Background The overall goal of this ASTDA award was to adapt and evaluate Respondent-Driven Sampling (RDS) to enhance Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (GC) screening activities. Specifically, the aims were to develop and evaluate a programmatic approach using RDS as a method to prospectively screen for Ct/GC in networks of infected persons, to compare the prevalence of Ct/GC infections detected via current venue-based screening activities to the prevalence of infection detected using RDS as a referral mechanism, and to determine and compare the cost per infection detected via current screening activities to the cost per infection using RDS.
Methods Using two components of RDS, the systematic referral scheme and the dual incentive structure, we developed a program to refer social and sexual contacts for Ct/GC screening. Initial seed participants ages 15–24 were identified and asked to recruit their peers for screening, who in turn recruited their peers, and so on. Persons received incentive for their own participation ($10) in addition to incentive for participation of those they refer ($10). Participants could refer up to 5 social and sexual contacts. Participants provided a urine specimen for Ct/GC screening and completed a brief survey questionnaire.
Results Between December 2008 and March 2010, 66 initial seeds were recruited. Of the 66 seeds, 17 (25%) were successful in recruiting referrals. A total of 439 referrals were recruited, resulting in 7 networks initiated from an infected seed and 10 networks from a non-infected seed. The majority of referrals, 372 (85%), belonged to a single network (Abstract S14.4 figure 1). The remaining 67 referrals belonged to 16 networks ranging in size from 2 to 18 members. Across all networks, 67% of referrals were male and 33% were female. The overall prevalence of infection was 5.7% for Ct and 6.9% for GC among the referrals. This is compared to a prevalence of 12.2% for Ct and 1.5% for GC detected through venue-based screening in the same age demographic.
Conclusions With the exception of one large network, RDS was not a particularly efficient way to screen for Ct/GC. Only one-fourth of those initially recruited by research staff in turn referred their social and sexual contacts. While social network testing has been adopted in the HIV testing realm, in the Ct/GC screening realm a focus on messages encouraging those who are tested to get their friends tested may have the greatest public health impact.
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