OPINION LEADER HIV INTERVENTION AMONG MIGRANT CHINESE

来自加州大学洛杉矶分校、中国预防医学科学院和上海公共卫生学院的艾滋病合作小组（ACT）建议在中国安徽省20个村庄的农民工中实施艾滋病预防的民意领袖（POL）模式。 占世界人口四分之一的中国，艾滋病疫情迅速蔓延，已有约120万人感染，超过所有亚洲国家的总和。 与非洲和印度类似，该国的2亿至2.5亿劳动力移民是艾滋病未来的关键，然而，艾滋病毒感染主要发生在农村地区（占人口的75%），移民每年迁移到城市时通过异性传播病毒。 虽然移徙者外出打工，但所有移徙者每年返回村庄两次（允许一年两次的后续评估，保留率超过90%），每年约有4个月接触干预措施。 建议采取以村庄为重点的干预措施，并在沿海城市开展艾滋病毒预防补充活动。 在第一阶段，建议开展两项活动：1）人种学研究，为干预措施的设计提供信息; 2）村庄选择、艾滋病毒/性传播疾病发病率以及制定评估和质量保证程序的可行性研究。在人种学的基础上，在第二阶段，将在一个村庄和一个对照村庄对拟议的POL干预措施进行试点研究，以测试所有程序的实施情况。 在III期（主试验）中，随机化将首先在安徽省阜阳地区的北方和南方进行。 在一个区域内，将随机选择10个村庄，在另一个区域内选择10个村庄（在社会经济地位、规模、移民百分比和识字率方面），结果是120名移民POL; 630名移民;每个区域1 500名村民。 一旦匹配，区域内的村庄将被随机分配到：1）POL干预，包括艾滋病毒预防社会营销活动，POL培训以传播预防信息，以及在村庄和城市持续获得艾滋病毒/性病检测，避孕套和性病治疗;或2）非干预控制条件。 在24个月内，艾滋病毒相关的主要（性病/艾滋病毒感染率，性风险）和次要（社会规范，收养率）的结果将在干预条件下的流动人口和非流动人口的村民相比，在基线，6，12，18和24个月的控制条件进行评估。 在第四阶段，将完成对结果的分析和传播。 ACT成功实施该项目的能力基于：以前成功的艾滋病毒预防试验，包括在中国的干预措施，以及参与艾滋病毒相关合作协议;来自经验丰富的中国合作者、官员和组织的项目支持;进入中国的研究中心;与经验丰富的中国研究人员合作，其中一些人曾在加州大学洛杉矶分校接受过培训;和UCLA-NPI的定性核心的合作。

An AIDS Collaborative Team (ACT) from UCLA, the Chinese Academy of Preventive Medicine and Shanghai School of Public Health proposes to implement the Popular Opinion Leader (POL) model for HIV prevention among migrant workers from 20 villages in Anhui Province, China. China, representing 1/4th of the world's population, has a rapidly emerging HIV epidemic with about 1.2 million already infected, more than the total of all the Asian nations combined. Similar to Africa and India, the country's 200-250 million labor migrants are a key to the epidemic's future, however, HIV infection is redominantly occurring in rural settings (75 percent of population) and migrants transmit the virus heterosexually when moving to the cities annually. While migrants travel for jobs, all migrants return to villages twice a year (allowing biannual follow-up assessments with greater than 90 percent retention) and for about 4 months a year to be exposed to the intervention. A village-focused intervention is proposed with supplementary HIV prevention activities in the costal cities. During Phase 1, two activities are proposed: 1) an ethnographic study to inform the intervention design; and 2) feasibility studies of village selection, HIV/STD rates, and development of assessment and quality assurance procedures. Building on the ethnography, in Phase 2, a pilot study of the proposed POL intervention will be conducted in 1 village with a contrast village to test implementation of all procedures. In Phase 3, the main trial, randomization will occur first at the level of region, the Northern and Southern Regions of Fuyang Prefecture within Anhui Province. Within one region, 10 villages will be randomly selected and 10 villages will be matched in the other region (on SES, size, percent of migrants, and literacy) resulting in 120 migrant POL; 630 migrants; 1,500 villagers per region. Once matched, villages within region will be randomly assigned to either: 1) the POL intervention that includes HIV prevention social marketing campaigns, POL training to diffuse prevention messages, and ongoing access in villages and cities to HIV/STD testing, condoms, and treatment for STD; or 2) a non- intervention control condition. Over 24 months, HIV-related primary (STD/HIV rates, sexual risk) and secondary (social norms, rate of adoption) outcomes will be assessed among migrants and the non-migrant villagers in the intervention condition compared to those in the control condition at baseline, 6, 12, 18 and 24 months. In Phase 4, analysis and dissemination of the results will be completed. The ACT's ability to successfully implement the project is based on: previous successful HIV prevention trials including interventions in China, and participation in HIV-related cooperative agreements; support of the project from experienced Chinese collaborators, officials and organizations; access to sites in China; collaboration with experienced Chinese investigators several of whom have trained at UCLA; and collaboration of the Qualitative Core of the UCLA-NPI.