Adapting and Pilot Testing a Multi-Level, Peer-Led HIV Prevention and Stigma Reduction Intervention for Adolescents in Western Kenya

Project Summary/Abstract Adolescents are particularly vulnerable to HIV and AIDS globally, including Kenya. In western Kenya, youth are disproportionately affected by HIV due to poverty and lack of education, which can lead to risky sexual behav- iors. Stigma is one of the primary barriers to HIV prevention among youth in Kenya. Our prior research in west- ern Kenya demonstrates that HIV-related stigma among youth is associated with lower odds of condom use and HIV testing, and stigma associated with sexual and reproductive health (SRH) also impacts HIV outcomes. Further, we found that social capital is protective against stigma, and youth are comfortable talking about sex and HIV in trusted groups of peers. However, youth lack skills and confidence to talk to adults and partners about HIV. Therefore, there is a critical need to strengthen young people’s resilience by improving communica- tion and building social capital, which will reduce HIV- and SRH-related stigma and increase HIV prevention in western Kenya. We will use implementation science methods to adapt a theory-based, evidence-informed in- tervention, Sisters Saving Sisters (SSS), in 4 important ways: (1) develop a version for boys (Brothers Saving Brothers [BSB]), (2) develop content on HIV- and SRH-related stigma, (3) add content PrEP and HIV testing; and (4) create content to improve communication between youth and their parents/caregivers. We hypothesize that our adapted intervention (SSS and BSB) will reduce HIV- and SRH-related stigma and increase HIV pre- ventive behaviors among youth in western Kenya. This study will take place in Kakamega County and will build upon an established partnership between the University of Iowa and Africa Community Leadership and Devel- opment to address the following specific aims: (1) Adapt SSS to reflect the experiences and perspectives of youth (ages 15-18) in western Kenya; (2) Determine the preliminary effectiveness of the adapted SSS and BSB intervention; and (3) Evaluate the feasibility, appropriateness, and acceptability of the adapted SSS and BSB intervention. For Aim 1, we will use the ADAPT-ITT framework to adapt and contextualize SSS by using theater testing and focus group discussions (FGDs) with our Youth Action Team (YAT) and Community Leader- ship Team (CLT). For Aim 2, we will implement a pilot randomized control trial by randomly assigning 3 villages each to the intervention and control. In each intervention village, separate groups of girls and boys (n=96) will receive the intervention over 3 weeks. In the control villages, youth (n=96) will receive the standard of care for HIV prevention and SRH. We will assess outcomes before the intervention, and at 3- and 6-months post-inter- vention. Primary outcomes are abstinence, condom use, PrEP use, and HIV testing; secondary outcomes in- clude behavioral intentions and HIV- and SRH-related stigma. For Aim 3, we will use an implementation sci- ence approach to assess acceptability, appropriateness, and feasibility through short surveys and FGDs with participants, parents/caregivers, peer educators, and YAT/CLT members. At the end of this project, we expect to have 2 curricula that will set the stage for a rigorous hybrid effectiveness-implementation study in Kenya.