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Respondent-driven sampling (RDS) is widely used to sample populations with higher risk of HIV infection for whom no sampling frames exist. However, few studies have been done to assess the consistency of RDS estimators in real world settings. We conducted an assessment study on the consistency of RDS estimators using data from the National HIV Behavioral Surveillance – People Who Inject Drugs surveys in Newark, New Jersey from 2005 to 2018. Population parameter estimates based on RDS-I, RDS-II, Gile's SS, and HCG were compared longitudinally and cross-sectionally. Population homophily statistics and differential recruitment statistics were estimated and compared. Convergence plots were used for RDS diagnosis. Sensitivity analyses were conducted on population size estimates and seeds biases. By comparing time-insensitive population parameters and population homophily statistics estimated by four RDS estimators, the study found that RDS-II and Gile's SS could provide longitudinally and cross-sectionally consistent estimates and population homophily statistics on gender and sexual orientation. Cross-sectional comparison of time-sensitive population parameter estimates also supported the consistency of RDS-II and Gile's SS. However, RDS-I and HCG did not perform well in those comparisons. In conclusion, RDS estimators may not address all inconsistencies, but RDS-II and Gile's SS are recommended to weight RDS samples given enough consistency was observed in them. [ABSTRACT FROM AUTHOR]

Abstract Background Poor sleep quality is a significant issue among people who inject drugs (PWID). This study aimed to evaluate sleep quality and associated factors among PWID in Iran. Methods Using respondent-driven sampling, 2,652 PWID (2,563 male) were recruited in 11 major cities in Iran between 2019 and 2020. The Pittsburgh Sleep Quality Index was utilized to measure sleep quality, and logistic regression was used to assess associations in RDSAnalyst, a software designed for respondent-driven sampling. Results The overall prevalence of poor sleep quality was 68.4% (68.3% among males and 70.2% among females). Married PWID had higher odds of poor sleep quality (Adjusted Odds Ratio (AOR): 1.41; 95% CI: 1.05, 1.91). Lack of access to sufficient food in the past 12 months was also associated with poor sleep quality (AOR: 1.73; 95% CI: 1.17, 2.57 for sometimes having no access, and AOR: 2.95; 95% CI: 1.93, 4.52 for always having no access compared to always having access). Additionally, good self-rated health was significantly associated with lower odds of poor sleep quality (AOR: 0.19; 95% CI: 0.11, 0.31). Conclusion Poor sleep quality is prevalent among PWID in Iran. It is recommended to mitigate the adverse effects of this issue and enhance the overall quality of life for PWID. Supportive interventions aimed at preventing and treating poor sleep quality, as well as improving overall health outcomes, are essential.

Background: Poor sleep quality is a significant issue among people who inject drugs (PWID). This study aimed to evaluate sleep quality and associated factors among PWID in Iran. Methods: Using respondent-driven sampling, 2,652 PWID (2,563 male) were recruited in 11 major cities in Iran between 2019 and 2020. The Pittsburgh Sleep Quality Index was utilized to measure sleep quality, and logistic regression was used to assess associations in RDSAnalyst, a software designed for respondent-driven sampling. Results: The overall prevalence of poor sleep quality was 68.4% (68.3% among males and 70.2% among females). Married PWID had higher odds of poor sleep quality (Adjusted Odds Ratio (AOR): 1.41; 95% CI: 1.05, 1.91). Lack of access to sufficient food in the past 12 months was also associated with poor sleep quality (AOR: 1.73; 95% CI: 1.17, 2.57 for sometimes having no access, and AOR: 2.95; 95% CI: 1.93, 4.52 for always having no access compared to always having access). Additionally, good self-rated health was significantly associated with lower odds of poor sleep quality (AOR: 0.19; 95% CI: 0.11, 0.31). Conclusion: Poor sleep quality is prevalent among PWID in Iran. It is recommended to mitigate the adverse effects of this issue and enhance the overall quality of life for PWID. Supportive interventions aimed at preventing and treating poor sleep quality, as well as improving overall health outcomes, are essential. [ABSTRACT FROM AUTHOR]

Purpose: We determined the size of the transgender population in Shiraz, Iran. Methods: In this cross-sectional study, the respondent-driven sampling technique was used by choosing eight seeds, three waves, and six coupons for each participant. The estimated population size was calculated by wisdom of the crowds, multiplier, and successive sampling–population size estimation (SS-PSE) methods. Pooling of results was done by an Anchored Multiplier calculator. Results: The mean age of participants (n=200) was 22.7±4 years, 197 (98.5%) were single, 86 (43%) were educated <12 years, 25 (12.5%) were not living with their families, and 52 (26%) were not financially supported by their parents. The transgender population was estimated by the wisdom of the crowds, multiplier, and SS-PSE methods to be 300 (95% confidence interval [CI]: 200–400), 677 (95% CI: 655–696), and 665 (95% CI: 624– 677), respectively. Their prevalence was found to be 0.017% (95% CI: 0.011–0.022%), 0.038% (95% CI: 0.036–0.039%), and 0.037% (95% CI: 0.034–0.038) using the same methods, respectively. Pooled results revealed that 22–37 per 100,000 general population were transgender individuals. Weighted estimation showed that trans men (56.6%) are more prevalent than trans women (43.4%), and only 17% of transgender people succeeded in gender reassignment. Conclusion: Transgender people should not be considered as marginalized groups of the community; they should be respected, heard, and valued. Establishing a standard and routine procedure for the collection of data on the status of transgender people and gender identity is necessary for policymaking and intervention programs. [ABSTRACT FROM AUTHOR]

Purpose: We aim to examine if respondent-driven sampling (RDS) is a feasible and efficient method to recruit Black and Latina/Hispanic transgender women into HIV research. Methods: As part of the National HIV Behavioral Surveillance Study among transgender women in New York City in 2019, RDS was implemented with a focus on recruiting Black and Latina/Hispanic transgender women. We identified factors independently associated with (1) peer recruitment and (2) presenting to the study with a photo coupon. Results: A total of 269 transgender women were enrolled, 94% of whom were Black or Latina/Hispanic. In terms of peer recruitment, 47% recruited at least one eligible peer. Compared with those who were aged 18–29 years, those aged 30–39 years (adjusted prevalence ratio [aPR]: 2.04; 95% confidence interval [CI]: 1.35–3.07) and those aged 50 years or older (aPR: 1.97; 95% CI: 1.32–2.94) were more likely to recruit an eligible peer. Peer recruitment was also associated with utilizing HIV prevention services in the past 12 months (aPR: 1.62; 95% CI: 1.18–2.23). We did not find any differences in presenting the study with a photo recruitment coupon versus a physical recruitment coupon. Conclusion: RDS was feasible and efficient in recruiting Black and Latina/Hispanic transgender women. Providing gender-affirming environments as well as allowing peer recruitment through photo coupons may have facilitated peer recruitment and study participation. Our findings regarding factors associated with peer recruitment could aid in future study design and may help in addressing the lack of HIV research among Black and Latina/Hispanic transgender women. [ABSTRACT FROM AUTHOR]

