应用Rasch模型对浙江省男男性行为者HIV感染相关性行为风险评估

Risk assessment of HIV infection-related sexual behavior among MSM: a Rasch model approach

目的应用罗氏(Rasch)模型在男男性行为者(MSM)中开展艾滋病病毒(HIV)相关的高危性行为风险测量,以评估不同类型的高危性行为对感染HIV的危险程度和排序。方法采用同伴推动抽样法(RDS)选取浙江省的杭州、宁波和温州共1 316名MSM开展横断面研究。通过Rasch模型方法评估由12项高危性行为组成的HIV性风险量表。结果Rasch分析结果表明,12项高危性行为满足模型使用的单维性和局部独立性要求。虽然个体信度较低,但是项目信度较高,达0.94。拟合度分析显示,各高危性行为条目与模型拟合较好,其拟合度指标infit和outfit均在可接受范围内。项目难度系数显示"与临时男性性伴有不安全肛交性行为"对感染HIV的风险最大。结论Rasch模型可在MSM中用来测量HIV感染相关性行为风险的水平,并建立每一种高危性行为对HIV传播的风险程度,为在MSM中开展HIV行为干预的设计和评估提供测量工具。

Objective To assess the severity and order of different types of sexual behaviors related to HIV/STI infection by using Rasch model among men who have sex with men(MSM).Methods A cross-sectional study using respondent-driven sampling was conducted among 1 316 MSM in the cities of Hangzhou,Ningbo and Wenzhou in Zhejiang province.The Rasch model was used to examine the psychometric properties of an HIV/STI sexual risk scale including 12 types of sexual behaviors.Results The Rasch analysis of the 12 items met the unidimensional and local independence assumption.Although the individual reliability was low at 0.08,the item reliability was relatively high,reaching 0.94.The fit statistics provided acceptable infit and outfit values.Item difficulty estimation showed that"having unsafe anal sex with a temporary male partner"was the most risky for HIV infection.Conclusion The findings suggest that the Rasch model can be utilized for measuring the level of sexual risks for HIV/STI infection as a single latent construct and for establishing the relative degree of severity of each type of sexual behaviors in HIV/STI transmission and acquisition among MSM.The measurement scale provides a useful tool to inform,design and evaluate behavioral interventions for HIV/STI infection among MSM.