Increasing HIV Testing Among Sexual and Gender Expansive Men in Kazakhstan: A Stepped-Wedge Randomized Trial of a Community-Level Intervention

Abstract

ABSTRACTImportanceHIV transmission in Kazakhstan has increased among men who have sex with men (MSM) and transgender and nonbinary people who have sex with men (TSM), driven by low HIV testing rates.ObjectiveTo determine if thePRIDE in HIV Careintervention had a community effect of increasing HIV testing among MSM and TSM in Kazakhstan.DesignWe employed a stepped-wedge, cluster-randomized controlled trial with MSM and TSM community members recruited from three cities in Kazakhstan: Almaty, Astana, and Shymkent. We collected serial cross-sectional data where community members completed one assessment between 21 August 2018, and 30 March 2022.SettingWe collected data from 629 MSM and TSM among the study cities. Community respondents were recruited from real-world (e.g., NGOs, bars, clubs) or virtual sites (e.g., social media, apps) where MSM and TSM in each of the three cities were known to frequent.ParticipantsEligibility criteria for community respondents were: (1) ≥18 years old; (2) identifying as male at any point in life or being assigned male at birth; (3) having consensual sex with another man in the past 12 months; (4) engaging in binge drinking (i.e., ≥5 drinks in a 2 hour period), illicit use of drugs, or both in the past 90 days; and (5) residing in one of the three study cities.InterventionThePRIDE in HIV Careintervention is a theory-driven “crowdsourcing and peer-actuated network intervention” designed to amplify community members’ successes and resilience via “influencers” who can strengthen and impart benefit to their networks and community.Main outcome measuresReceived an HIV test in the prior six months.ResultsThere was a statistically significant increase in odds of recent HIV testing for every additional month the intervention was implemented in a respondent’s city (AOR=1.08,95% CI=1.05-1.12;p<.001).ConclusionsThePRIDE in HIV Careintervention appears to be efficacious in enacting a community wide increase—i.e., promoted HIV testing among those who did not go through the intervention itself—in HIV testing among MSM and TSM.Trial RegistrationThis trial is registered withclinicaltrials.gov(NCT02786615).FundingNational Institute on Drug Abuse (NIDA), grant number R01DA040513.KEY POINTSQuestionDoes thePRIDE in HIV Careintervention exert a community effect of increasing HIV testing among men who have sex with men (MSM) and transgender and nonbinary people who have sex with men (TSM) in Kazakhstan?FindingsWe employed a stepped-wedge, cluster-randomized controlled trial among three cities in Kazakhstan. There was a statistically significant increase in odds of recent HIV testing for every additional month the intervention was implemented in a respondent’s city.MeaningThe intervention increased HIV testing among MSM and TSM in Kazakhstan who had not directly received the intervention, providing support for a community-wide impact.