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合作小组（ACT）提出在中国安徽省20个村庄的农民工中实施民意领袖（POL）预防艾滋病模型。占世界人口四分之一的中国，艾滋病毒迅速蔓延，已有大约120万人感染，比所有亚洲国家的总和还多。与非洲和印度类似，该国2 - 2.5亿流动劳工是未来艾滋病流行的关键，然而，艾滋病毒感染主要发生在农村地区（占人口的75%），每年移民到城市时通过异性恋传播病毒。当移民外出工作时，所有移民每年返回村庄两次（允许一年两次的随访评估，保留率超过90%），每年约有4个月的时间接受干预。提出了一项以村庄为重点的干预措施，并在沿海城市开展补充艾滋病毒预防活动。在第一阶段，建议开展两项活动：1)进行民族志研究，为干预设计提供信息；2)对村庄选择、艾滋病毒/性病发病率以及制定评估和质量保证程序进行可行性研究。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POL干预措施进行试点研究，以测试所有程序的实施情况。在第三阶段的主要试验中，随机化将首先在地区层面进行，即安徽省阜阳市北部和南部地区。在一个地区内随机选择10个村庄，在另一个地区匹配10个村庄（社会经济地位、规模、移民比例、识字率），得到120个移民POL；630移民;每个地区1500人。一旦匹配，区域内的村庄将被随机分配：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个月的时间里，与基线、6个月、12个月、18个月和24个月的对照组相比，将评估干预条件下移民和非移民村民与艾滋病毒相关的初级（性病/艾滋病毒感染率、性风险）和二级（社会规范、采用率）结果。在第四阶段，将完成分析和传播结果。ACT成功实施该项目的能力基于：之前在中国成功的艾滋病预防试验，包括干预措施，以及参与艾滋病相关合作协议；经验丰富的中国合作者、官员和组织对项目的支持；访问中国境内的网站；与经验丰富的中国调查人员合作，其中一些人曾在加州大学洛杉矶分校接受培训；以及加州大学洛杉矶分校新项目质量核心的合作。

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.