Respondent-driven sampling (RDS) is a potential strategy for addressing challenges in accurate estimation of abortion incidence, but it relies on often untested assumptions. We conducted an RDS study to estimate the cumulative lifetime incidence of abortion in Soweto, Johannesburg, South Africa (April-December 2018), to evaluate whether RDS assumptions were met, and to compare RDS estimates of incidence with estimates adjusted for employment and age based on census data. A total of 849 participants were recruited from 11 seed participants between April and December 2018. The assumption that individuals can identify target population members and the assumption of approximation of sampling with replacement was met. There were minor violations of the assumptions of seed independence from the final sample and reciprocity of ties. Assumptions of accurate degree reporting and random recruitment were not met. Failure to meet assumptions yielded a study sample with different employment characteristics than those of the target population; this could not be resolved by standard RDS methods. The RDS estimate of cumulative lifetime abortion incidence was 12.1% (95% confidence interval: 9.8, 14.3), and the employment-adjusted estimate was 16.9% (95% confidence interval: 12.8, 22.1). We caution researchers in using RDS for representative estimates of abortion incidence. Use of postsurvey weights to adjust for differences in characteristics between the sample and the target population may yield more representative results.

PURPOSE: Respondent-driven sampling (RDS) uses long-chain referral whereby members of the target population recruit other members. We describe the use of RDS for a mixed-methods sexual and reproductive health (SRH) study in Kisumu, Kenya. METHODS: Initial seeds for the cross-sectional surveys were selected from adolescents aged 15-19 residing in urban informal settlements. Participants were provided up to five referral coupons to distribute. RESULTS: Across four communities, 18 seeds were selected, 13,489 coupons distributed, and 3381 adolescents referred, yielding a 25% coupon return rate. We enrolled 3061 participants for a 23% survey rate. Median referral lag time was three days (IQR 1, 7). Demographic characteristics reached equilibrium between recruitment waves 5 to 8 in three communities, and waves 7 to 15 in the fourth. CONCLUSIONS: Our study demonstrated that RDS is a feasible and efficient approach for recruiting a large sample of adolescents. Though our research focused on SRH, many adolescents residing in the impoverished urban environments where our study was implemented also experience food insecurity, housing instability and violence. RDS can therefore be a valuable recruitment approach for future studies to reach vulnerable adolescents and design interventions that address the variety of health-related challenges that affect this underserved population.

Respondent-driven sampling (RDS) is widely used to sample populations with higher risk of HIV infection for whom no sampling frames exist. However, few studies have been done to assess the reliability of RDS in real world settings. We assessed the reliability of naïve RDS samples using five rounds of the National HIV Behavioral Surveillance – People Who Inject Drugs surveys in Newark, New Jersey from 2005 to 2018. Specifically, we compared the distributions of time-insensitive demographic characteristics in temporally adjacent RDS samples with Monte Carlo Two-Sample Kolmogorov-Smirnov Test with 100,000 replicates. The distributions of time-sensitive demographic characteristics were also compared as sensitivity analyses. The study showed that repeated RDS samples among people who inject drugs in the greater Newark area, New Jersey were reliable in most of time-insensitive demographics and recruitment homophily statistics. Sensitivity analyses of time-sensitive demographics also presented consistencies in most of temporally adjacent samples. In conclusion, RDS has the potential to provide reliable samples, but demographic characteristics of RDS samples may be easily biased by homophily. Future studies using RDS may need to pay more attention to potential homophily bias and consider necessary diagnostic procedures and sample adjustments. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Sexually transmitted infections (STIs) disproportionately affect transgender women and travestis (TGW), who often lack access to healthcare due to stigma and discrimination. We describe the approach and methodology of a study investigating the prevalence of syphilis, HIV, hepatitis A, B, and C, Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), and human papillomavirus (HPV) among TGW, as well as their knowledge and perceptions regarding syphilis, to better inform policies to curb STIs among this vulnerable population. Methods: TransOdara was a multicentric, cross-sectional study conducted among TGW in five capital cities from major Brazilian regions between December 2019 and July 2021. Self-identified transgender women and travestis aged >18 years were recruited using respondent-driven sampling after a qualitative formative phase, completed an interviewer-led questionnaire, were offered a physical examination, and were also asked to provide samples from multiple sites to detect various STIs, starting vaccination and treatment when indicated. Results: A total of 1,317 participants were recruited from the five study locations: Campo Grande (n=181, 13.7%), Manaus (n=340, 25.8%), Porto Alegre (n=192, 14.6%), Salvador (n=201, 15.3%), and São Paulo (n=403, 30.6%). The recruitment period varied at each study location due to logistic constraints imposed by the COVID-19 pandemic. Conclusion: Despite the enormous challenges posed by the co-occurrence of the COVID-19 pandemic and field work targeting a vulnerable, elusive, and scattered population, the TransOdara project has been effectively implemented. Caveats did not preclude 1,300 TGW from being interviewed and tested, amid a significant epidemic that disrupted health services and research projects in Brazil and worldwide.

Abstract Background Accurate prevalence estimates of drug use and its harms are important to characterize burden and develop interventions to reduce negative health outcomes and disparities. Lack of a sampling frame for marginalized/stigmatized populations, including persons who use drugs (PWUD) in rural settings, makes this challenging. Respondent-driven sampling (RDS) is frequently used to recruit PWUD. However, the validity of RDS-generated population-level prevalence estimates relies on assumptions that should be evaluated. Methods RDS was used to recruit PWUD across seven Rural Opioid Initiative studies between 2018-2020. To evaluate RDS assumptions, we computed recruitment homophily and design effects, generated convergence and bottleneck plots, and tested for recruitment and degree differences. We compared sample proportions with three RDS-adjusted estimators (two variations of RDS-I and RDS-II) for five variables of interest (past 30-day use of heroin, fentanyl, and methamphetamine; past 6-month homelessness; and being positive for hepatitis C virus (HCV) antibody) using linear regression with robust confidence intervals. We compared regression estimates for the associations between HCV positive antibody status and (a) heroin use, (b) fentanyl use, and (c) age using RDS-1 and RDS-II probability weights and no weights using logistic and modified Poisson regression and random-effects meta-analyses. Results Among 2,842 PWUD, median age was 34 years and 43% were female. Most participants (54%) reported opioids as their drug of choice, however regional differences were present (e.g., methamphetamine range: 4-52%). Many recruitment chains were not long enough to achieve sample equilibrium. Recruitment homophily was present for some variables. Differences with respect to recruitment and degree varied across studies. Prevalence estimates varied only slightly with different RDS weighting approaches, most confidence intervals overlapped. Variations in measures of association varied little based on weighting approach. Conclusions RDS was a useful recruitment tool for PWUD in rural settings. However, several violations of key RDS assumptions were observed which slightly impacts estimation of proportion although not associations.

