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Validity of self-reported needle exchange attendance among injection drug users: implications for program evaluation
Mahboobeh Safaeian1, Ron Brookmeyer, David Vlahov
1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
American Journal of Epidemiology
|January 16, 2002
Summary
Self-reported needle exchange program (NEP) attendance may inaccurately affect human immunodeficiency virus (HIV) risk estimates. Verifying NEP use with program records is crucial for accurate HIV prevention program evaluations.
Area of Science:
- Public Health
- Epidemiology
- Infectious Disease Prevention
Background:
- Needle exchange programs (NEPs) aim to reduce human immunodeficiency virus (HIV) transmission among injection drug users.
- Conflicting evidence exists regarding NEP effectiveness, potentially due to reliance on self-reported attendance data.
- Differential misreporting of NEP attendance can bias estimates of HIV risk and prevention program efficacy.
Purpose of the Study:
- To assess the accuracy of self-reported NEP attendance compared to official program records.
- To investigate how misreporting of NEP attendance influences estimates of HIV risk factors and seroconversion.
- To quantify the impact of self-reported versus actual NEP use on observed associations with HIV incidence.
Main Methods:
- Prospective cohort study in Baltimore, Maryland (1994-1997) involving 1,315 participants.
- Comparison of self-reported NEP attendance with verified attendance data from the Baltimore NEP.
- Multivariate analyses (generalized estimating equations, Poisson regression) to model predictors of HIV seroconversion and assess bias.
Main Results:
- 86.7% concordance between self-reported and actual NEP attendance; significant overreporting (11.0%) and underreporting (2.2%) occurred.
- Overreporters were more likely to inject drugs frequently, deny needle sharing, and be HIV seroconverters.
- Models using self-reported NEP data underestimated the protective association against HIV seroconversion by 18% compared to models using actual program data.
Conclusions:
- Self-reported NEP attendance is prone to significant misreporting, impacting HIV risk and prevention evaluations.
- Accurate assessment of NEP attendance using program records is essential for reliable estimation of program effectiveness.
- Findings highlight the need for improved data collection methods in studies evaluating harm reduction interventions like NEPs.