Feasibility, acceptability and preliminary effects of a social network-based, peer-led HIV self-testing intervention among men in two Ugandan fishing communities

Abstract

Background Social network-based interventions can improve uptake of health interventions. However, limited evidence exists on their feasibility and acceptability in fishing community settings. We assessed the feasibility, acceptability and preliminary effects of a social network-based, peer-led HIV self-testing (HIVST) intervention among men in Uganda. Methods The PEer-led HIVST intervention for MEN (PEST4MEN) is a pilot intervention conducted among men (15 + years) in Kalangala and Buvuma island districts. Data were collected between July and September 2022. The intervention was implemented through 22 “peer-leaders” who were trained in HIVST use and distribution processes and requested to refer at least 20 members from their social networks. A total of 475 men were referred; of these, 400 met the study enrolment criteria. Enrolled men were administered a baseline questionnaire and requested to pick two kits from their peer-leaders. The intervention was deemed feasible if > 80% of the kits given to the peer-leaders were distributed to men within their social networks and acceptable if > 80% of those who received the kits used them to self-test for HIV. First-time HIV-positive testers were asked if they linked to HIV care. Data were analyzed using STATA version 16.0. Results Of 400 men, 272 (67.9%) were aged 18–34 years; 227 (56.7%) were engaged in fishing or fishing-related activities while 328 (82%) had ever tested for HIV. Of 361 men (90.2%) interviewed at follow-up, 355 (98.3%) reported that they received kits from their peer-leaders; 352 (99.1%) used them to self-test for HIV. Of those who self-tested, 339 (96.3%) returned used kits for re-reading. Fifty-one men (14.5%) had reactive self-test results; of these, 16 men (31.4%) were first-time HIV-positive testers. Of first-time HIV-positive testers, 14 men (87.5%) went for confirmatory HIV testing, seven men (50%) were confirmed as HIV-positive and five men (71.4%) were linked to HIV care. Conclusion Our peer-led HIVST intervention was feasible and acceptable and identified a sizeable proportion of previously undiagnosed HIV-positive men who were linked to HIV care. However, while these results are promising, we recommend additional research in a large study, preferably in other fishing community settings, prior to the roll-out of this intervention. Trial registration ClinicalTrials.Gov: NCT05685498 (retrospectively registered on January 17, 2023).