Background: Accurate prevalence estimates of drug use and its harms are important to characterize burden and develop interventions to reduce negative health outcomes and disparities. Lack of a sampling frame for marginalized/stigmatized populations, including persons who use drugs (PWUD) in rural settings, makes this challenging. Respondent-driven sampling (RDS) is frequently used to recruit PWUD. However, the validity of RDS-generated population-level prevalence estimates relies on assumptions that should be evaluated. Methods: RDS was used to recruit PWUD across seven Rural Opioid Initiative studies between 2018-2020. To evaluate RDS assumptions, we computed recruitment homophily and design effects, generated convergence and bottleneck plots, and tested for recruitment and degree differences. We compared sample proportions with three RDS-adjusted estimators (two variations of RDS-I and RDS-II) for five variables of interest (past 30-day use of heroin, fentanyl, and methamphetamine; past 6-month homelessness; and being positive for hepatitis C virus (HCV) antibody) using linear regression with robust confidence intervals. We compared regression estimates for the associations between HCV positive antibody status and (a) heroin use, (b) fentanyl use, and (c) age using RDS-1 and RDS-II probability weights and no weights using logistic and modified Poisson regression and random-effects meta-analyses. Results: Among 2,842 PWUD, median age was 34 years and 43% were female. Most participants (54%) reported opioids as their drug of choice, however regional differences were present (e.g., methamphetamine range: 4-52%). Many recruitment chains were not long enough to achieve sample equilibrium. Recruitment homophily was present for some variables. Differences with respect to recruitment and degree varied across studies. Prevalence estimates varied only slightly with different RDS weighting approaches, most confidence intervals overlapped. Variations in measures of association varied little based on weighting approach. Conclusions: RDS was a useful recruitment tool for PWUD in rural settings. However, several violations of key RDS assumptions were observed which slightly impacts estimation of proportion although not associations. [ABSTRACT FROM AUTHOR]

Legal status has shown far-reaching consequences for international migrants' incorporation trajectories and outcomes in Western contexts. In dialogue with the extant research, we examine the implications of legal status for subjective well-being of Central Asian migrant women in the Russian Federation. Using survey data collected through respondent-driven sampling in two large cities, we compare migrants with regularized and irregular legal statuses on several interrelated yet distinct dimensions of subjective well-being. We find that, regardless of other factors, regularized status has a strong positive association with migrants' perception of their rights and freedoms but not with their feeling of being respected in society. Regularized status is positively associated with self-efficacy and negatively with depression. Yet, no net legal status difference is found in migrants' views on their relations with other migrants or on treatment of migrants by native-borns. The findings are situated within the cross-national scholarship on the ramifications of racialized immigrant (il)legality and its implications for membership and belonging.

Abstract Background Respondent-driven sampling (RDS) is a peer chain-recruitment method for populations without a sampling frame or that are hard-to-reach. Although RDS is usually done face-to-face, the online version (WebRDS) has drawn a lot of attention as it has many potential benefits, despite this, to date there is no clear framework for its implementation. This article aims to provide guidance for researchers who want to recruit through a WebRDS. Methods Description of the development phase: guidance is provided addressing aspects related to the formative research, the design of the questionnaire, the implementation of the coupon system using a free software and the diffusion plan, using as an example a web-based cross-sectional study conducted in Spain between April and June 2022 describing the working conditions and health status of homecare workers for dependent people. Results The application of the survey: we discuss about the monitoring strategies throughout the recruitment process and potential problems along with proposed solutions. Conclusions Under certain conditions, it is possible to obtain a sample with recruitment performance similar to that of other RDS without the need for monetary incentives and using a free access software, considerably reducing costs and allowing its use to be extended to other research groups.

Abstract Background The unique socioeconomic context in Palestine, characterized by political and economic tensions, creates conditions that facilitate the spread of illicit drug use among Palestinians. This paper presents findings from a 2017 survey of high-risk drug use (HRDU) among males in four regions in Palestine: the West Bank (north, middle, and south) and the Gaza Strip. These findings are essential for developing effective policies to respond to the increasing use of drugs among Palestinians. Methods Eligible participants were males aged 15 years and above who used at least one drug other than non-synthetic hashish or marijuana during the previous week. Participants underwent a face-to-face interview and had their drug use verified by urinalysis. Data were collected using respondent-driven sampling and data were analyzed using the successive sampling estimator. Multivariate regression analysis was conducted to examine factors associated with ever seeking rehabilitation services for illicit drug use in the West Bank and the Gaza Strip. Results A total of 400 males who use drugs were sampled in Gaza, plus 299 in the south, 300 in the north, and 299 in the middle region of the West Bank. It is estimated that there are 26,500 male HRDUs in Palestine comprising 1.8% of the male population aged 15 and above. Findings indicate that polydrug use is a serious issue in Palestine, especially in the West Bank, and that synthetic marijuana is prevalent among teenagers and young adults. Conclusions Palestine must strengthen its national efforts to scale up harm reduction and treatment and care options for people suffering from drug use disorders, especially those involved in polydrug use. Additional measures are needed to prevent substance use among children and youth, support the families of people who use drugs, and ensure the continuity of HRDU services during emergencies.

Abstract Background The ongoing war in Yemen has created a severe and protracted crisis that has left nearly three-quarters of the population in need of urgent humanitarian assistance. Despite eight years of conflict there exist few robust estimates of how the conflict (and the conflict combined with the COVID-19 pandemic) have affected mortality in Yemen. As the security situation has limited access to affected populations we have designed a novel alternative to local mortality surveys. Methods We used a web-based, respondent-driven sampling method to disseminate a mortality survey amongst the global Yemeni diaspora. We used Cox proportional hazards survival models to estimate the association between the exposure (i.e. between the pre-conflict, conflict, and conflict/pandemic periods) and mortality risk, adjusted for gender and birth cohort. Results Eighty-nine eligible respondents completed the survey. Respondents provided data on the status of 1704 individuals of whom 85 (5%) had died; of these 65 (3.8%) were reported to have died in Yemen. An analysis of survivorship of respondents’ parents after their 50th birthday (adjusted for gender and birth cohort) provided weak evidence that the war and pandemic periods were associated with higher mortality when compared to the pre-war period. Analysis of the subset of individuals who died in Yemen also suggested an increased, but non-significant hazard of dying during the war/pandemic period: this association tended towards significance when allowing for varying degrees of out-migration from Yemen across the cohort. The number of deaths amongst respondents’ siblings and children under five in Yemen were too low to allow meaningful analysis. Conclusions Our data suggest increased mortality during the war/pandemic period, compared to the pre-war period, among older Yemeni adults. However, our findings require careful interpretation as our study design cannot establish causation, and as our small and non-representative sample appeared skewed towards higher-income, urban communities. Surveys of diaspora populations offer a promising means of describing mortality patterns in crisis-affected populations; though, large numbers of respondents are likely required to achieve accurate mortality estimates and to adjust for selection bias.

