Wu Elwin, Lee Yong Gun, Vinogradov Vitaliy, Zhakupova Gulnara, Mergenova Gaukhar, Davis Alissa, Paine Emily A, Hunt Timothy, Reeder Kelsey, Primbetova Sholpan, Terlikbayeva Assel, Laughney Caitlin, Chang Mingway, Baiserkin Baurzhan, Abishev Asylkhan, Tukeyev Marat, Abdraimov Sabit, Denebayeva Alfiya, Kasymbekova Sairankul, Tazhibayeva Galiya, Kozhakhmet Mashirov
Social Intervention Group, Columbia School of Social Work, New York, NY, USA.
Global Health Research Center of Central Asia, Almaty, Kazakhstan.
medRxiv. 2024 Aug 2:2024.08.01.24311235. doi: 10.1101/2024.08.01.24311235.
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.
To determine if the intervention had a community effect of increasing HIV testing among MSM and TSM in Kazakhstan.
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.
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.
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.
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.
Received an HIV test in the prior six months.
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).
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.
This trial is registered with clinicaltrials.gov (NCT02786615).
National Institute on Drug Abuse (NIDA), grant number R01DA040513.
在哈萨克斯坦，由于艾滋病毒检测率低，男男性行为者（MSM）以及与男性发生性行为的跨性别者和非二元性别者（TSM）中的艾滋病毒传播有所增加。
确定该干预措施是否对哈萨克斯坦的男男性行为者和与男性发生性行为的跨性别者中的艾滋病毒检测产生社区层面的促进作用。
我们采用了阶梯式楔形整群随机对照试验，从哈萨克斯坦的三个城市（阿拉木图、阿斯塔纳和奇姆肯特）招募男男性行为者和与男性发生性行为的跨性别者社区成员。我们收集了系列横断面数据，社区成员在2018年8月21日至2022年3月30日期间完成了一次评估。
我们在研究城市的629名男男性行为者和与男性发生性行为的跨性别者中收集了数据。社区受访者是从现实世界场所（如非政府组织、酒吧、俱乐部）或虚拟场所（如社交媒体、应用程序）招募的，这三个城市的男男性行为者和与男性发生性行为的跨性别者常在这些地方活动。
社区受访者的纳入标准为：（1）年龄≥18岁；（2）在生命中的任何时候自我认同为男性或出生时被指定为男性；（3）在过去12个月内与另一名男性发生过双方自愿的性行为；（4）在过去90天内有暴饮行为（即2小时内饮用≥5杯酒）、非法使用毒品或两者皆有；（5）居住在三个研究城市之一。
该干预措施是一种理论驱动的“众包和同伴驱动的网络干预”，旨在通过“有影响力的人”放大社区成员的成功经验和恢复力，这些“有影响力的人”可以加强并使其社交网络和社区受益。
在过去六个月内接受过艾滋病毒检测。
在受访者所在城市，干预措施每多实施一个月，近期艾滋病毒检测的几率就有统计学上的显著增加（比值比=1.08，95%置信区间为1.05 - 1.12；P<.001）。
该干预措施似乎有效地在社区范围内提高了艾滋病毒检测率，即在未直接参与干预的男男性行为者和与男性发生性行为的跨性别者中促进了艾滋病毒检测。
本试验已在ClinicalTrials.gov注册（NCT02786615）。
美国国立药物滥用研究所（NIDA），资助编号R01DA040513。
