Journal of Urban Health

, Volume 87, Issue 2, pp 304–317 | Cite as

Evaluating Recruitment among Female Sex Workers and Injecting Drug Users at Risk for HIV Using Respondent-driven Sampling in Estonia

  • Anneli Uusküla
  • Lisa G. Johnston
  • Mait Raag
  • Aire Trummal
  • Ave Talu
  • Don C. Des Jarlais


Few recent publications have highlighted theoretical and methodological challenges using respondent-driven sampling (RDS). To explore why recruitment with RDS may work in some populations and not in others, we assess the implementation of RDS to recruit female sex workers (FSWs) and injection drug users (IDUs) into a human immunodeficiency virus biological and risk behavior survey in Tallinn, Estonia. Recruitment of FSWs was slower and more challenging than that of IDUs. The IDU study recruited 350 participants within 7 weeks, while the FSW study recruited 227 participants over 28 weeks. Implementation modifications that did not negatively impact key RDS theoretical and methodological requirements were used to improve recruitment during the FSW study. We recommend that all RDS studies include a formative research process to involve the participation of target populations and key persons associated with these populations in the study planning and throughout the implementation processes to improve recruitment from the outset and to respond to poor recruitment during data collection.


Injecting drug users Female sex workers Respondent-driven sampling HIV Estonia 



This research was supported in part through grant R01 DA 03574 from the US National Institute on Drug Abuse, by the Global Fund to Fight AIDS, Tuberculosis, and Malaria who funded this study through the National Institute for Health Development in Estonia (EST-202-G01-H-00), Norwegian Financial Mechanism/EEA (grant EE0016) and by US Civilian Research Development Foundation grant (ESX0-2722-TA-06).

Authors express their gratitude to the teams at the NGOs Me Aitame Sind, Corrigo, and to all participants of the study.

The content of this paper has not been published elsewhere, nor is it being considered elsewhere, nor are there any conflicts of interest contained therein.


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Copyright information

© The New York Academy of Medicine 2010

Authors and Affiliations

  • Anneli Uusküla
    • 1
  • Lisa G. Johnston
    • 2
  • Mait Raag
    • 1
  • Aire Trummal
    • 3
  • Ave Talu
    • 4
  • Don C. Des Jarlais
    • 5
  1. 1.Department of Public HealthUniversity of TartuTartuEstonia
  2. 2.School of Public Health and Tropical MedicineTulane UniversityNew OrleansUSA
  3. 3.Department of Surveillance and EvaluationNational Institute for Health DevelopmentTallinnEstonia
  4. 4.Estonian Drug Monitoring CenterNational Institute for Health DevelopmentTallinnEstonia
  5. 5.Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical CenterNew YorkUSA

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