Background: Street children are vulnerable to adverse health and risk behaviors and drug use. Substance use among street children has been well documented in several countries. This study reports sociodemographic and peer, family, and stress-related factors associated with substance use and non-use in a representative sample of street children of Delhi. Methods: This cross-sectional survey was conducted through six NGOs working with street children, using Respondent Driven Sampling, in nine districts of Delhi (n = 766, 7–18 years). The multivariable model was developed by applying binary logistic regression analysis. Results: The rate of substance use was 49%. Significant association was found between substance use in the past year and increasing age [Odds Ratio: OR (95% Confidence Interval)] [1.22(1.12,1.33)], male sex [4.34 (2.28,8.26)], lacking psychosocial support from family/relatives [3.27(1.84,5.80)], being engaged in earning from illegal sources, [3.04(1.75,5.29)], family use of substance [2.59(1.38,4.89)], presence of substance-using peers [29.86(14.38,62.01)], lack of non-drug-using peers [2.35(1.46,3.79)], and not possessing basic amenities [2.26(1.31,3.93)]. Conclusion: Multiple modifiable factors exist within the family and peer group, including risk and protective factors or a consequence of substance use. Some challenges in the form of difficulty in reaching out to them and poor treatment seeking by those using substances warrant intensification in both primary and secondary prevention initiatives. [ABSTRACT FROM AUTHOR]

The Central Sahel region has one of the world's fastest-growing populations of internally displaced persons (IDPs). To better understand the risk factors associated with displacement, this study utilized respondent-driven sampling to recruit otherwise hard-to-reach IDPs in remote and urban areas in Burkina Faso, Mali, and Niger. From August to October 2021, 4144 IDPs were surveyed, and nine targeted vulnerability profiles were measured across the domains of gender, health, and protection. The study revealed a high prevalence of risk factors and vulnerability among IDPs, with notable geographic differences. The majority of IDPs fell into at least one category of vulnerability, with health vulnerabilities being the most common. Internally displaced persons reported overlapping vulnerabilities in health, particularly chronic illness, mental health issues, and disability. Women had higher odds of vulnerability than men. Statistically significant associations were site-specific, and some were inconsistent across contexts, highlighting the cross-cutting and pervasive nature of vulnerability among IDPs. [ABSTRACT FROM AUTHOR]

Successive sampling population size estimation (SS-PSE) is a method used by government agencies, aid organizations, and researchers around the world to estimate the size of hidden populations using data from respondent-driven sampling surveys. SS-PSE addresses a specific need in estimation, since many countries rely on having accurate size estimates to plan and allocate finite resources to address the needs of hidden populations. However, SS-PSE relies on several assumptions, one of which requires the underlying social network of the hidden population to be fully connected. We propose two modifications to SS-PSE for estimating the size of hidden populations whose underlying social network is composed of disjoint clusters. The first method is a theoretically straightforward extension of SS-PSE, but it relies on prior information that may be difficult to obtain in practice. The second method extends the Bayesian SS-PSE model by introducing a new set of parameters that allow for clustered estimation without requiring the additional prior information. After providing theoretical justification for both novel methods, we then assess their performance using simulations and apply the Clustered SS-PSE method to a population of internally displaced persons in Bamako, Mali. [ABSTRACT FROM AUTHOR]

Public health and welfare systems request documentation on approaches to diagnose, treat, and manage myalgic encephalomyelitis and assess disability-benefit conditions. Our objective is to document ME patients' experiences with services/interventions and assess differences between those meeting different diagnostic criteria, importantly the impact of post-exertional malaise. We surveyed 660 fatigue patients in Norway using respondent-driven sampling and applied validated DePaul University algorithms to estimate Canadian and Fukuda criteria proxies. Patients on average perceived most interventions as having low-to-negative health effects. Responses differed significantly between sub-groups for some key interventions. The PEM score was strongly associated with the experience of most interventions. Better designed and targeted interventions are needed to prevent harm to the patient group. The PEM score appears to be a strong determinant and adequate tool for assessing patient tolerance for certain interventions. There is no known treatment for ME, and "do-no-harm" should be a guiding principle in all practice. [ABSTRACT FROM AUTHOR]

Abstract Background Respondent-driven sampling (RDS) refers both to a chain-referral sampling method and an analytical model for analysing sampled data. Web-based respondent-driven sampling (webRDS) uses internet-based recruitment coupled with an electronic survey to carry out RDS studies; there is currently no commercially available webRDS solution. We designed and developed a webRDS solution to support a research study aimed at estimating conflict-attributable mortality in Yemen. Our webRDS solution is composed of an existing survey platform (i.e. ODK) and a bespoke RDS system. The RDS system is designed to administer and manage an RDS survey cascade and includes: (1) an application programming interface, (2) a study participant client, and (3) an administrator interface. We report here on the design of the webRDS solution and its implementation. Results We consulted members of the Yemeni diaspora throughout the development of the solution. Technical obstacles were largely the result of: WhatsApp’s policies on bulk messaging and automated messaging behaviour, the inherent constraints of SMS messaging, and SMS filtering behaviour. Language support was straight-forward yet time consuming. Survey uptake was lower than expected. Factors which may have impacted uptake include: our use of consumable survey links, low interest amongst the diaspora population, lack of material incentives, and the length and subject matter of the survey itself. The SMS/WhatsApp messaging integration was relatively complex and limited the information we could send potential participants. Conclusion Despite lower-than expected survey uptake we believe our webRDS solution provides efficient and flexible means to survey a globally diverse population.

Abstract Background The Engage Study is a longitudinal biobehavioral cohort study of gay, bisexual and other men who have sex with men (GBM) in Toronto, Montreal, and Vancouver. Baseline data (2,449 participants) were collected from February 2017 - August 2019 using respondent-driven sampling (RDS). Recruitment in Montreal required fewer seeds, had a much shorter recruitment period, and recruited the largest sample. Methods To better understand why RDS recruitment was more successful in Montreal compared to other sites, we conducted an analysis to examine RDS recruitment characteristics for GBM in each of the three study sites, explore demographic characteristics and measures of homophily, that is, the tendency of individuals to recruit other study participants who are like themselves, and compared motivations for study participation. Results Montreal had the greatest proportion of participants over the age of 45 (29.1% in Montreal, 24.6% in Vancouver, and 21.0% in Toronto) and the highest homophily for this age group, but homophily was high across the three cities. Montreal also reported the lowest percentage of participants with an annual income greater or equal to $60,000 (7.9% in Montreal, 13.1% in Vancouver and 10.6% in Toronto), but homophily was similar across all three cities. The majority of participants indicated interest in sexual health and HIV as the main reason for participating (36.1% in Montreal, 34.7% in Vancouver, and 29.8% in Toronto). Financial interest as the main reason for participation was low (12.7% in Montreal, 10.6% in Vancouver, and 5.7% in Toronto). Conclusion Taken together, although we found some differences in study demographic characteristics and homophily scores, we were unable to fully explain the different recruitment success based on the data available. Our study underlines the fact that success of RDS implementation may vary by unknown factors, and that researchers should be proactive and flexible to account for variability.

