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

IMPORTANCE

HIV 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.

OBJECTIVE

To determine if the intervention had a community effect of increasing HIV testing among MSM and TSM in Kazakhstan.

DESIGN

We 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.

SETTING

We 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.

PARTICIPANTS

Eligibility 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.

INTERVENTION

The intervention 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 MEASURES

Received an HIV test in the prior six months.

RESULTS

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 (=1.08, =1.05-1.12; <.001).

CONCLUSIONS

The 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.

TRIAL REGISTRATION

This trial is registered with clinicaltrials.gov (NCT02786615).

FUNDING

National Institute on Drug Abuse (NIDA), grant number R01DA040513.