The HOPE social media intervention for global HIV prevention in Peru: a cluster randomised controlled trial

doi:10.1016/S2352-3018(14)00006-X

The Lancet HIV

Volume 2, Issue 1, January 2015, Pages e27-e32

https://doi.org/10.1016/S2352-3018(14)00006-X Get rights and content

Summary

Background

Social media technologies offer new approaches to HIV prevention and promotion of testing. We examined the efficacy of the Harnessing Online Peer Education (HOPE) social media intervention to increase HIV testing among men who have sex with men (MSM) in Peru.

Methods

In this cluster randomised controlled trial, Peruvian MSM from Greater Lima (including Callao) who had sex with a man in the past 12 months, were 18 years of age or older, were HIV negative or serostatus unknown, and had a Facebook account or were willing to create one (N=556) were randomly assigned (1:1) by concealed allocation to join intervention or control groups on Facebook for 12 weeks. For the intervention, Peruvian MSM were trained and assigned to be HIV prevention mentors (peer-leaders) to participants in Facebook groups. The interventions period lasted 12 weeks. Participants in control groups received an enhanced standard of care, including standard offline HIV prevention available in Peru and participation in Facebook groups (without peer leaders) that provided study updates and HIV testing information. After accepting a request to join the groups, continued participation was voluntary. Participants also completed questionnaires on HIV risk behaviours and social media use at baseline and 12 week follow-up. The primary outcome was the number of participants who received a free HIV test at a local community clinic. The facebook groups were analysed as clusters to account for intracluster correlations. This trial is registered with ClinicalTrials.gov, number NCT01701206.

Findings

Of 49 peer-leaders recruited, 34 completed training and were assigned at random to the intervention Facebook groups. Between March 19, 2012, and June 11, 2012, and Sept 26, 2012, and Dec 19, 2012, 556 participants were randomly assigned to intervention groups (N=278) or control groups (N=278); we analyse data for 252 and 246. 43 participants (17%) in the intervention group and 16 (7%) in the control groups got tested for HIV (adjusted odds ratio 2·61, 95% CI 1·55–4·38). No adverse events were reported.

Interpretation

Development of peer-mentored social media communities seemed to be an efficacious method to increase HIV testing among high-risk populations in Peru. Results suggest that the HOPE social media intervention could improve HIV testing rates among MSM in Peru.

Funding

National Institute of Mental Health.

Introduction

More than 95% of people with HIV live in low-income and middle-income countries (LMICs).¹ HIV is among the top five causes of death, disproportionately affecting particular vulnerable populations such as men who have sex with men (MSM).2, 3, 4 In Peru, for example, the HIV prevalence among the general population is about 0·4%,⁵ but the prevalence in MSM is 12·4%.6, 7 Increased testing in MSM can improve awareness of serostatus and decrease HIV transmission.⁸ Low cost, novel interventions are needed to increase HIV testing among MSM in LMIC.

Community peer-led HIV interventions, based on the theory of diffusion of innovations, are designed to increase HIV prevention and testing behaviours by changing social norms and HIV-related stigma.9, 10 Peer-led HIV interventions that train peer health educators to deliver community-based HIV prevention information, have increased condom use and decreased unprotected anal intercourse, with behaviour change sustained for up to 3 years.11, 12 Online technologies might rapidly and cost-effectively deliver peer-led HIV prevention among at-risk populations.13, 14, 15 Addressing at-risk populations of internet and social media users is especially important because internet sex-seekers might be at increased risk of HIV.16, 17, 18 Use of mobile technology has grown exponentially, especially in Peru,¹⁹ making social media a potentially useful instrument to deliver low-cost peer-led HIV prevention interventions in resource-limited settings.20, 21 However, this approach has not been systematically tested.

We tested the efficacy of using the HOPE (Harnessing Online Peer Education) social media intervention for the promotion of HIV testing. The HOPE Peru intervention is not a diffusion of innovations study by formal terms,9, 10 but is a blended intervention that incorporates components of that theory and other psychologically driven theories and interventions.20, 22, 23, 24

Section snippets

Study design and participants

The HOPE Peru study was a cluster randomised trial. Based on diffusion of innovations theory recommendations that 15% of a population (or 15 peer leaders for each 100 participants) would be needed for a peer intervention,¹⁰ and other research using community organisations to identify peer leaders,22, 25 49 peer leaders were recruited with the help of the staff from the Epicentro Gay Men's Community Center in Lima, Peru. Centre staff gave study fliers to potential peer-leaders fitting inclusion

Results

Between March 19, 2012, and June 11, 2012, and Sept 26, 2012, and Dec 19, 2012, 556 participants were randomly assigned to an HIV intervention group (n=278) or control group (n=278; figure). 300 eligible participants were recruited during the first wave and randomly assigned to either intervention groups (n=150) or control groups (n=150). Each study arm had four clusters or peer-led Facebook groups with 37 or 38 participants each. Similarly, 256 participants were recruited in the second wave

Discussion

In this cluster randomised trial of Peruvian MSM, the HOPE Peru social media intervention led to an almost three-fold increase in the odds of getting an HIV test compared with a control group (panel). This study is important because it is the first social media-based randomised controlled trial assessing HIV testing; it suggests the efficacy of use of the HOPE social media approach as a low cost HIV intervention in Peru and potentially other similar settings; it includes both self-reported

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ArticlesThe HOPE social media intervention for global HIV prevention in Peru: a cluster randomised controlled trial

Summary

Background

Methods

Findings

Interpretation

Funding

Introduction

Section snippets

Study design and participants

Results

Discussion

Lancet

Lancet

Curr Opin HIV AIDS

2013 Global Summary of the AIDS Epidemic

Response to the AIDS pandemic—a global health model

N Engl J Med

The reemerging hiv/aids epidemic in men who have sex with men

JAMA

Prevalences of sexually transmitted infections in young adults and female sex workers in Peru: a national population-based survey

Lancet Infect Dis

UNAIDS 2010 Report on the Global AIDS Epidemic

2012 Country Progress Report: Peru

Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA

AIDS