BackgroundEfforts to increase HIV testing, diagnosis and care are critical to curbing HIV epidemics among cisgender men who have sex with men (MSM) and transgender women (TW) in low- and middle-income countries (LMIC). We compared the effectiveness of respondent-driven sampling (RDS) and venue-based sampling (VBS) for identifying previously undiagnosed HIV infection among MSM and TW in Tijuana, Mexico.MethodsBetween March 2015 and December 2018, we conducted RDS within the social networks of MSM and TW and VBS at venues frequented by MSM and TW to socialize and meet sexual partners. Those reached by RDS/VBS who reported at least 18 years of age, anal sex with MSM or TW, and no previous HIV diagnosis were eligible for HIV testing.ResultsOf those screened following recruitment via RDS (N = 1232; 98.6% MSM; 1.3% TW), 60.8% (749/1232) were eligible for HIV testing and 97.5% (730/749) were tested for HIV infection, which led to the identification of 36 newly diagnosed HIV infections (4.9%). Of those screened following recruitment via VBS (N = 2560; 95.2% MSM; 4.6% TW), 56.5% (1446/2560) were eligible for HIV testing and 92.8% (1342/1446) were tested for HIV infection, which led to the identification of 82 newly diagnosed HIV infections (6.1%). The proportion of new HIV diagnoses did not differ by recruitment method (ratio = 0.81, 95% confidence interval: 0.55 to 1.18). Compared to those recruited via RDS, those tested following recruitment via VBS were younger, more likely to identify as gay, and more likely to identify as TW. Compared to those recruited via VBS, those newly diagnosed with HIV infection following recruitment via RDS reported higher levels of internalized stigma and were more likely to report injection drug use and a history of deportation from the United States.ConclusionsDespite RDS and VBS being equally effective for identifying undiagnosed HIV infection, each recruitment method reached different subgroups of MSM and TW in Tijuana. Our findings suggest that there may be benefits to using both RDS and VBS to increase the identification of previously undiagnosed HIV infection and ultimately support HIV care engagement among MSM and TW in Mexico and other similar LMIC.

It is challenging to quantitatively measure the health vulnerability and risk factors of refugees and migrants residing outside of formal settlement settings. For hard-to-reach populations without available sampling frames, researchers have increasingly turned to novel sampling and statistical methods, like respondent-driven sampling (RDS). "Standard" RDS is typically conducted face-to-face at fixed sites. However, during the coronavirus disease 2019 (COVID-19) pandemic, face-to-face survey methods and recruitment approaches posed high potential risk of virus transmission and infection, making remote RDS approaches optimal. In this paper, we explore the feasibility of implementing telephone and Internet RDS strategies to assess challenges faced by Venezuelan refugees and migrants in the city of Bogotá, Colombia's capital, and the department of Norte de Santander, the main Venezuelan-Colombian border crossing site. We describe RDS assumptions, survey design, formative research, and the implementation of both strategies and present diagnostics for determining whether assumptions are met. Phone-based recruitment strategies in both locations and the Internet strategy in Bogotá achieved their calculated sample size; however, the Internet strategy in Norte de Santander did not. Most RDS assumptions were sufficiently met at sites where sample sizes were reached. These surveys provide valuable lessons for implementing innovative remote strategies with which to study hard-to-reach populations such as refugees and migrants. [ABSTRACT FROM AUTHOR]

Background: Respondent-driven sampling (RDS) is a peer chain-recruitment method for populations without a sampling frame or that are hard-to-reach. Although RDS is usually done face-to-face, the online version (WebRDS) has drawn a lot of attention as it has many potential benefits, despite this, to date there is no clear framework for its implementation. This article aims to provide guidance for researchers who want to recruit through a WebRDS. Methods: Description of the development phase: guidance is provided addressing aspects related to the formative research, the design of the questionnaire, the implementation of the coupon system using a free software and the diffusion plan, using as an example a web-based cross-sectional study conducted in Spain between April and June 2022 describing the working conditions and health status of homecare workers for dependent people. Results: The application of the survey: we discuss about the monitoring strategies throughout the recruitment process and potential problems along with proposed solutions. Conclusions: Under certain conditions, it is possible to obtain a sample with recruitment performance similar to that of other RDS without the need for monetary incentives and using a free access software, considerably reducing costs and allowing its use to be extended to other research groups. [ABSTRACT FROM AUTHOR]

Background: The unique socioeconomic context in Palestine, characterized by political and economic tensions, creates conditions that facilitate the spread of illicit drug use among Palestinians. This paper presents findings from a 2017 survey of high-risk drug use (HRDU) among males in four regions in Palestine: the West Bank (north, middle, and south) and the Gaza Strip. These findings are essential for developing effective policies to respond to the increasing use of drugs among Palestinians. Methods: Eligible participants were males aged 15 years and above who used at least one drug other than non-synthetic hashish or marijuana during the previous week. Participants underwent a face-to-face interview and had their drug use verified by urinalysis. Data were collected using respondent-driven sampling and data were analyzed using the successive sampling estimator. Multivariate regression analysis was conducted to examine factors associated with ever seeking rehabilitation services for illicit drug use in the West Bank and the Gaza Strip. Results: A total of 400 males who use drugs were sampled in Gaza, plus 299 in the south, 300 in the north, and 299 in the middle region of the West Bank. It is estimated that there are 26,500 male HRDUs in Palestine comprising 1.8% of the male population aged 15 and above. Findings indicate that polydrug use is a serious issue in Palestine, especially in the West Bank, and that synthetic marijuana is prevalent among teenagers and young adults. Conclusions: Palestine must strengthen its national efforts to scale up harm reduction and treatment and care options for people suffering from drug use disorders, especially those involved in polydrug use. Additional measures are needed to prevent substance use among children and youth, support the families of people who use drugs, and ensure the continuity of HRDU services during emergencies. [ABSTRACT FROM AUTHOR]

The Fridays for Future (FFF) movement has emerged as a critical force in environmental activism in response to pressing climate challenges. Despite its global prominence, few studies have delved deeply into the internal lines of thought within FFF communities. Our research fills this gap by exploring the diverse perspectives within the Italian FFF community and how these viewpoints influence the movement's civic and political dedication to environmental sustainability. We are specifically interested in the shades of green, namely the internal variations of attitudes and beliefs of the FFF participants. We conducted empirical research with over 300 climate activists from the FFF movement in Italy, collecting data from March to October 2022 using a Web-based respondent-driven sampling technique (webRDS). The questionnaire, comprising 27 questions, covers topics such as political values, institutional trust, technological attitudes, climate knowledge, and personal lifestyles. We chose Multiple Correspondence Analysis (MCA) for our analysis due to its valuable mathematical properties, capability for producing insightful visual representations, and efficient computational features. The analysis reveals four distinct groups within the Italian FFF community based on their attitudes and actions related to environmental sustainability. These groups include Activist Equalizer, Disillusioned Technophobes, Institution Trustee, and Laissez-faire Solitaries, challenging the prevailing notion that FFF activists solely fit the profile of Activist Equalizers often depicted in media and public discourse. Findings offer a novel picture of the FFF movement in Italy and contribute to a better understanding of how the internal diversity of FFF impacts the efficacy and future trajectory of environmental activism. This research offers new insight into the political role of FFF and its potential influence on climate-related political actions. [ABSTRACT FROM AUTHOR]

