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Men who have sex with men and transgender women are hard-to-reach populations for research. Social media-based tools may overcome certain barriers in accessing these groups and are being tested in an ongoing study exploring HIV home-test kit use to reduce risk behavior.
White-Hispanics and African-Americans were more likely to be recruited through personal contacts; community events successfully reached Hispanic volunteers.
Incorporating recruitment queries into pre-screening forms can help modify recruitment strategies for greater efficacy and efficiency. Findings suggest that recruitment strategies need to be tailored to reach specific target populations. Similarly, although 0.
Recruitment of these populations for ongoing research into prevention modalities is time-consuming and costly, in part due to persistent stigma and discrimination 148 — The use of social media and internet venues in research studies offer a unique opportunity to reach and involve these underrepresented populations in research. For example, social media and smartphone apps have been reported as effective recruitment tools for health-related research and may have benefits over traditional recruitment strategies e.
Compared to online recruitment, enrolling a single MSM in a randomized controlled trial via field-based recruitment strategies could require an additional 2.
Internet recruitment methods have also been demonstrated to be effective for recruiting transgender individuals into research studies Arayasirikul et al. Martinez et al.
Using an online pre-screening eligibility survey, Grov et al. Such success can be attributed to increase in access and use of online tools.
MSM were early adopters of using the internet to meet sexual partners 25 In a qualitative study to understand social media use and how it related to HIV risk behaviors among urban youth Black and Latino gay and bisexual men and TGW, all used social media e. This rise in social media has also led to the creation of multiple platforms for MSM to find sexual partners; many of these are geo-social networking GSN platforms that use location to enable connections among people in close proximity.
Evidence suggests that MSM who seek sexual partners using social media tools are more likely to have diagnoses of sexually transmitted infections STIsa greater of sexual partners, a greater of sexual partners known to be HIV-positive, and more frequent unprotected anal intercourse UAI In addition, time spent seeking a sexual partner online has been shown to correlate with an increase in the odds of having UAI In a systematic review that included MSM and TGW social networking app users, there were substantial ranges in the prevalence of unprotected sex, of partners, and prevalence of HIV Other researchers found that transgender and older participants were less likely to use websites or apps compared to other participants Therefore, using these apps for research recruitment has the potential to reach high-risk and potentially underrepresented populations but may be less successful for recruiting transgender individuals.
We analyzed recruitment strategies seeking HIV-negative MSM and TGW for a randomized controlled trial for efficiency in 1 reaching eligible participants, 2 finding participants who would make and attend an enrollment appointment, and 3 determining relative time investments per successful recruitment. Recruitment commenced late March and continues through with a planned target of participants. To prospectively evaluate recruitment strategies, questions were incorporated into a pre-screening form to assess how potential participants learned about the study and what led them to inquire about it.
Recruiters tracked recruitment methods and noted challenges and successes in weekly team meetings.
This paper reports on the findings to achieve approximately the first half of planned enrollment. All those approached were pre-screened in person or by telephone and asked how they learned about the study and what led them to seek more information about it.
They could respond to a list of options or specify other motivations not included on the form. All participant inquiries were recorded in a database. They reported having multiple sexual partners, never or seldom using a condom, at least 3 episodes of unprotected receptive anal intercourse, and having intercourse at least three times per month on average in the past three months with a serostatus-unknown or HIV-positive partner.
Eligibility was confirmed at the initial, in-person study appointment Visit 1. For in-person recruitment, staff solicited phone s from interested individuals at one-time events or community organizations and contacted them for pre-screening. Those contacted via Craigslist or Facebook could call recruitment staff directly while those using dating apps received IRB-approved messages about the study and, if interested, received or exchanged contact information.
Those eligible on pre-screening were invited to complete an in-person eligibility questionnaire at our research office Visit 1 using a computer-assisted self-interview CASIwhich asked for detailed information about sexual risk behavior and willingness to test sexual partners for HIV. The purpose of the two-part eligibility screening was to ensure that the study truly reached a population with a high HIV risk profile. Individuals who passed the second eligibility screening were invited to return in the near future to be randomized into either the intervention or control group.
The recruiting team was comprised of 5 part-time staff members at the NYC site and 1 primary recruiter and 2 secondary recruiters at the San Juan, Puerto Rico study site.
Other team members participated in one-time recruitment events. In San Juan all team members were bilingual and native Puerto Rican. In-person strategies in NYC and San Juan included single events, referrals, distribution of flyers and palm cards, and information tables.
Word-of-mouth referrals were considered an in-person recruitment strategy and included family, friends, other participants, and recruiters from a separate study. In San Juan, prior study registries were used to contact potential participants; this was categorized as a type of referral.
The San Juan team also had access to radio announcements and newspaper coverage and used printed palm cards at in-person events and for pick-up at other recruitment sites. Social media-based strategies included: Craigslist posts and responses, a Facebook for the study which was frequently updated and contained links to further study information and a Twitter link, and apps.
