Controlled Trial of Game Changers: A Group Intervention to Train HIV Clients to be Change Agents for HIV Prevention in Uganda

PROJECT SUMMARY In Uganda, HIV prevalence is estimated to be 6.2% among those aged 15-64, and is higher (6.9%) in Kampala, the proposed study setting. Political and cultural barriers, including limited government funding and HIV stigma, impede HIV prevention and have led to projections of rapid increases in HIV incidence. The proposed research will be a randomized controlled trial (RCT) of Game Changers, a 6-session peer-led group intervention that aims to empower and mobilize people living with HIV (PLWH) to be agents for HIV prevention in their social networks. By decreasing stigma among PLWH and their social network members, and training PLWH on strategies to engage social network members in discussions around HIV, Game Changers provides PLWH with the tools to do prevention advocacy. Game Changers was developed through an NIMH R34 that found high feasibility and acceptability, and preliminary intervention effects on increased HIV prevention advocacy between PLWH and their social network members, reduced internalized stigma, and increased HIV-serostatus disclosure to social network members among PLWH, and medium to large effects on increased condom use and HIV testing among a subsample of network members. The Specific Aims are: (1) To conduct an RCT of Game Changers, a peer- led group intervention for PLWH in Uganda, to test intervention effects on the primary outcomes of reduced condomless sex, increased HIV testing, and decreased enacted HIV stigma among social network members; (2) To test intervention effects on the secondary outcomes of reduced internalized HIV stigma, increased HIV serostatus disclosure, and increased viral load suppression among PLWH, and PrEP uptake among social network members; (3) To examine whether increased HIV prevention advocacy by PLWH mediates intervention effects on social network members’ increased condom use and HIV testing, and whether increased HIV disclosure by PLWH mediates intervention effects on social network members’ reduced enacted HIV stigma; and (4) To conduct a cost-effectiveness analysis of the intervention. We will recruit 210 PLWH, randomizing 105 to the intervention and 105 to an attention control. Each PLWH will be asked to recruit social network members to complete assessments (736 total, 368/arm), to test intervention effects on social networks. All participants will complete surveys at baseline and 6-, 12-, and 18-months post-baseline; PLWH will also complete social network assessments. The cost-effectiveness analysis will inform policymakers about whether Game Changers is a feasible intervention in which to invest. Our approach is particularly timely in the era of biomedical interventions, which require widespread penetration of effective HIV prevention messaging into communities. Positioning PLWH as central to the solution for controlling (vs. causing) the HIV epidemic has the potential to reduce HIV stigma and improve prevention outcomes at the individual, household, and network levels.