A national recruitment strategy for HIV-serodiscordant partners living in Canada for the Positive Plus One study: a mixed-methods study

Min Xi; Sandra Bullock; Joshua B Mendelsohn; James Iveniuk; Veronika Moravan; Ann N Burchell; Darrell H S Tan; Amrita Daftary; Tamara Thompson; Bertrand Lebouché; Laura Bisaillon; Ted Myers; Liviana Calzavara

doi:10.1186/s12889-022-13153-5

A national recruitment strategy for HIV-serodiscordant partners living in Canada for the Positive Plus One study: a mixed-methods study

BMC Public Health. 2022 Apr 26;22(1):832. doi: 10.1186/s12889-022-13153-5.

Authors

Min Xi^{1

2

3}, Sandra Bullock⁴, Joshua B Mendelsohn⁵, James Iveniuk⁶, Veronika Moravan⁷, Ann N Burchell^{3

8

9}, Darrell H S Tan^{2

8

10}, Amrita Daftary¹¹, Tamara Thompson¹², Bertrand Lebouché^{13

14

15}, Laura Bisaillon¹⁶, Ted Myers³, Liviana Calzavara³

Affiliations

¹ KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada.
² Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada.
³ Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
⁴ Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada. s.bullock@utoronto.ca.
⁵ College of Health Professions, Pace University, New York, 10038, USA.
⁶ Academic Research Centers, NORC at the University of Chicago, Chicago, IL, 60637, USA.
⁷ VM Stats, Toronto, ON, M5A 4R3, Canada.
⁸ MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, M5B 1W8, Canada.
⁹ Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, M5G 1V7, Canada.
¹⁰ Division of Infectious Diseases, St Michael's Hospital, Unity Health Toronto, Toronto, ON, M5B 1W8, Canada.
¹¹ School of Global Health and Dahdaleh Institute for Global Health Research, York University, Toronto, ON, M3J 1P3, Canada.
¹² Faculty of Health Sciences, Douglas College, Coquitlam, BC, V3B 7X3, Canada.
¹³ Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, H3S 1Z1, Canada.
¹⁴ Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre Montreal, Montreal, QC, H4A 3J1, Canada.
¹⁵ Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, H4A 35S, Canada.
¹⁶ Department of Health and Society, University of Toronto Scarborough, Toronto, ON, M1C 1A4, Canada.

Abstract

Background: With the recent shift in focus to addressing HIV risk within relationships and couple-based interventions to prevent HIV transmission, successful recruitment of individuals involved in HIV-serodiscordant relationships is crucial. This paper evaluates methods used by the Positive Plus One (PP1) study to recruit and collect data on a diverse national sample of dyads and individuals involved in current or past HIV-serodiscordant relationships, discusses the strengths and limitations of the recruitment approach, and makes recommendations to inform the interpretation of study results and the design of future studies.

Methods: PP1 used a multi-pronged approach to recruit adults involved in a current or past HIV-serodiscordant relationship in Canada from 2016 to 2018 to complete a survey and an interview. Upon survey completion, index (first recruited) partners were invited to recruit their primary current HIV-serodiscordant partner. We investigated participant enrollment by recruitment source, participant-, relationship-, and dyad-level sociodemographic characteristics, missing data, and correlates of participation for individuals recruited by their partners.

Results: We recruited 613 participants (355 HIV-positive; 258 HIV-negative) across 10 Canadian provinces, including 153 complete dyads and 307 individuals who participated alone, and representing 460 HIV-serodiscordant relationships. Among those in current relationships, HIV-positive participants were more likely than HIV-negative participants to learn of the study through an ASO staff member (36% v. 20%, p < 0.001), ASO listserv/newsletter (12% v. 5%, p = 0.007), or physician/staff at a clinic (20% v. 11%, p = 0.006). HIV-negative participants involved in current relationships were more likely than HIV-positive participants to learn of the study through their partner (46% v. 8%, p < 0.001). Seventy-eight percent of index participants invited their primary HIV-serodiscordant partner to participate, and 40% were successful. Successful recruitment of primary partners was associated with longer relationship duration, higher relationship satisfaction, and a virally suppressed HIV-positive partner.

Conclusions: Our findings provide important new information on and support the use of a multi-pronged approach to recruit HIV-positive and HIV-negative individuals involved in HIV-serodiscordant relationships in Canada. More creative strategies are needed to help index partners recruit their partner in relationships with lower satisfaction and shorter duration and further minimize the risk of "happy couple" bias.

Keywords: Canada; Dyad; HIV; HIV-serodiscordant couple; Recruitment; Study design; Study method.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Canada
HIV Infections* / prevention & control
Humans
Sexual Behavior
Sexual Partners*