J. Med. Internet Res. - Assessment of a new web-based sexual concurrency measurement tool for men who have sex with men.


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CKGROUND: Men who have sex with men (MSM) are the most affected risk group in the United States' human immunodeficiency virus (HIV) epidemic. Sexual concurrency, the overlapping of partnerships in time, accelerates HIV transmission in populations and has been documented at high levels among MSM. However, concurrency is challenging to measure empirically and variations in assessment techniques used (primarily the date overlap and direct question approaches) and the outcomes derived from them have led to heterogeneity and questionable validity of estimates among MSM and other populations.OBJECTIVE: The aim was to evaluate a novel Web-based and interactive partnership-timing module designed for measuring concurrency among MSM, and to compare outcomes measured by the partnership-timing module to those of typical approaches in an online study of MSM.METHODS: In an online study of MSM aged =18 years, we assessed concurrency by using the direct question method and by gathering the dates of first and last sex, with enhanced programming logic, for each reported partner in the previous 6 months. From these methods, we computed multiple concurrency cumulative prevalence outcomes: direct question, day resolution / date overlap, and month resolution / date overlap including both 1-month ties and excluding ties. We additionally computed variants of the UNAIDS point prevalence outcome. The partnership-timing module was also administered. It uses an interactive month resolution calendar to improve recall and follow-up questions to resolve temporal ambiguities, combines elements of the direct question and date overlap approaches. The agreement between the partnership-timing module and other concurrency outcomes was assessed with percent agreement, kappa statistic (), and matched odds ratios at the individual, dyad, and triad levels of analysis.RESULTS: Among 2737 MSM who completed the partnership section of the partnership-timing module, 41.07% (1124/2737) of individuals had concurrent partners in the previous 6 months. The partnership-timing module had the highest degree of agreement with the direct question. Agreement was lower with date overlap outcomes (agreement range 79%-81%, range .55-.59) and lowest with the UNAIDS outcome at 5 months before interview (65% agreement, =.14, 95% CI .12-.16). All agreements declined after excluding individuals with 1 sex partner (always classified as not engaging in concurrency), although the highest agreement was still observed with the direct question technique (81% agreement, =.59, 95% CI .55-.63). Similar patterns in agreement were observed with dyad- and triad-level outcomes.CONCLUSIONS: The partnership-timing module showed strong concurrency detection ability and agreement with previous measures. These levels of agreement were greater than others have reported among previous measures. The partnership-timing module may be well suited to quantifying concurrency among MSM at multiple levels of analysis.

Resumo Limpo

ckground men sex men msm affect risk group unit state human immunodefici virus hiv epidem sexual concurr overlap partnership time acceler hiv transmiss popul document high level among msm howev concurr challeng measur empir variat assess techniqu use primarili date overlap direct question approach outcom deriv led heterogen question valid estim among msm populationsobject aim evalu novel webbas interact partnershiptim modul design measur concurr among msm compar outcom measur partnershiptim modul typic approach onlin studi msmmethod onlin studi msm age year assess concurr use direct question method gather date first last sex enhanc program logic report partner previous month method comput multipl concurr cumul preval outcom direct question day resolut date overlap month resolut date overlap includ month tie exclud tie addit comput variant unaid point preval outcom partnershiptim modul also administ use interact month resolut calendar improv recal followup question resolv tempor ambigu combin element direct question date overlap approach agreement partnershiptim modul concurr outcom assess percent agreement kappa statist match odd ratio individu dyad triad level analysisresult among msm complet partnership section partnershiptim modul individu concurr partner previous month partnershiptim modul highest degre agreement direct question agreement lower date overlap outcom agreement rang rang lowest unaid outcom month interview agreement ci agreement declin exclud individu sex partner alway classifi engag concurr although highest agreement still observ direct question techniqu agreement ci similar pattern agreement observ dyad triadlevel outcomesconclus partnershiptim modul show strong concurr detect abil agreement previous measur level agreement greater other report among previous measur partnershiptim modul may well suit quantifi concurr among msm multipl level analysi

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