The recruitment team maintained field notes, and recruitment strategies were logged in weekly team meeting minutes. Scripts for social media interactions were developed and approved by the IRBs. These could be copied and pasted easily and sent to potential participants.
Our recruitment protocol was similar to that developed and applied successfully by Martinez et al. We compared each recruitment strategy based on the total of individuals pre-screened according to their eligibility.
Recruitment strategies were ranked in terms of successfully recruited participants. We summarized recruitment team responses to questions and additional experiences to report advantages and challenges for each recruitment strategy.
Of the individuals pre-screened, were eligible, came in for Visit 1 and completed a demographic questionnaire, were determined eligible to enroll, and are currently enrolled in the study or have completed all procedures. Of those who attended Visit 1, 20 were ineligible due to testing HIV-positive, and an additional 25 were ineligible based on their responses to survey questions.
Four eligible participants dropped out before Visit 2. The study Facebook had likes since it was published. Recruitment at bars and clubs was more effective in San Juan 13 eligible participants versus 1 in NYC. Relatively high percentages of minority racial and ethnic groups were reached Table 2. Social media platforms were effective in recruiting participants of all races and ethnicities compared to other methods Figure 1.
Hispanic and African-American participants were effectively recruited through the referral method while Whites were not.
TGW participants were most likely to enter the study through referrals 8 of 18 enrollees Figure 3. Referrals included participants alerted to the study by active or formerly enrolled persons as well as collaborations with recruiters from other HIV studies with different inclusion criteria.
Additionally, the PR staff contacted individuals who had participated in research studies at their study site. Recruitment efforts were discussed weekly and strategies adjusted accordingly.
Recruitment occurred mostly Monday through Friday, but apps also were activated during evening hours and weekends to ers at times when greater s were active. The estimated range of time using social-media based tools was 20—30 hours per week while the estimated range of time using in-person strategies was 15—17 hours per week.
Different recruiters specialized in recruitment strategies. For example, one recruiter estimated spending 12 hours per week using social-media based strategies, while another estimated spending 5 hours per week using in-person strategies aimed at recruiting TGW. The San Juan recruitment team spent more time on traditional strategies as users have adopted social media tools there more slowly.
Recruiting hard-to-reach populations of racially and ethnically diverse MSM and TGW reporting high-risk sexual behaviors into research studies is imperative to derailing the current HIV trends and preventing further spread of the disease 14. Although each of our recruitment strategies was successful, social media-based strategies drew in the largest s of potential participants, except for the upper-age. On the other hand, word-of-mouth referrals reached the most high-risk, eligible participants. One-time events, such as tabling at Pride events, were the least effective and least efficient.
Participants who tested HIV positive at Visit 1 were not more likely to be recruited from certain venues. The high of individuals who reported being HIV negative at recruitment, but tested positive at Visit 1, may highlight our success at reaching high-risk populations.
Many online and app platforms include search filters e. Additionally, most platforms save message thre for considerable periods, which allowed recruiters to avoid repeated contacts that might agitate users. However, social media recruitment remains time consuming and labor intensive and offers no guarantees of success.
In addition, developing a rapport with potential participants is often difficult online. Although the study Facebook garnered high s of likes and views, it brought in only a single participant. While Craigslist was quite successful in recruiting participants, we encountered unique challenges with its use.
Posts on Craigslist are automatically prevented from being duplicated or re-posted within one week. Therefore, recruiters re-posted study-related content as often as possible. Similar to experiences in our study, Grov et al. Since Craigslist users do not create profiles and messages are sent to a randomly generated address, recruiters were unable to keep track of prior contacts with any one individual. Findings from our study suggest that the use of social media-based tools facilitated the recruitment of hard-to-reach and underrepresented populations by possibly reducing the stigma associated with traditional recruitment strategies.
High prevalence rates of stigma reported by high-risk populations has been well-documented 35 MSM have reported their preference for using the internet as a way to meet sexual partners compared to bars and clubs, attributing this preference to lower levels of stigma associated with anonymous encounters via the internet 37 It is possible that the greater levels of confidentiality provided by social-media based strategies increased the likelihood for individuals to our study.
Interested parties could pursue details of the study with recruiters via the web-based platforms prior to a telephone contact.
This may have encouraged individuals wary of disclosing stigmatized behaviors, such as condomless intercourse and multiple sex partners, and enabled recruiters to use their outreach hours more efficiently. Our findings are in line with similar studies in which social media-based methods of recruiting MSM were successful 2122 Similarly, Bolding et al.
Traditional in-person and referrals were still important recruitment strategies for our study. Referrals resulted in the highest percentage eligible at pre-screen. ZIP: 00918 00913 00911 00917 00915 00912 00926 00927 00924 00925 00923 00920 00921 00906 00907 00901 00909 00936 00969 00902 00908 00910 00919 00922 00928 00929 00930 00931 00935 00937 00939 00940 00955 00975