1

1Denver Public Health, Denver, USA

Results Conclusions

Contact Information: For more information or for additional copies of this abstract, please contact Kathryn DeYoung at kathryn.deyoung@dhha.org

Background

Methods

ObjectiveObjective

Men who have sex with men (MSM) account for the majority of new HIV diagnoses in Denver.

The National HIV Behavioral Surveillance System (NHBS) is a 20-site cyclical survey of those at increased HIV risk. Men who have sex with men (MSM) are surveyed every three years.

MSM cycles utilize a time-space venue-based sampling approach, recruiting at bars, restaurants, and other venues with a high ratio of MSM attendees.

NHBS has not been previously evaluated in Denver.

To evaluate implementation of the MSM1, MSM2, and MSM3 cycles of NHBS in Denver, conducted in 2005, 2008, and 2011, respectively.

CDC guidelines for evaluating public health surveillance systems include these attributes: Acceptability, flexibility, simplicity (qualitative)Data quality, representativeness, system sensitivity (quantitative)

Acceptability, flexibility, simplicity, and data quality: Assessed through local stakeholder input, reviews of protocols, local formative research, & process indicators

Representativeness and system sensitivity to trends:Comparison of responses to demographic and HIV testing history questions among Denver NHBS-MSM participants with comparable samples from local sources

Denver data sources:NHBS MSM cycles: 2005, 2008, 2011Denver Public Health records from STD clinic patients and outreach HIV testing (census, not sample)

Included patients who would have been eligible to participate in NHBS-MSM cycles (2005, 2008, 2011)

Demographic characteristics and HIV testing history among Denver MSM by data source

NHBS n(%)

STD Clinic n(%)

Outreach2 n(%)

Total 1919 3560 1794

Race / Ethnicity American Indian 24 (1) 16 (0) 19 (1)

Black 126 (7) 247 (7) 105 (6) Hispanic 454 (24) 845 (24) 346 (19)

Other / Mixed race 124 (7) 180 (5) 136 (8) White 1172 (62) 2272 (64) 1188 (66)

Age 18 – 24 261 (14) 861 (24) 318 (18) 25 – 29 292 (15) 742 (21) 295 (16) 30 – 39 579 (30) 958 (27) 430 (24)

40– 49 487 (25) 634 (18) 397 (22) >50 300 (16) 365 (10) 354 (20)

Mean Years Since Latest HIV Test4

(95%CI)2.27

(2.08-2.45)1.77

(1.57-1.98)1.52

(1.30-1.75)Last Known HIV Status3

Negative 1505 (83) 960 (88) 911 (94) Positive 281 (16) 102 (9) 47 (5)

Indeterminate/Unknown 25 (1) 32 (3) 8 (1)New HIV Diagnosis4,5 34 (3) 37 (4) 23 (2)

Representativeness: GoodSite works to represent African Americans and Hispanics

Inclusion of younger MSM increasing but hindered by venue options

Concern: representation of internet-based MSM population

Data quality: GoodQuality as high as self-report data collection method permitsMaintained by interviewer-guided data collection

Acceptability: GoodParticipants: In MSM2 and MSM3, 100% of eligible recruits interviewed; 84-92% accepted HIV testingVenue owners: Participating owners enthusiastic; non-participating owners concerned about client impactNHBS staff: Satisfied with venue selection, recruitment methods, and data security

Simplicity: LowThe cyclical nature of NHBS does not allow adequate time or funding for local analysis, interpretation, dissemination of resultsData management issues

101 errors corrected in MSM2, 298 corrected in MSM3 Quality and timeliness of final datasets from CDC improved

after transition to data management by DCC (MSM3)

This study was supported in part by an appointment to the Applied Epidemiology Fellowship Program administered by the Council of State and Territorial Epidemiologists (CSTE) and funded by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement Number 5U38HM000414-5.

LimitationsThere is no comparable population-based sample of MSM with which to compare NHBS.

RecommendationsLocal implementation of NHBS has good representativeness, sensitivity, acceptability. These could be improved by continuing efforts to include underrepresented groups and by meeting with venue owners before events to improve buy-in.

System complexity reduces local usefulness. Possible solutions include acquisition of cleaned data and code from CDC; funding of additional resources for data analysis and communication of results; and production of a local operations manual to document changes in NHBS methods over time and other factors to be considered in interpretation of data.

Median age by NHBS venue Top locations where NHBS respondent met last male sex partner (by cycle)