Expanded Social Network Recruitment to HIV Testing (E-SNRHT) Intervention to Locate Undiagnosed Cases and Reduce HIV-related Stigma

Summary

In South Africa's large generalized HIV epidemic, male-to-female transmission comprises a large proportion of transmission events, but men are much less likely to seek HIV testing, and disproportionately remain undiagnosed. HIV-related stigma is a key barrier to recruiting men to HIV testing in South Africa, as they report feeling blamed by their partners and communities for HIV transmission. This barrier must be addressed to increase testing among men and other testing-avoidant people in order to locate "hard-to-reach" undiagnosed cases and make progress towards 95-95-95 goals. Peer recruitment via social networks is an effective mechanism for promoting HIV testing, because people seek health information from peers, and peers influence health behavior norms within networks. However, standard risk network recruitment is limited in that: 1) recruiting one's own risk partners can trigger stigma and blame for HIV; and 2) it excludes people who have not engaged in HIV risk behavior recently and/or who no longer have contact with their risk partners. The Investigative Team for the present study developed an expanded social network recruitment to HIV testing (E-SNRHT) intervention to address these limitations and reduce stigma as a barrier to testing. E-SNRHT asks "seeds" (i.e., initial participants) who have been newly diagnosed with HIV (NDH) to recruit their expanded social network members (i.e., anyone they know) who they think could benefit from HIV testing or could have an undiagnosed HIV infection, tests these network members, and refers them to ART (if positive) or follow-up testing (if negative). By asking participants to recruit non-risk partners, E-SNRHT is designed to increase their comfort and likelihood of recruiting others, especially those who have avoided testing due to stigma. The Investigative Team's two previous pilot studies of E-SNRHT found that it recruits men to HIV testing at much higher rates than standard risk network recruitment; locates people with newly diagnosed HIV (PNDH; i.e., people with previously undiagnosed HIV infection) at a much higher rate per seed than standard risk network recruitment; and recruits people who have not tested in years, have never tested, and/or have not engaged in HIV risk behavior recently but have undiagnosed HIV infection. These pilot studies also found that E-SNRHT reduces HIV-related stigma and increases HIV-related social support among networks; and that 76% of E-SNRHT participants who were NDH started ART within 10 weeks. As participants recruit each other, their discussions help to normalize talking about HIV, thereby improving levels of stigma and support, which in turn should increase HIV service use and improve HIV care cascade outcomes. The present study will conduct a site-randomized trial of E-SNRHT, with 32 Department of Health clinics in KwaZulu-Natal, South Africa serving as sites. This study will compare E-SNRHT clinics to business-as-usual control clinics on: their rates of recruiting men to testing (Aim 1a) and locating PNDH (1b); participants' reports of HIV-related stigma and social support (Aim 2a); and treatment cascade outcomes (2b). Implementation science methods and qualitative methods will also be used to develop best practices (Aim 3) for future scale-up in South Africa and adaptation to other settings.

Conditions

• Undiagnosed HIV Infection
• Populations That Are Reluctant to Test for HIV
• Long-term Undiagnosed HIV Infection
• Individuals With Newly-diagnosed HIV Infection
• HIV-related Stigma
• Access to HIV Testing

Interventions

BEHAVIORAL

Expanded Social Network Recruitment to HIV Testing (E-SNRHT) Intervention

The E-SNRHT intervention will recruit people newly diagnosed with HIV as "seeds," briefly remind them of HIV transmission risks and how HIV spreads through networks, and ask them to recruit people in their expanded social networks (i.e., anyone they know) who they think might benefit from being tested for HIV, regardless of whether or not they have engaged in any HIV risk behaviors together. By including expanded social networks, E-SNRHT aims to broaden the reach of HIV testing to people who are reluctant to participate in risk partner recruitment and/or to seek clinic testing. Network members recruited by a seed will also be asked to recruit additional people they know using the same education and recruitment instructions provided to seeds. All network members will be tested for HIV and provided with pre- and post-test counseling, all participants diagnosed with HIV will be referred to care, and all participants who test negative will be referred to 3-month follow-up HIV testing.

Sponsors & Collaborators

• National Institute of Mental Health (NIMH)

  collaborator NIH

• Human Sciences Research Council

  collaborator OTHER_GOV

• NYU Langone Health

  collaborator OTHER

• University of Illinois at Chicago

  lead OTHER

Principal Investigators

• Leslie D. Williams, Ph.D. · University of Illinois Chicago

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2025-09-30

Primary Completion

2027-12-01

Completion

2027-12-01

Countries

• South Africa

Study Locations