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

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. PRIDE in HIV Care is an intervention designed to have a community-level effect of increasing HIV testing among MSM and TSM in Kazakhstan. The intervention was tested using a stepped-wedge, cluster-randomized controlled trial 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. The PRIDE in HIV Care 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. We collected serial cross-sectional data where MSM and TSM (N = 629) among the study cities completed one assessment between 21 August 2018, and 30 March 2022. The primary outcome was whether they had 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 (AOR = 1.08, 95% CI = 1.05–1.12; p < .001). 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. Trial Registration. This trial is registered with clinicaltrials.gov (NCT02786615).