Dr. Weiming Tang, Dermatology Hospital of Southern Medical University

Introduction

In China, the transmission of HIV (Human Immunodeficiency Virus) primarily occurs through sexual transmission. [1] Partner notification services help those who are HIV-positive inform their sexual partners of their infection status and guide these partners to undergo HIV testing. [2] Thus, it is crucial for identifying newly infected individuals and preventing further HIV transmission. [3] Currently, the partner notification rate among key populations in China (e.g., men who have sex with men) is low. [4] To increase the acceptance of partner notification services (HIV PS) among men who have sex with men living with HIV (MLWH), the Dermatology Hospital of Southern Medical University collaborated with the China Program Office of the University of North Carolina to establish the Saith Project. This initiative aims to develop a crowdsourced intervention scheme through a series of crowdsourcing competitions in partnership with community organizations.

Crowdsourcing is a strategy that involves broad community participation by pooling individual wisdom and resources to address specific societal issues. [5] In this project, crowdsourcing contests were used to develop partner notification services specifically tailored for men who have sex with men. From July 23-26, 2023, the 12th International AIDS Society HIV Science Conference (IAS 2023) was held in Australia. At the conference, Dr. Weiming Tang’s team from the Dermatology Hospital of Southern Medical University reported the latest developments of the Saith Project (abstract number: EPC0470). They summarized the acceptability, feasibility, and preliminary effectiveness of the crowdsourced interventions. The findings provide a scientific basis for enhancing the acceptance of HIV partner notification services among MLWH, exploring effective interventions in the field of AIDS prevention and control.

This study conducted a pilot randomized controlled trial with an intervention-to-control ratio of 2:1. It compared the partner notification status of newly identified MLWH and their partners’ HIV testing situations. The control group received traditional HIV partner notification services, where referral cards were distributed. The infected individuals would hand over these cards to their partners and accompany them to an HIV clinic for testing. In contrast, the intervention group received crowdsourced HIV partner notification services, integrating strategies like distributing HIV self-test kits for fixed partners, digital intervention materials based on WeChat, and anonymous medical personnel notification along with contractual notification support services.

The main research outcomes focus on three aspects:

1. Feasibility

– This includes the feasibility of the study (recruitment capabilities for newly diagnosed MLWH within 12 months and a 3-month follow-up rate for the enrolled cases) and the feasibility of the intervention (frequency of materials or services usage through crowdsourcing). This evaluation aims to understand the realistic implementation challenges, which will help identify potential challenges and guide intervention optimization.

2. Acceptability

– Measured using a five-point Likert scale to assess the crowdsourced materials, this determines the willingness and feelings of the participants about using the intervention.

3. Preliminary effectiveness

– The proportion of sexual partners tested for HIV within three months after enrollment. This key metric evaluates the actual effect of the crowdsourced intervention to determine its initial positive results.

Between July 2021 and May 2022, HIV clinics in Guangzhou and Zhuhai recruited a total of 121 newly diagnosed MLWH, with 81 in the intervention group and 40 in the control group. The average age of participants was 30.2 years (SD: 9.24), with 75% identifying as homosexual. The 3-month follow-up rates for the intervention and control groups were 93% (75/81) and 83% (33/40), respectively. In the crowdsourced intervention group, all participants received digital intervention materials based on WeChat with an average access of 2.3 times. 31 received HIV self-test kits for redistribution, 23 of whom successfully passed them to their partners. Six participants used the medical personnel notification service, contacting a total of nine partners. Therefore, the study and intervention scheme are generally feasible. The intervention also demonstrated acceptability with material users rating the HIV self-test kit distribution at 4.4 out of 5 and the digital intervention materials at 4.1 out of 5. Among all partners, 38% (65/171) in the intervention group and 27% (24/89) in the control group underwent HIV testing—a marginally significant difference of 11% (95% CI = [-2%, 24%]). Among fixed male partners, the difference in the proportion of partners tested for HIV was 9% (68% vs. 59%, 95% CI = [-17%, 34%]). Among casual male partners, the difference was 12% (22% vs. 10%, 95% CI = [-1%, 24%]).

Based on the study results, crowdsourced HIV partner notification services have good acceptability among the MLWH population in China. Crowdsourcing’s strength lies in its ability to engage the end-users of partner notification services, allowing them to participate heavily in intervention development based on their needs. This community participation is crucial for improving service acceptance and utilization rates among the MLWH population. Furthermore, the feasibility of the crowdsourced intervention scheme was verified in this study. By leveraging existing social networks and digital platforms, as well as providing notification services tailored to different partner types, the intervention considers the needs of MLWH and their partners, reducing the burden of notification and making HIV testing more convenient for partners. Lastly, the crowdsourced service shows a positive improvement in the proportion of partners undergoing HIV testing, especially among casual male partners. However, the increase is only marginally significant, possibly due to the small sample size, suggesting further randomized controlled trials with larger samples are needed. The notification and testing rates for casual partners remain relatively low, implying that future partner notification services need further optimization to better cover this population.

Summary

In summary, crowdsourced HIV partner notification services show potential for acceptability, feasibility, and increasing partner HIV testing rates among MLWH in China. This study offers preliminary empirical evidence on how to expand the coverage of HIV partner notification services among key populations in low- and middle-income countries through crowdsourced interventions.

References

[1] Wu Zunyou. New characteristics of sexual transmission of AIDS in China and the challenges faced in prevention and treatment. Chinese Journal of Epidemiology, 2018.

[2] World Health Organization. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. 2021

[3] Hogben, M., McNally, T., McPheeters, M., Hutchinson, A.B. and Task Force on Community Preventive Services, 2007. The effectiveness of HIV partner counseling and referral services in increasing identification of HIV-positive individuals: a systematic review. American journal of preventive medicine, 33(2), pp.S89-S100.

[4] Wang, Alberta L., Rui-Rui Peng, Joseph D. Tucker, Myron S. Cohen, and Xiang-Sheng Chen. “Partner notification uptake for sexually transmitted infections in China: a systematic literature review.” Sexually transmitted infections 88, no. 5 (2012): 386-393.

[5] World Health Organization, and UNICEF. Crowdsourcing in health and health research: a practical guide. No. TDR/STRA/18.4. World Health Organization, 2018.