A Peer-Based HIV/STI Self-Testing Intervention to Promote HIV Prevention in Latinx Sexual Minority Men: A Pilot Randomized Controlled Trial

Background and Purpose: Latinx gay, bisexual, and other sexual minority men (SMM) are disproportionately affected by HIV and other sexually transmitted infections (STIs) in the U.S. Yet, they experience inequitable access to HIV prevention strategies such as pre-exposure prophylaxis (PrEP) and screening for HIV and other STIs. As factors such as immigration status, language, education, and stigma can present additional challenges to PrEP uptake and HIV/STI testing among Latinx SMM, increased efforts to promote HIV/STI prevention in this population are urgently needed to reach the goals of ending the HIV epidemic. This pilot study evaluated the feasibility, acceptability, and effects on HIV/STI testing and PrEP use outcomes of a peer-based HIV prevention intervention that integrated HIV/STI self-testing kits for Latinx SMM.

Methods: We conducted a pilot randomized controlled trial of the peer-based intervention with 50 Latinx immigrant SMM in King County, WA. Peers who identified as Latinx, immigrant, and SMM, were trained to recruit participants and deliver the intervention. Thirty participants were randomly assigned to either the intervention, Listos (Spanish for "ready”), which included peer counseling (guided by the Information, Motivation, and Behavioral Skills Model) to initiate HIV/STI testing and PrEP use) as well as HIV/STI self-testing kits that were mailed to participants; or the control group (n=20), which only included peer counseling. As the study was implemented at the start of the COVID-19 pandemic, all intervention components were delivered virtually (phone and internet communication methods). Participants completed online questionnaires at pre-intervention, 1-, 6-, and 12-week follow-ups. We performed a 2-sample t-test for equality of proportions with continuity correction to examine effects of the Listos intervention on HIV testing, STI testing, PrEP uptake outcomes.

Results:

A greater proportion of participants in the intervention group (0.73) reported testing for STIs than those in the control group (0.37) (p=.02) by the 12-week follow-up. The difference in the proportion of participants in the intervention and control groups that were motivated to think about PrEP use (0.84 vs. 0.59) approached significance (p=0.07). While there were no differences between the proportions of participants in the intervention and control groups that tested for HIV by the 12-week follow up, 80 percent of participants across both groups indicated that the peer-based program motivated them to get tested for HIV.

Implications:

By facilitating access to HIV/STI testing through self-testing kits and enhancing testing and PrEP information, motivation, behavioral skills, and empowerment through peers, our peer-based program demonstrated potential to increase HIV prevention behaviors in Latinx immigrant SMM. Peer-based programs that offer self-testing and virtual modes of accessing information may be a feasible and acceptable strategy to reach Latinx immigrant SMM and enhance HIV prevention behaviors in circumstances when in-person services are limited or unavailable due to conditions such as the COVID-19 pandemic. Additionally, the findings suggest that peer-delivered interventions may be an efficacious tool to increase STI testing among this population. Future studies with long-term evaluation that assess the sustainability of such programs are needed.