Crowdsourcing to Reduce HIV Stigma Among Adolescents and Young Adults in Kazakhstan

Study Overview
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Brief Summary
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This project will assess whether a digital crowdsourced intervention can reduce HIV stigma and promote HIV self-testing among adolescents and young adults (AYA). NIH has emphasized the need for research on interventions to reduce HIV-associated stigma and its impact on the prevention and treatment of HIV/AIDS, particularly in low and middle income countries (LMICs). The proposed study has the highest public health significance: it uses a community-based participatory approach to engage local AYA to develop a digital crowdsourced HIV stigma reduction and self-testing intervention to reduce HIV stigma and increase HIV testing. Study Aim 1: To develop a crowdsourced digital HIV stigma reduction and self-testing intervention targeting AYA in Kazakhstan. Using a community-based participatory approach that engages local adolescents and young adults (AYA) and youth organizations, we will launch a national crowdsourcing contest in which AYA will design multimedia content to reduce HIV stigma in order to promote HIV testing among peers. Study Aim 2: To pilot test this crowdsourced HIV stigma reduction and self-testing intervention in a preliminary efficacy trial. We will assess the intervention's feasibility and acceptability and obtain preliminary estimates of its effects on decreasing HIV stigma (primary outcome) and increasing HIV testing (secondary outcome) among AYA in Kazakhstan who received the intervention compared to individuals who did not. Participants (n=168) will be randomized 1:1 to: 1) receive the winning multimedia crowdsourced HIV stigma reduction content and a link for HIV self-testing, or 2) receive standard Kazakhstan Ministry of Health HIV informational materials and a link for HIV self-testing.

Detailed Description
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This project will assess whether a digital crowdsourced intervention can reduce HIV stigma and promote HIV self-testing among adolescents and young adults (AYA). Globally AYA are at increased risk for HIV acquisition. In Eastern Europe and Central Asia (EECA), new HIV infections among 15-24 year old AYA are expected to increase 28% by 2030. In Kazakhstan, one in four HIV infections occur among AYA. Despite the growing HIV burden among AYA in Kazakhstan, this population has some of the lowest HIV testing rates in the country, largely due to stigma. Yet few efforts in Kazakhstan address HIV stigma and the role it plays as a barrier to HIV testing. Digital technologies and crowdsourcing campaigns (i.e., engaging groups of AYA online to address public health challenges and share solutions) are scalable, cost-effective tools that can increase HIV testing services and reduce HIV stigma in low and middle income countries (LMICs) and other resource- constrained settings. Crowdsourcing may be particularly successful among AYA, given their high levels of social media use and technological literacy. Complementing the crowdsourcing approach, mailing HIV rapid test kits can enable AYA to avoid the stigma associated with attending the AIDS Center and overcome transportation barriers.

Official Title
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Reducing HIV Stigma to Increase HIV Testing Among Adolescents and Young Adults in Kazakhstan Using a Crowdsourcing Approach

Conditions
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Stigma, Social, HIV Testing

Intervention / Treatment
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* Behavioral: Digital Crowdsourced Intervention to Reduce HIV Stigma among Adolescents and Young Adults


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 16-24 Report previous sex with another individual Reside in Kazakhstan Exclusion Criteria: Not willing to provide consent or not able to understand study procedures

Ages Eligible for Study
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Minimum Age: 16 Years
Maximum Age: 24 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Single Group Assignment
Interventional Model Description: Participants will be randomized to receive the digital crowdsourced intervention or standard of care (existing HIV informational materials). We will examine effects of the intervention on reducing HIV stigma and increasing HIV testing.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Crowdsourced Intervention<br>The digital crowdsourced intervention will be presented to participants in the intervention arm. | Behavioral: Digital Crowdsourced Intervention to Reduce HIV Stigma among Adolescents and Young Adults<br>* Adolescents and young adults will participate in a crowdsourcing contest to create digital materials to reduce HIV stigma in order to increase HIV testing. Entries will be judged by a community judging panel and expert judging panel. Winning entries will be selected for the digital intervention and presented to participants in the intervention arm.<br>|
| No Intervention: Standard of Care<br>Standard HIV informational materials currently used by the Kazakhstan Ministry of Health will be presented to participants in the control arm. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean score change in HIV Stigma Scale | This is to measure HIV stigma. The scale/questionnaire is comprised of 10 items on a 4-point Likert scale (score range from 4-40). Higher scores indicate higher levels of stigma. Outcome will be assessing in mean score change from baseline to 3 months follow-up. | Baseline and 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Uptake of HIV self-test | This is to measure HIV testing. The number is generated by whether an HIV self-test kit was ordered and is a dichotomous outcome (yes/no). | Up to 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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HIV stigma