Paper # 852|
Use of Time-Location Sampling for HIV Surveillance in Street Youth
Dmitry Kissin*1, L Zapata1, C Robbins1, R Yorick2, N Shevchenko3, E Finnerty4, D Jamieson1, P Marchbanks1, and S Hillis1
1CDC, Atlanta, GA, US; 2HlthRight Intl, St Petersburg, Russia; 3HlthRight Intl, Kiev, Ukraine; and 4HlthRight Intl, New York, NY, US
Background: Accurate HIV surveillance of
hard-to-reach populations is critical to the global “know your epidemic”
mandate. Although half of new HIV cases occur in youth globally, reliable data
on HIV seroprevalence among street and out-of-school youth, a subpopulation of
youth who are more vulnerable to acquiring HIV, are largely unavailable. We
adapted time-location sampling to assess HIV seroprevalence among street and
out-of-school youth in 4 Eastern European cities.
Methods: Cross-sectional assessments were conducted in
St. Petersburg, Russia (April to May 2006) and Kiev, Odessa and Donetsk, Ukraine (May 2008 to December 2008). Comprehensive mapping of all street youth
locations in each city was conducted to develop city-specific sampling frames. Since
the population of street youth occupying a given site did not vary by day of
the week or time of day, random selection of sites did not require allowances
for day or time. Sites selected into the sample were visited during hours of maximum
street youth activity. The assessment included rapid HIV testing for all
consenting 15 to 24 year olds (15 to 19 year olds in St. Petersburg) street
youth at selected sites and an interviewer-administered survey. Adjusted odds
ratios (AOR) were calculated using logistic regression.
Results: A total of 132 sites were identified, of
which 96 were randomly selected to enroll approximately 300 youth per city.
Common locations included metro or train stations, street markets, feeding
centers or fast-food sites, parks and computer clubs. Of 1,499 youth
approached, 1,300 (86.7%) were eligible for participation and 1,242 (95.5%) of
those were enrolled. HIV seroprevalence in street youth was 37.4% in Russia and 18.4% in Ukraine. Characteristics independently associated with HIV infection among
street youth in Russia and Ukraine, respectively, included: injection drug use
(AOR 23.0 and 9.0), sharing needles (AOR 13.3 and 6.8), being diagnosed with a sexually
transmitted infection (AOR 2.1 and 2.8), being an orphan/lack of parental support
(AOR 3.3 and 1.7).
Conclusions: Time-location sampling is a probability
sampling methodology that can be successfully utilized in hard-to-reach
populations. It is an efficient, inexpensive, reproducible and accurate method
of HIV surveillance in street and out-of-school youth. Using this methodology,
we found that street youth in Russia and Ukraine have extremely high HIV
seroprevalences associated with social, sexual and drug-related factors.