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Abstract：
BACKGROUND: Accurate prevalence estimates of drug use and its harms are important to characterize burden and develop interventions to reduce negative health outcomes and disparities. Lack of a sampling frame for marginalized/stigmatized populations, including persons who use drugs (PWUD) in rural settings, makes this challenging. Respondent-driven sampling (RDS) is frequently used to recruit PWUD. However, the validity of RDS-generated population-level prevalence estimates relies on assumptions that should be evaluated.
METHODS: RDS was used to recruit PWUD across seven Rural Opioid Initiative studies between 2018-2020. To evaluate RDS assumptions, we computed recruitment homophily and design effects, generated convergence and bottleneck plots, and tested for recruitment and degree differences. We compared sample proportions with three RDS-adjusted estimators (two variations of RDS-I and RDS-II) for five variables of interest (past 30-day use of heroin, fentanyl, and methamphetamine; past 6-month homelessness; and being positive for hepatitis C virus (HCV) antibody) using linear regression with robust confidence intervals. We compared regression estimates for the associations between HCV positive antibody status and (a) heroin use, (b) fentanyl use, and (c) age using RDS-1 and RDS-II probability weights and no weights using logistic and modified Poisson regression and random-effects meta-analyses.
RESULTS: Among 2,842 PWUD, median age was 34 years and 43% were female. Most participants (54%) reported opioids as their drug of choice, however regional differences were present (e.g., methamphetamine range: 4-52%). Many recruitment chains were not long enough to achieve sample equilibrium. Recruitment homophily was present for some variables. Differences with respect to recruitment and degree varied across studies. Prevalence estimates varied only slightly with different RDS weighting approaches, most confidence intervals overlapped. Variations in measures of association varied little based on weighting approach.
CONCLUSIONS: RDS was a useful recruitment tool for PWUD in rural settings. However, several violations of key RDS assumptions were observed which slightly impacts estimation of proportion although not associations.
METHODS: RDS was used to recruit PWUD across seven Rural Opioid Initiative studies between 2018-2020. To evaluate RDS assumptions, we computed recruitment homophily and design effects, generated convergence and bottleneck plots, and tested for recruitment and degree differences. We compared sample proportions with three RDS-adjusted estimators (two variations of RDS-I and RDS-II) for five variables of interest (past 30-day use of heroin, fentanyl, and methamphetamine; past 6-month homelessness; and being positive for hepatitis C virus (HCV) antibody) using linear regression with robust confidence intervals. We compared regression estimates for the associations between HCV positive antibody status and (a) heroin use, (b) fentanyl use, and (c) age using RDS-1 and RDS-II probability weights and no weights using logistic and modified Poisson regression and random-effects meta-analyses.
RESULTS: Among 2,842 PWUD, median age was 34 years and 43% were female. Most participants (54%) reported opioids as their drug of choice, however regional differences were present (e.g., methamphetamine range: 4-52%). Many recruitment chains were not long enough to achieve sample equilibrium. Recruitment homophily was present for some variables. Differences with respect to recruitment and degree varied across studies. Prevalence estimates varied only slightly with different RDS weighting approaches, most confidence intervals overlapped. Variations in measures of association varied little based on weighting approach.
CONCLUSIONS: RDS was a useful recruitment tool for PWUD in rural settings. However, several violations of key RDS assumptions were observed which slightly impacts estimation of proportion although not associations.
摘要：
背景：药物使用及其危害的准确患病率估计对于表征负担和制定干预措施以减少负面健康结果和差异非常重要。缺乏边缘化/受污名化人口的抽样框架，包括在农村地区使用毒品（PWUD）的人，使这具有挑战性。受访者驱动的抽样（RDS）经常用于招募PWUD。然而,RDS生成的人群患病率估计值的有效性依赖于应评估的假设.
方法：在2018-2020年间，在7项农村阿片类药物倡议研究中，使用RDS招募PWUD。要评估RDS假设，我们计算了招聘的同质性和设计效果，生成的收敛和瓶颈图，并测试招聘和学位差异。我们将样本比例与三个RDS调整的估计器（RDS-I和RDS-II的两个变体）进行了五个感兴趣的变量（过去30天使用海洛因，芬太尼,和甲基苯丙胺;过去6个月无家可归;并使用具有稳健置信区间的线性回归对丙型肝炎病毒（HCV）抗体呈阳性）。我们比较了HCV阳性抗体状态和（a）海洛因使用之间的关联的回归估计，(b)使用芬太尼，（c）使用RDS-1和RDS-II概率权重的年龄，使用逻辑和改进的泊松回归和随机效应荟萃分析的无权重。
结果：在2,842名PWUD中，中位年龄为34岁,43%为女性.大多数参与者（54％）报告阿片类药物是他们选择的药物，然而，存在区域差异(例如，甲基苯丙胺范围：4-52％）。许多招聘链的长度不足以实现样本均衡。对于一些变量，招募同性恋是存在的。在不同的研究中，招聘和学位方面的差异各不相同。患病率估计值仅随RDS加权方法的不同而略有不同，大多数置信区间重叠。基于加权方法，关联度量的变化不大。
结论：RDS是农村地区PWUD的有用招募工具。然而,观察到一些违反关键RDS假设的行为,这些行为轻微影响了对比例的估计,尽管没有关联.
方法：在2018-2020年间，在7项农村阿片类药物倡议研究中，使用RDS招募PWUD。要评估RDS假设，我们计算了招聘的同质性和设计效果，生成的收敛和瓶颈图，并测试招聘和学位差异。我们将样本比例与三个RDS调整的估计器（RDS-I和RDS-II的两个变体）进行了五个感兴趣的变量（过去30天使用海洛因，芬太尼,和甲基苯丙胺;过去6个月无家可归;并使用具有稳健置信区间的线性回归对丙型肝炎病毒（HCV）抗体呈阳性）。我们比较了HCV阳性抗体状态和（a）海洛因使用之间的关联的回归估计，(b)使用芬太尼，（c）使用RDS-1和RDS-II概率权重的年龄，使用逻辑和改进的泊松回归和随机效应荟萃分析的无权重。
结果：在2,842名PWUD中，中位年龄为34岁,43%为女性.大多数参与者（54％）报告阿片类药物是他们选择的药物，然而，存在区域差异(例如，甲基苯丙胺范围：4-52％）。许多招聘链的长度不足以实现样本均衡。对于一些变量，招募同性恋是存在的。在不同的研究中，招聘和学位方面的差异各不相同。患病率估计值仅随RDS加权方法的不同而略有不同，大多数置信区间重叠。基于加权方法，关联度量的变化不大。
结论：RDS是农村地区PWUD的有用招募工具。然而,观察到一些违反关键RDS假设的行为,这些行为轻微影响了对比例的估计,尽管没有关联.
