Evaluation of the National HIV Behavioral Surveillance System Among Men Who Have Sex With Men in Denver, Colorado

BACKGROUND: The National HIV Behavioral Surveillance System (NHBS) is a 20-site cyclical survey of those at increased HIV risk, including men who have sex with men (MSM). NHBS measures progress toward the National HIV/AIDS Strategy goal of reducing new infections by assessing trends in HIV risk, testing behaviors, and prevalence. MSM cycles utilize a time-space venue-based sampling approach. Our objective was to assess implementation of the MSM2 and MSM3 cycles in Denver, conducted in 2008 and 2011, respectively.

METHODS: Local stakeholder input and reviews of protocols, local formative research, and process indicators informed assessment of the following attributes: acceptability, flexibility, and simplicity. Three alternative local and national data sources have been identified for evaluation of data quality, representativeness, and system sensitivity, pending approval by the local institutional review board.

RESULTS: Acceptability: NHBS staff expressed satisfaction with venue selection, recruitment methods, and data security. A handful of venue owners refused access to their venue, concerned about negative impact on their customers. In MSM2, 47% of individuals approached accepted screening for eligibility; 100% of those eligible were interviewed; 84% of those interviewed accepted HIV testing. In MSM3, 36% of those approached were screened; 100% of those eligible were interviewed; 92% of those interviewed accepted HIV testing.  Flexibility: Sites may select any venues that represent the local MSM population and meet certain criteria. Inclusion of a local questionnaire with the core questionnaire allows sites to assess emerging trends in their MSM populations.  Simplicity: Each cycle requires a year for formative research, data collection, and data cleaning. In Denver, ~9 staff participated in formative research activities; 4 full-time and approximately 15 part-time staff were needed for data collection on >500 eligible participants. Each completed interview required approximately 2.2 contract staff hours, in addition to varying effort from full-time staff. Data cleaning included correction of 101 errors in MSM2 and 298 in MSM3. The addition of a Data Coordinating Center in MSM3 increased simplicity of venue scheduling and improved data management efficiency.

CONCLUSIONS: In Denver, NHBS-MSM acceptability is high in staff, excellent among eligible participants, and fair among venue owners. Local flexibility is high and balanced with the needs of a national system. The system is not simple; it is resource-intensive and subject to error but captures extensive participant data. Local analysis and dissemination of results are limited by resource constraints. Assessment of quantitative attributes will permit further evaluation of this system.