Establishing the acceptability and feasibility of using social network-driven recruitment to test for hepatitis C in men who have sex with men.

问题：丙型肝炎病毒（HCV）是一种病毒感染，可导致肝衰竭和肝癌。我们现在已经有了耐受性良好且有效的药物来清除HCV。但在英国估计的21万感染者中，高达50%的人不知道自己被感染。如果我们发现并治疗所有感染者，我们可以减少肝脏疾病并阻止HCV传播给他人。注射毒品的人（PWID）是英国最大的受影响群体。大多数HCV检测策略针对PWID，但自2000年以来，越来越多的男男性行为者（MSM），特别是艾滋病毒感染者，通过性行为感染了HCV。他们的风险因素与PWID不同。更多的HIV阴性的男男性接触者现在正在感染HCV，因此有感染HCV风险的男男性接触者在参加性健康（SH）诊所时应该进行检测。但这并不总是发生，许多男男性接触者不参加SH诊所。因此，在SH诊所进行检测会遗漏一些有风险的MSM。传统的伴侣通知--检测被诊断为HCV感染者的伴侣--通常是不可能做到的，因为通常有许多匿名的、无法追踪的伴侣。方法：我将开发和试点一种社交网络驱动的招募（SNDR）干预，以发现并为那些有HCV风险但尚未接受检测的人提供检测。HCV的风险取决于与之交往以及发生性关系的人的风险。社会接触影响行为和被接受为“正常”的行为，包括危险行为。这些网络中关于检测行为的更多信息可以使检测更有针对性，并成为接触那些不参与护理的人的手段。研究使用参与者（称为种子）从他们的网络（分身）中招募社会（包括性）同伴，这些同伴反过来招募他们的分身来接触“隐藏”人群。采用这种方法有助于在雅典的PWID中发现未确诊的艾滋病毒病例。我建议在英国的MSM中使用SNDR检测HCV。种子将招募有感染HCV风险的变异体。每个改变者将完成一份关于他们的网络和HCV风险的问卷，返回一个干血斑样本进行HCV检测，然后招募更多的改变者，创造一个“招募链”。 目的：探索当前的检测需求，以及MSM招募同龄人检测HCV的新招募策略是否可能被接受，是否可以覆盖目前未进行检测的高危人群，并可以在随机对照试验（RCT）中进行检测。参会人员：任何16岁以上的男男性行为者，在莫蒂默市场中心（伦敦市中心的SH/HIV诊所）新诊断为HCV，以及他们的社交和性接触者，并持有有效的招募券。采访不去SH诊所的MSM（从同性恋桑拿房招募）和感染HCV的MSM。我将询问有关检测、对HCV风险的看法、HCV诊断的披露以及他们对干预措施的想法，例如接近的改变数量。我还将与性健康诊所的工作人员讨论他们决定测试或不测试HCV以及为什么。2.使用访谈数据帮助设计一份调查问卷，探索HCV风险因素和社会（和性）网络。该问卷将与男男性行为者一起试行和完善。3.试行SNDR招募和测试方法。4.评估这些数据，以了解MSM之间的网络和丙型肝炎感染的风险。这些信息将为MSM网络提供新的见解，并寻找其他高危人群。参与者将获得有关HCV的信息和HCV检测结果。我将继续让患者和公众参与这项研究，以确保其研究结果能够传达给公众以及研究人员和医疗团队。这项可行性研究的结果可用于计划随机对照试验，以确定该策略的有效性。这项随机对照试验的公共卫生益处包括更好的针对性检测和对HCV传播方式的了解。

The problem: Hepatitis C virus (HCV) is a viral infection that can cause liver failure and liver cancer. We now have well tolerated and effective drugs to clear HCV. But up to 50% of the estimated 210,000 infected people in the UK do not know they are infected. If we find and treat all infected people we can decrease liver disease and stop HCV being spread to others. People who inject drugs (PWID) are the largest affected group in the UK. Most HCV testing strategies target PWID, but since 2000, increasing numbers of men who have sex with men (MSM), especially those with HIV, have been infected sexually with HCV. Their risk factors differ from PWID. More HIV negative MSM are getting HCV now so MSM at risk of HCV infection should be tested when attending sexual health (SH) clinics. But this does not always happen and many MSM do not attend SH clinics. So testing in SH clinics will miss some MSM at risk. Traditional partner notification-testing partners of those diagnosed with HCV- is often impossible to do as often there are many anonymous untraceable partners.The approach: I will develop and pilot a social network driven recruitment (SNDR) intervention to find and offer testing to people who are at risk of HCV but who are not already being tested. Risk of HCV depends on the risk in the people one socialises with as well as has sex with. Social contacts influence behaviour and what is accepted as 'normal', including risky behaviour. More information about testing behaviours in these networks could allow better targeting of testing and a means to reach those not engaged with care. Studies have used a participant (known as a seed) to recruit social (including sexual) peers from their networks (alters) who in turn recruit their alters to reach 'hidden' populations. Adaptations to this method have helped find undiagnosed HIV cases in PWID in Athens. I propose to use SNDR for HCV in MSM in the UK. Seeds will recruit alters at risk of HCV. Each alter will complete a questionnaire about their networks and HCV risk, return a dried blood spot sample for HCV testing and then recruit further alters, creating a 'recruitment chain'. Aim: to explore current testing needs and if this new recruitment strategy of MSM recruiting peers to test for HCV is potentially acceptable, reaches those at risk who are currently not testing and could be tested in a randomised controlled trial (RCT). Participants: Any MSM aged 16+ years and newly diagnosed with HCV at the Mortimer Market Centre (SH/HIV clinic in central London) and their social and sexual contacts with a valid recruitment coupon.Plan of investigation:1. Interview MSM who do not go to SH clinics (recruited from gay saunas) and MSM who have had HCV. I will ask about testing, perception of HCV risk, disclosure of HCV diagnosis and their thoughts on the intervention e.g. number of alters approached. I will also talk to sexual health clinic staff about who they decide to test or not test for HCV and why. 2. Use the interview data to help design a questionnaire exploring HCV risk factors and social (and sexual) networks. The questionnaire will be piloted and refined with MSM. 3. Pilot the SNDR method of recruiting and testing. 4. Evaluate the data to look at the networks among MSM and the risk of hepatitis C infection.This information will provide new insight into the networks of MSM and look for other at risk groups. Participants will be given information about HCV and the results of their HCV test. I will continue to involve patients and the public in the study to make sure its findings reach the public as well as researchers and medical teams. The findings from this feasibility study can be used to plan a randomised controlled trial to determine the efficacy of this strategy. Public health benefits of this randomised controlled trial include better targeted testing and understanding of how HCV spreads.