Compared to campus-based alcohol interventions for college students, services for emerging adult (EA) risky drinkers who reside off-campus in disadvantaged communities are not well established. This web survey assessed drinking practices, problems, and preferences for professional and lay helping resources spanning digital and in-person formats among community-dwelling EAs to guide services for them and determine whether drinking risk levels varied by preferences for help. Digital respondent-driven sampling recruited EA risky drinkers from disadvantaged communities (N  = 356; M age = 23.6 years, 64.0% women, 77.4% employed, 64.9% residing in impoverished areas above the US average, 53.5% income < $20k/year). A web survey assessed participants' drinking practices and problems, including alcohol use disorder symptoms, and help-seeking preferences for smartphone apps; online help; in-person help from doctors, clinics, teachers, and school programs; mutual help groups; and help from friends and family. Preferences were related to participant drinking risks using generalized linear modeling. Modeling results showed that risk levels were related to help-seeking preferences. EAs reporting more negative consequences preferred smartphone apps and help from friends, whereas EAs reporting fewer negative consequences and drinking days preferred professional in-person help (P s < 0.05). Although >90% fulfilled alcohol use disorder diagnostic criteria, <4% had received an alcohol-related intervention. EAs who are riskier drinkers appear less likely to use professional resources in favor of informal and online resources that allow greater anonymity. Findings can guide services for this underserved population that are responsive to drinker risk levels. [ABSTRACT FROM AUTHOR]

Background: The ongoing war in Yemen has created a severe and protracted crisis that has left nearly three-quarters of the population in need of urgent humanitarian assistance. Despite eight years of conflict there exist few robust estimates of how the conflict (and the conflict combined with the COVID-19 pandemic) have affected mortality in Yemen. As the security situation has limited access to affected populations we have designed a novel alternative to local mortality surveys. Methods: We used a web-based, respondent-driven sampling method to disseminate a mortality survey amongst the global Yemeni diaspora. We used Cox proportional hazards survival models to estimate the association between the exposure (i.e. between the pre-conflict, conflict, and conflict/pandemic periods) and mortality risk, adjusted for gender and birth cohort. Results: Eighty-nine eligible respondents completed the survey. Respondents provided data on the status of 1704 individuals of whom 85 (5%) had died; of these 65 (3.8%) were reported to have died in Yemen. An analysis of survivorship of respondents' parents after their 50th birthday (adjusted for gender and birth cohort) provided weak evidence that the war and pandemic periods were associated with higher mortality when compared to the pre-war period. Analysis of the subset of individuals who died in Yemen also suggested an increased, but non-significant hazard of dying during the war/pandemic period: this association tended towards significance when allowing for varying degrees of out-migration from Yemen across the cohort. The number of deaths amongst respondents' siblings and children under five in Yemen were too low to allow meaningful analysis. Conclusions: Our data suggest increased mortality during the war/pandemic period, compared to the pre-war period, among older Yemeni adults. However, our findings require careful interpretation as our study design cannot establish causation, and as our small and non-representative sample appeared skewed towards higher-income, urban communities. Surveys of diaspora populations offer a promising means of describing mortality patterns in crisis-affected populations; though, large numbers of respondents are likely required to achieve accurate mortality estimates and to adjust for selection bias. [ABSTRACT FROM AUTHOR]

Respondent-driven sampling (RDS) is used to measure trait or disease prevalence in populations that are difficult to reach and often marginalized. The authors evaluated the performance of RDS estimators under varying conditions of trait prevalence, homophily, and relative activity. They used large simulated networks (N = 20,000) derived from real-world RDS degree reports and an empirical Facebook network (N = 22,470) to evaluate estimators of binary and categorical trait prevalence. Variability in prevalence estimates is higher when network degree is drawn from real-world samples than from the commonly assumed Poisson distribution, resulting in lower coverage rates. Newer estimators perform well when the sample is a substantive proportion of the population, but bias is present when the population size is unknown. The choice of preferred RDS estimator needs to be study specific, considering both statistical properties and knowledge of the population under study. [ABSTRACT FROM AUTHOR]

Background: Respondent-driven sampling (RDS) refers both to a chain-referral sampling method and an analytical model for analysing sampled data. Web-based respondent-driven sampling (webRDS) uses internet-based recruitment coupled with an electronic survey to carry out RDS studies; there is currently no commercially available webRDS solution. We designed and developed a webRDS solution to support a research study aimed at estimating conflict-attributable mortality in Yemen. Our webRDS solution is composed of an existing survey platform (i.e. ODK) and a bespoke RDS system. The RDS system is designed to administer and manage an RDS survey cascade and includes: (1) an application programming interface, (2) a study participant client, and (3) an administrator interface. We report here on the design of the webRDS solution and its implementation. Results: We consulted members of the Yemeni diaspora throughout the development of the solution. Technical obstacles were largely the result of: WhatsApp's policies on bulk messaging and automated messaging behaviour, the inherent constraints of SMS messaging, and SMS filtering behaviour. Language support was straight-forward yet time consuming. Survey uptake was lower than expected. Factors which may have impacted uptake include: our use of consumable survey links, low interest amongst the diaspora population, lack of material incentives, and the length and subject matter of the survey itself. The SMS/WhatsApp messaging integration was relatively complex and limited the information we could send potential participants. Conclusion: Despite lower-than expected survey uptake we believe our webRDS solution provides efficient and flexible means to survey a globally diverse population. [ABSTRACT FROM AUTHOR]

