HIV incidence among men who have sex with men using geosocial networking smartphone application in Beijing, China: an open cohort study

Background:Sexual transmission among men who have sex with men(MSM)is the dominant route of HIV transmission in China.Extensive use of geosocial networking(GSN)smartphone application(app)has dramatically changed the pattern of sexual behaviors and HIV risk among MSM;but data on HIV incidence and the changing risk behaviors of GSN app-using MSM are limited.We aims to assess the HIV incidence and its correlates among gay GSN app-using MSM in China.Methods:We constructed an open cohort which was initiated and maintained using a GSN app to assess the HIV incidence among app-using MSM,recruited from June 2017 to December 2018.MSM completed an online questionnaire on their sociodemographic characteristics,sexual behaviors,recreational drug use and sexually transmitted infections status.Then each man had an HIV test,and those tested negatives were enrolled into the cohort.Participants completed follow-ups with additional HIV tests though the app during the study period,and were censored at HIV seroconversion or study end date.HIV incidence was calculated by dividing the sum of observed HIV seroconversions by the observed person-time.Univariate(Chi-square test and Fisher's exact test)and multivariate(proportional hazards regression)analyses were used to examine correlates of HIV incidence.Results:A total of 6957 HIV negative MSM were enrolled in the open cohort,37 seroconversions occurred among 1937 men contributing 1065 observed person-years:HIV incidence was 3.47 per 100 person-years[95%confidence interval(Cl):2.37-4.57].More than five sexual partners[hazard ratio(HR)=2.65,95%Cl:1.04-6.67],and sex with HIV positive partners(HR=3.82,95%Cl:1.16-12.64)in the preceding six months were positively associated with HIV seroconversion.Consistent condom use for anal sex(HR=0.27,95%Cl:0.07-0.96),and reporting insertive anal sex only(HR=0.23,95%Cl:0.08-0.62)in the preceding six months were protective factors for HIV seroconversion.Conclusions:Tailored interventions targeting app-using MSM are urgently needed given their high risk of HIV.As a new tool for accessing MSM at higher HIV risk,GSN smartphone app could play an important role in HIV research among MSM.

Crowdsourcing in health and medical research:a systematic review

Background:Crowdsourcing is used increasingly in health and medical research.Crowdsourcing is the process of aggregating crowd wisdom to solve a problem.The purpose of this systematic review is to summarize quantitative evidence on crowdsourcing to improve health.Methods:We followed Cochrane systematic review guidance and systematically searched seven databases up to September 4th 2019.Studies were included if they reported on crowdsourcing and related to health or medicine.Studies were excluded if recruitment was the only use of crowdsourcing.We determined the level of evidence associated with review findings using the GRADE approach.Results:We screened 3508 citations,accessed 362 articles,and included 188 studies.Ninety-six studies examined effectiveness,127 examined feasibility,and 37 examined cost.The most common purposes were to evaluate surgical skills(17 studies),to create sexual health messages(seven studies),and to provide layperson cardiopulmonary resuscitation(CPR)out-of-hospital(six studies).Seventeen observational studies used crowdsourcing to evaluate surgical skills,finding that crowdsourcing evaluation was as effective as expert evaluation(low quality).Four studies used a challenge contest to solicit human immunodeficiency virus(HIV)testing promotion materials and increase HIV testing rates(moderate quality),and two of the four studies found this approach saved money.Three studies suggested that an interactive technology system increased rates of layperson initiated CPR out-ofhospital(moderate quality).However,studies analyzing crowdsourcing to evaluate surgical skills and laypersoninitiated CPR were only from high-income countries.Five studies examined crowdsourcing to inform artificial intelligence projects,most often related to annotation of medical data.Crowdsourcing was evaluated using different outcomes,limiting the extent to which studies could be pooled.Conclusions:Crowdsourcing has been used to improve health in many settings.Although crowdsourcing is effective at improving behavioral outcomes,more research is needed to understand effects on clinical outcomes and costs.More research is needed on crowdsourcing as a tool to develop artificial intelligence systems in medicine.