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Where Science Meets Community: the Men of Asia Testing for HIV study HIV Prevention Conference 2005 Atlanta, GA Tri Do, MD, MPH University of California, San Francisco Center for AIDS Prevention Studies Positive Health Program, San Francisco General Hospital Disclosures No conflicts of interest No off label use of medical drugs or devices Funded by NIH T32 Training Grant and NIH RO1 HD 046354-01A1 Background Lack of sound national epidemiological data on API MSM and HIV infection risk, probable under reporting of prevalence Lack of awareness of HIV infection, late stage diagnosis, delayed HIV testing patterns, low return for results Evidence of rising HIV risk, prevalence Data influences policy and funding, and therefore service availability Need for increased HIV testing History of MATH • A lot of groundwork conducted by agencies, advocates, associations, researchers 1996 API HIV Research Summit 2000 API MSM survey collaboration to ensure data uniformity across agencies 2001 Idea for the MATH study conceptualized 2002 API SHARE Conference 2003 Proposal submitted to NICHD May 2004 Revised, resubmitted Jan, scored well, funded for September 2004 Specific Aims of MATH to estimate the prevalence and incidence of HIV infection among AAPI MSM; to describe the socio-cultural and individual-level factors related to HIV testing and knowledge of HIV infection status among AAPI MSM; to examine the socio-cultural and individual-level correlates of HIV risk among AAPI MSM; and to evaluate a consortium model framework for conducting scientific, community-based HIV research. Initial Study Design Enroll 2,400 API MSM in 6 metropolitan areas (SF, LA, NYC, Boston, Phil, Washington, D.C.) Over sample Chinese, Filipino, Japanese, Korean, Vietnamese men (400 each) + 400 “other” Account for differences between cities, age groups, recruitment sites, ethnicity, acculturation Implement the study in multiple languages (the first research attempt to do so) Initial Study Design, cont Venue/media-based recruitment, and reach difficult-to-reach persons through respondent-driven sampling technique Conduct rapid HIV testing using the OraQuick Rapid HIV-1 with confirmatory testing, CD4, VL, HIV clade Administer a behavioral survey instrument focusing on HIV testing behaviors, APIspecific cultural resiliency and factors, emerging issues (i.e. travel) Partnership with API ASOs and CHCs Capacity building with organizational assessment component Consortium model of research with evaluation of collaboration Assure quality of services, meet regulatory requirements Maintain high level of scientific standard Inclusion of issues important to communities within study variables and design (outreach, target populations) Milestones, events Funding cut 15% Baseline assessment of HIV testing, service, and research capacities Commitment from community partner agencies, consortium agreement Changes in community partners able to participate in the MATH study Execution of contracts Feb 2005 First meeting of consortium, MATH Face-to-Face (F2F) F2F: Community Concerns Deliverables – – – – Language and outreach capacities vary between agencies Flexibility around recruitment targets (e.g. by ethnicity) Costs of advertising, confirmatory testing Changing testing/research capacity with staffing Ethical issues related to RDS – Confidentiality – Incentives – Use of results (e.g. can clients learn BSI results?) Community Concerns – Clients served in various cities differed from Census data on ethnic breakdown – HIV testing service vs. research study – Literacy level, availability of audio survey – Homophobia in API communities, racism in gay community – Health care service utilization F2F: Scientific Concerns Will decreases in sample size adversely affect the confidence of conclusions drawn from the findings? Will changing the target ethnicities make the results less generalizable to API MSM in general? Will increasing the number of ethnic groups change statistical significance? Is the inclusion of “South Asian” as a group (vs. the more ‘monolithic’ ethnic groups) valid? Current study design 2,000 API MSM in 5 metropolitan areas Over sampling of Chinese, Filipino, Japanese, South Asian, Vietnamese. Languages will only include Chinese, Vietnamese, English Use of OraQuick Advance with blood-based confirmatory and other HIV-related tests, with storage of specimens Ongoing capacity and target assessment Lessons to date Costs of translation, technical difficulties Expectations of funders Changes in staffing patterns at agencies Slow pace of scientific research Changes that occurred to the study design were a result of the collaborative process, and the scientific integrity of the study was maintained Extra effort on collab. created good will, buy-in What is the alternative recruitment options? (e.g. investigator hires staff to recruit in each city) How does the present study differ from HIV testing services already provide by agencies? Acknowledgements API HIV/AIDS Advocates Our Community Partners: Funders: AIDS Services in Asian Communities (Philadelphia) – Office of Minority Health – National Institutes of Health, NICHD MATH team: Vince Crisostomo, Frank Wong, PhD, Martha Lee, PHD, Jordana De Leon, MPH, Royce Park, MPH, Joseph Truong, Dee Reinertson, Susan Eisenberg MATH Consortium Convener: Asian and Pacific Islander American Health Forum – ManChui Leung Scientific Partners: John Chin, Willi McFarland, Kyung-Hee Choi Asian Americans for Community Involvement (Santa Clara) Asian Health Services (Oakland) Asian Pacific AIDS Intervention Team (Los Angeles) Asian & Pacific Islander Coalition on HIV/AIDS (New York City) Asian & Pacific Islander Wellness Center (San Francisco) Massachusetts Asians & Pacific Islanders for Health (Boston)