Background: The Engage Study is a longitudinal biobehavioral cohort study of gay, bisexual and other men who have sex with men (GBM) in Toronto, Montreal, and Vancouver. Baseline data (2,449 participants) were collected from February 2017 - August 2019 using respondent-driven sampling (RDS). Recruitment in Montreal required fewer seeds, had a much shorter recruitment period, and recruited the largest sample. Methods: To better understand why RDS recruitment was more successful in Montreal compared to other sites, we conducted an analysis to examine RDS recruitment characteristics for GBM in each of the three study sites, explore demographic characteristics and measures of homophily, that is, the tendency of individuals to recruit other study participants who are like themselves, and compared motivations for study participation. Results: Montreal had the greatest proportion of participants over the age of 45 (29.1% in Montreal, 24.6% in Vancouver, and 21.0% in Toronto) and the highest homophily for this age group, but homophily was high across the three cities. Montreal also reported the lowest percentage of participants with an annual income greater or equal to $60,000 (7.9% in Montreal, 13.1% in Vancouver and 10.6% in Toronto), but homophily was similar across all three cities. The majority of participants indicated interest in sexual health and HIV as the main reason for participating (36.1% in Montreal, 34.7% in Vancouver, and 29.8% in Toronto). Financial interest as the main reason for participation was low (12.7% in Montreal, 10.6% in Vancouver, and 5.7% in Toronto). Conclusion: Taken together, although we found some differences in study demographic characteristics and homophily scores, we were unable to fully explain the different recruitment success based on the data available. Our study underlines the fact that success of RDS implementation may vary by unknown factors, and that researchers should be proactive and flexible to account for variability. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the impact of different logistic regression estimators applied to RDS studies via simulation and the analysis of empirical data. Four simulated populations were created with different connectivity characteristics. Each simulated individual received two attributes, one of them associated to the infection process. RDS samples with different sizes were obtained. The observed coverage of three logistic regression estimators were applied to assess the association between the attributes and the infection status. In simulated datasets, unweighted logistic regression estimators emerged as the best option, although all estimators showed a fairly good performance. In the empirical dataset, the performance of weighted estimators presented an unexpected behavior, making them a risky option. The unweighted logistic regression estimator is a reliable option to be applied to RDS samples, with a performance roughly similar to random samples and, therefore, should be the preferred option. [ABSTRACT FROM AUTHOR]

We assessed how the high-skilled migrants' statuses in Mainland China and Hong Kong and the discrepancies between the two statuses are related to their well-being outcomes. We used respondent-driven sampling method and obtained an analytical sample of 2,864 participants. The majority of the high-skilled migrants perceived higher status in Mainland China than in Hong Kong which is more consequential for their health and well-being. Compared to those who perceived similar statuses in the two locations, migrants who perceived different statuses tended to report lower levels of psychological well-being, providing evidence to the detrimental effects of status inconsistency. [ABSTRACT FROM AUTHOR]

Despite the overall decline in human immunodeficiency virus (HIV) prevalence, it remains unacceptably high in key populations. This study aimed to estimate prevalence of HIV infection and high-risk behaviors among female sex workers (FSWs). This study was a cross-sectional survey of FSWs conducted between December 2019 and August 2020 in eight geographically diverse cities in Iran. After providing informed consent, participants completed a bio-behavioral questionnaire and after completion of the interview, rapid diagnostic tests (RDT) and dried blood spots (DBS) were collected to determine HIV and syphilis status as per national guidelines, if the women consented. All analyzes were based on RDS adjustment. Weighting was done according to Giles'SS estimator. Among the 1515 FSWs, the overall prevalence of HIV and syphilis were 1.6% (95% CI: 0.8–2.3) and zero, respectively. The highest HIV prevalence was observed in Shiraz (5.1%) and Khorramabad city (1.6%). In addition, HIV-positive FSWs had a higher mean age at first sexual contact than HIV-negative FSWs (21.4 ± 5.6 vs. 17.2 ± 4.2 years). Injection drug use and a history of arrest or incarceration were associated with an increased odds of HIV infection (OR = 6.25; 95% CI: 1.90-20.55 and OR = 4.57; 95% CI: 1.64–12.72, respectively). Based on the results, strategies to improve early HIV diagnosis, harm reduction, and use of testing and treatment strategies are needed to reduce and control HIV infections. [ABSTRACT FROM AUTHOR]

Respondent-driven sampling (RDS) uses long-chain referral whereby members of the target population recruit other members. We describe the use of RDS for a mixed-methods sexual and reproductive health (SRH) study in Kisumu, Kenya. Initial seeds for the cross-sectional surveys were selected from adolescents aged 15–19 residing in urban informal settlements. Participants were provided up to five referral coupons to distribute. Across four communities, 18 seeds were selected, 13,489 coupons distributed, and 3381 adolescents referred, yielding a 25% coupon return rate. We enrolled 3061 participants for a 23% survey rate. Median referral lag time was three days (IQR 1, 7). Demographic characteristics reached equilibrium between recruitment waves 5 to 8 in three communities, and waves 7 to 15 in the fourth. Our study demonstrated that RDS is a feasible and efficient approach for recruiting a large sample of adolescents. Though our research focused on SRH, many adolescents residing in the impoverished urban environments where our study was implemented also experience food insecurity, housing instability and violence. RDS can therefore be a valuable recruitment approach for future studies to reach vulnerable adolescents and design interventions that address the variety of health-related challenges that affect this underserved population. [ABSTRACT FROM AUTHOR]

Estimates of the population size of people who inject drugs (PWID) are essential for efficient program planning and for monitoring key targets. Existing estimates in Greece are based on the capture-recapture method applied to drug treatment sources. We aimed to obtain estimates based on data collected from a community-based program addressing PWID in Athens, Greece. The program was implemented in 2012–2013 to increase diagnosis and treatment for HIV among PWID during an HIV outbreak. Five Responden-Driven Sampling (RDS) rounds were used to recruit participants. A unique code was used to identify participants among rounds. Capture-recapture was applied to estimate the population size in 2013 (PWID with injection in the past 12 months; active PWID with injection in the past 30 days). Log-linear models were applied. In 2013, the estimated number of active PWID in Athens was 4,117 [95% confidence interval (CI): 3,728–4,507] (vs. 1,956 [95% CI: 1,525–2,565] the existing population size estimate). Based on this estimate, the coverage of needle and syringe programs in 2013 was 103 syringes/PWID/year (vs. 216 based on the existing estimate). The population prevalence of injecting drug use in Athens (past 12 months) was 0.222% (95% CI: 0.200–0.245). The inclusion of data from community-based programs in the estimation of the PWID population size resulted in 2.1-fold higher estimates, compared to the official estimates obtained from drug treatment data, and indicates the need for re-evaluation of necessary resources for harm reduction and elimination of HIV and hepatitis C in PWID. [ABSTRACT FROM AUTHOR]

Abstract Objective Adolescents and youth constitute a significant proportion of the population in developing nations. Conventional survey methods risk missing adolescents/youth because their family planning/contraception (FP/C) behavior is hidden. Respondent-driven sampling (RDS), a modified chain-referral recruitment sampling approach, was used to reach unmarried adolescents/youth aged 15–24 in Nairobi, Kenya to measure key FP/C indicators. Seeds were selected and issued with three coupons which they used to invite their peers, male or female, to participate in the study. Referred participants were also given coupons to invite others till sample size was achieved. We report on key implementation parameters following standard RDS reporting recommendations. Results A total of 1674 coupons were issued to generate a sample size of 1354. Coupon return rate was 82.7%. Study participants self-administered most survey questions and missing data was low. Differential enrolment by gender was seen with 56.0% of females recruiting females while 44.0% of males recruited males. In about two months, it was possible to reach the desired sample size using RDS methodology. Implementation challenges included presentation of expired coupons, recruitment of ineligible participants and difficulty recruiting seeds and recruits from affluent neighborhoods. Challenges were consistent with RDS implementation in other settings and populations. RDS can complement standard surveillance/survey approaches, particularly for mobile populations like adolescents/youth.

