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Applying RDS to assess risk & protective factors and HIV related risk behaviors among young men who have sex with men (YMSM)

Dr. Myo Myo MonResearch Scientist

Department of Medical Research (LM)Ministry of Health, Myanmar

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Collaborative research project between

Department of Medical Research (Lower

Myanmar) and UNESCO

Funded by UNESCO

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Outline of presentation

• Background of the study• Preparation• Field data collection• Recruitment pattern• Challenges• Lessons learned

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Background of the study

Objectives

• To identify the risk & protective factors influencing YMSM in relation to HIV transmission at individual level, family, school & immediate environment

• To find out the association between risk & protective factors and HIV related risk behaviors

• To provide information for development of appropriate strategies and interventions for HIV prevention & control programs focusing on YMSM

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Background (cont.)

• Study areaTwo townships Yangon Monywa

• Sample size200 YMSM in each

township

Monywa

Yangon

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Eligibility criteria• Age 18 to 26 years• Men who have practiced male to male sexual

behavior and/or same sex attraction which fall under one of three sub-groupsApwint feminine type who dresses and acts

as femaleApone non-feminine type who are mostly

hidden Tha-nge musculine men who have sexual

relationship with either apwint, apone or female

Background (cont.)

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Research Methodology Training• About 30 Hours training (both theory &

group work) • Capacity building for MSM on research

methodology develop research proposal• Facilitate participation of MSM in research

studies related to them• Select 3 peer interviewers

Preparation

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Formative Research• Selection of seeds• Incentive amount and type

Cash or kind Primary & secondary

• Interview site• Opening hours and days

Preparation (cont.)

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Coupon Design• Two separable parts in different colors• Blue part for recruitment • Yellow part for payment (secondary

incentive)• Front side - coupon number, expired date,

interview site’s address with bus lines info, opening hours

• Back side - eligibility criteria and terms and conditions for payment

Preparation (cont.)

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Title of study

Coupon No.

Expiry date

Opening hours &

dateInterview

site address

Coupon (front)

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Coupon (back)

Eligibility criteria and terms & conditions

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Training of interview team• Interview team Investigator, 3 MSM, 3

research assistants from DMR• Half day training specific to current study• Training covered:

QuestionnaireRDS methodCoupon distribution and management

Preparation (cont.)

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• One coupon manager• One person managing

incentives• Four trained interviewers• Supervision by Principal

Investigator• Interview site at user-

friendly drop-in centers (PSI & MSI)

Field Data Collection

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Township-1 (Yangon)

• 7 seeds • 8 waves• Within one month• Two interview sites

Recruitment Pattern

Township-2 (Monywa)

• 4 seeds • 5 waves• Within two weeks• One interview site

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Recruitment graph of Township-1 (Yangon)

Some seeds are not successful

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Recruitment by type of MSM, Yangon

AponeApwintTha-nge

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Recruitment graph of Monywa

Short recruitment waves

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Recruitment by type of MSM, Monywa

AponeApwintTha-nge

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• Seed selectionAlthough we choose YMSM who have large

social networks, 3 seeds were not successful; needed to add more seeds

• Interview site selectionAlthough we chose drop-in centers

situated close to the downtown area, some MSM did not want to come as it was quite far from their place

Add another interview site for peri-urban areas

Challenges

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• Eligibility criteriaDifficult to recruit younger age group

Definition of some type of MSM (e.g: Tha-nge) should be set carefully

• Screening of right participantsImportant to ask some screening questions

before enrollment

Challenges (cont.)

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• Information on the couponDetailed explanation is needed although

full information was described on the coupon

Providing contact phone number is very important as many MSM would like to confirm the survey location

• Recruitment period and recruitment waveShort recruitment period shorter wavesLong recruitment period longer waves

Challenges (cont.)

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• Data management and analysis for RDSUnfamiliar with RDS specific softwarePossible errors in coupon numberingPossible duplication of coupon numbersChallenging data analysis

Challenges (cont.)

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Lessons learned• Importance of conducting formative

assessment• Enquiry of fairs and festivals (joined by all

MSM)• Need of adequate recruitment period• Importance of explaining eligibility criteria

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THANK YOU