OPINION LEADER HIV INTERVENTION AMONG MIGRANT CHINESE

来自加州大学洛杉矶分校、中国预防医学研究院和上海公共卫生学院的艾滋病协作组提出，在安徽省20个村庄的农民工中实施民意领袖(POL)模式来预防艾滋病毒，中国说。中国代表着世界四分之一的人口，艾滋病疫情迅速蔓延，目前已有约120万人感染，比所有亚洲国家的总和还要多。与非洲和印度类似，该国2亿至2.5亿劳动力移民是疫情未来的关键，然而，艾滋病毒感染主要发生在农村地区(75%的人口)，移民在每年迁入城市时以异性方式传播病毒。在流动人口外出工作期间，所有流动人口每年返回村庄两次(允许一年两次的跟踪评估，留存率超过90%)，并每年有大约4个月的时间接受干预。建议在沿海城市开展以乡村为重点的干预和补充艾滋病毒预防活动。在第一阶段，拟开展两项活动：1)人种学研究，为干预设计提供信息；2)对村庄选择、艾滋病毒/性传播疾病比率以及评估和质量保证程序的制定进行可行性研究。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油污干预进行试点研究，以测试所有程序的执行情况。在第三阶段的主要试验中，将首先在区域层面、安徽省内阜阳地区的北部和南部地区进行随机抽样。在一个地区内，将随机选择10个村庄，并在另一个地区(在社会经济地位、规模、移民比例和识字率方面)匹配10个村庄，从而产生120个流动人口、630个流动人口、每个地区1500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，以及在农村和城市持续获得艾滋病毒/STD检测、避孕套和性病治疗；或2)非干预控制条件。在24个月内，将评估移民和非移民村民在基线、6个月、12个月、18个月和24个月时在干预条件下与对照条件下的艾滋病毒相关初级结果(性传播疾病/艾滋病毒感染率、性风险)和次级结果(社会规范、收养率)。在第四阶段，将完成对结果的分析和传播。ACT成功实施该项目的基础是：以前成功的艾滋病毒预防试验，包括对中国的干预，以及对艾滋病毒相关合作协议的参与；有经验的中国合作者、官员和组织对该项目的支持；对中国遗址的访问；与有经验的中国研究人员的合作，其中几人曾在加州大学洛杉矶分校接受过培训；以及加州大学洛杉矶分校新公共卫生学院质量核心的合作。

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.