Respondent-driven sampling (RDS) is a method for sampling from a target population by leveraging social connections. RDS is invaluable to the study of hard-to-reach populations. However, RDS is costly and can be infeasible. RDS is infeasible when RDS point estimators have small effective sample sizes (large design effects) or when RDS interval estimators have large confidence intervals relative to estimates obtained in previous studies or poor coverage. As a result, researchers need tools to assess whether or not estimation of certain characteristics of interest for specific populations is feasible in advance. In this paper, we develop a simulation-based framework for using pilot data-in the form of a convenience sample of aggregated, egocentric data and estimates of subpopulation sizes within the target population-to assess whether or not RDS is feasible for estimating characteristics of a target population. in doing so, we assume that more is known about egos than alters in the pilot data, which is often the case with aggregated, egocentric data in practice. We build on existing methods for estimating the structure of social networks from aggregated, egocentric sample data and estimates of subpopulation sizes within the target population. We apply this framework to assess the feasibility of estimating the proportion male, proportion bisexual, proportion depressed and proportion infected with HIV/AIDS within three spatially distinct target populations of older lesbian, gay and bisexual adults using pilot data from the caring and Aging with Pride Study and the Gallup Daily Tracking Survey. We conclude that using an RDS sample of 300 subjects is infeasible for estimating the proportion male, but feasible for estimating the proportion bisexual, proportion depressed and proportion infected with HIV/AIDS in all three target populations.

PurposeThis paper presents an overview of different kinds of risk and social network methods and the kinds of research questions each can address.Recent findingsIt also reviews what network research has discovered about how network characteristics are associated with HIV and other infections, risk behaviors, preventive behaviors, and care, and discusses some ways in which network-based public health interventions have been conducted. Based on this, risk and social network research and interventions seem both feasible and valuable for addressing the many public health and social problems raised by the widespread use of opioids in the US South.

Background: Gay geosocial networking apps, also known as "gay apps," have gained increasing popularity in the men who have sex with men (MSM) community. Certain sexuality traits and gay app use are both associated with high-risk sexual behaviors among MSM. However, little is known about the underlying mechanism of such relationships. Objective: Based on the uses and gratifications theory, this study aimed to test the mediation effect of gay app use on the relationship between sexuality traits (sexual compulsivity and sexual sensation seeking) and high-risk sexual behaviors (multiple sexual partners and unprotected anal intercourse) among MSM. Methods: A cross-sectional, multicenter study was conducted in Wuhan and Changsha, China, from August to October 2020. A representative sample of 402 MSM was recruited through respondent-driven sampling. A self-administered web-based structured questionnaire was used to collect data on sociodemographic information, high-risk sexual behaviors, gay app use, sexual compulsivity, and sexual sensation seeking. Path analysis was conducted to assess the mediation effect. Results: Our study revealed that 67.42% (n=271) of MSM used gay apps for seeking potential sexual partners, with 37.06% (n=149) of them engaging in unprotected anal intercourse, and 45.42% (n=218) of them having multiple sexual partners. Of the participants, 17.16% (n=69) reported significant sexual compulsivity, while 29.10% (n=117) reported significant sexual sensation seeking. Notably, gay app usage partially mediated the relationship between sexual compulsivity and multiple sexual partners but fully mediated the relationship between sexual compulsivity and unprotected anal intercourse. Furthermore, gay app usage partially mediated the relationship between sexual sensation seeking and multiple sexual partners but fully mediated the relationship between sexual sensation seeking and unprotected anal intercourse. Conclusions: High-risk sexual behaviors are common among MSM. Most MSM rely on gay apps to find sexual partners, which, when combined with higher levels of sexual compulsivity and sexual sensation seeking, can increase the likelihood of engaging in high-risk sexual behaviors. Therefore, interventions aimed at reducing these behaviors among MSM should focus on addressing the use of gay apps, while also considering the influence of their sexuality traits on gay app use. [ABSTRACT FROM AUTHOR]

Background: Despite the negative impact of unsafe abortions on women's health and rights, the degree of abortion safety remains strikingly undocumented for a large share of abortions globally. Data on how women induce abortions (method, setting, provider) are central to the measurement of abortion safety. However, health-facility statistics and direct questioning in population surveys do not yield representative data on abortion care seeking pathways in settings where access to abortion services is highly restricted. Recent developments in survey methodologies to study stigmatized / illegal behaviour and hidden populations rely on the fact that such information circulates within social networks; however, such efforts have yet to give convincing results for unsafe abortions. Objective: This article presents the protocol of a study whose purpose is to apply and develop further two network-based methods to contribute to the generation of reliable population-level information on the safety of abortions in contexts where access to legal abortion services is highly restricted. Methods: This study plans to obtain population-level data on abortion care seeking in two Health and Demographic Surveillance Systems in urban Kenya and rural Burkina Faso by applying two methods: Anonymous Third-Party Reporting (ATPR) (also known as confidantes' method) and Respondent Driven Sampling (RDS). We will conduct a mixed methods formative study to determine whether these network-based approaches are pertinent in the study contexts. The ATPR will be refined notably by incorporating elements of the Network Scale-Up Method (NSUM) to correct or account for certain of its biases (transmission, barrier, social desirability, selection). The RDS will provide reliable alternative estimates of abortion safety if large samples and equilibrium can be reached; an RDS multiplex variant (also including social referents) will be tested. Discussion: This study aims at documenting abortion safety in two local sites using ATPR and RDS. If successful, it will provide data on the safety profiles of abortion seekers across sociodemographic categories in two contrasted settings in sub-Saharan Africa. It will advance the formative research needed to determine whether ATPR and RDS are applicable or not in a given context. It will improve the questionnaire and correcting factors for the ATPR, improve the capacity of RDS to produce quasi-representative data on abortion safety, and advance the validation of both methods. Plain English summary: Representative data on how women induce abortions and their consequences are central to measurements of abortion safety. However, due to the stigmatized nature of abortion, measuring the details of the process is challenging when the latter occur out of the realm of the law and do not result in complications registered in hospital statistics. Hence, there is sparse empirical population-level data on how women terminate their pregnancies in countries where access to abortion services is highly restricted, as well as little data on the side effects and complications associated with the methods they chose and health seeking for these complications. Recent developments in indirect survey methodologies to study stigmatized/illegal behaviour and hidden populations are likely to improve the quality of data collected on abortion safety in restrictive contexts: all are based on the sharing of information on stigmatized practices in social networks. We propose to refine and pilot two such network-based methods to validate their use for collecting (quasi) representative data on abortion safety in large population health surveys. These two approaches are: (i) a modified Anonymous Third-Party Reporting method (ATPR) integrating elements of the Network-Scale-up Method (NSUM) and (ii) Respondent-Driven Sampling (RDS). We will conduct this study in two African Health and Demographic Surveillance Systems (HDSS) sites, one urban (Nairobi, Kenya), and one comprising a town and adjacent villages (Kaya, Burkina Faso). [ABSTRACT FROM AUTHOR]

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