Abstract: A Stepped-Wedge Cluster Randomized Trial of Pride in HIV Care: A Crowdsourcing and Peer-Actuated Network Intervention to Increase Engagement in the HIV Care Continuum for Sexual Minority and Gender Expansive Men in Kazakhstan (Society for Social Work and Research 29th Annual Conference)

Schedule:

Thursday, January 16, 2025

Jefferson A, Level 4 (Sheraton Grand Seattle)

* noted as presenting author

Elwin Wu, PhD, Professor of Social Work, Columbia University School of Social Work, New York, NY

Yong Gun Lee, PhD, Assistant Professor, The University of Hong Kong (HKU), Hong Kong, Hong Kong

Vitaliy Vinogradov, Project Director, Columbia University Global Health Research Center of Central Asia (GHRCCA), Almaty, Kazakhstan

Gulnara Zhakupova, MSW, Project Director, Columbia University Global Health Research Center of Central Asia (GHRCCA), Almaty, Kazakhstan

Gaukhar Mergenova, MD, MS, Project Director, Columbia University Global Health Research Center of Central Asia (GHRCCA), Almaty, Kazakhstan

Alissa Davis, PhD, Associate Professor, Columbia University, New York, NY

Emily Paine, PhD, Assistant Professor, Columbia University, NY

Timothy Hunt, PhD, Associate Director, Columbia University School of Social Work, New York, NY

Kelsey Reeder, LCSW-R, PhD Candidate, Psychotherapist, Columbia University School of Social Work, New York, NY

Sholpan Primbetova, MS, MPharm, Deputy Regional Director, Columbia University Global Health Research Center of Central Asia (GHRCCA), Almaty, Kazakhstan

Assel Terlikbayeva, MD, Regional Director, Columbia University Global Health Research Center of Central Asia (GHRCCA), Almaty, Kazakhstan

Caitlin Laughney, PhD, MSW, Postdoctoral Research Fellow, Columbia University, New York, NY

Mingway Chang, PhD, Associate Research Scientist, Columbia University

Baurzhan Baiserkin, Director, Kazakh Scientific Center of Dermatology and Infectious Diseases, Kazakhstan

Asylkhan Abihsev, Deputy Director, Kazakh Scientific Center of Dermatology and Infectious Diseases, Kazakhstan

Marat Tukeyev, Director, Center of AIDS Prevention of Almaty, Kazakhstan

Sabit Abdraimov, Director, Center of AIDS Prevention of Astana, Kazakhstan

Alfiya Denebayeva, Deputy Director, Center of AIDS Prevention of Almaty, Kazakhstan

Sairankul Kasymbekova, Head of the Clinical Monitoring Department, Kazakh Scientific Center of Dermatology and Infectious Diseases, Kazakhstan

Galiya Tazhibayeva, Head of the Clinical-Diagnostic Lab, Kazakh Scientific Center of Dermatology and Infectious Diseases, Kazakhstan

Mashirov Kozhakmet, Deputy Director, Center of AIDS Prevention of Shymkent, Kazakhstan

BACKGROUND AND PURPOSE: Despite the general successes in HIV prevention globally, HIV transmission in Kazakhstan has been increasing in the past decade, particularly among men who have sex with men (MSM) and trans individuals who have sex with men (TSM). National surveillance data indicated that the largest gap from the UNAIDS 90-90-90 targets (at the time) in the HIV care continuum for MSM and TSM was with knowing one was living with HIV, i.e., HIV testing. The primary aim of this trial was to determine if the Peer Reach and Influencer-Driven Engagement in the HIV Care Continuum (PRIDE in HIV Care) intervention—a crowdsourcing and peer-actuated network intervention—could exert a community effect of increasing HIV testing among MSM and TSM in Kazakhstan.

METHODS: The intervention was tested in a NIDA-funded stepped-wedge, cluster-randomized controlled trial (clinicaltrials.gov #NCT02786615). The trial was conducted from 2018-2022 with MSM and TSM across three cities in Kazakhstan: Almaty, Astana, and Shymkent. The order of intervention implementation by city was randomly set to occur in 6-month increments. Data were collected from 629 MSM and TSM and analyzed accordingly in a serial cross-sectional manner, with the primary outcome being receiving an HIV test in the prior six months. We used multilevel regression to test the hypothesis that the odds of having a recent (i.e., in the 6 months prior to assessment) HIV test would increase as a function of time (measured in months) since the intervention began to be implemented in a respondent’s city.

RESULTS: Of the 629 individuals who enrolled, 560 (89%) were cismen, 37 (5.9%) were transwomen, 2 (0.3%) were transmen, and 30 (4.8%) were nonbinary/genderqueer/agender/etc. Subsequently, 213 of these individuals received PRIDE in HIV Care that prompted them to use social marketing principles to encourage other MSM and TSM in the social networks in their communities to undergo HIV testing, care, and prevention. There was a statistically significant increase in the 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).

CONCLUSIONS AND IMPLICATIONS: The PRIDE in HIV Care intervention 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. Given the crowdsourcing and social marketing/network aspect of the intervention, this study supports the use of community-sourced solutions and community-driven health promotion, which not only offloads the burden and challenges of researcher and “expert” driven approaches (e.g., medical models of psychosocial interventions), but also fosters empowerment of populations who experience systemic marginalization and discrimination.