Multi-level intersectional stigma reduction intervention to increase HIV testing among men who have sex with men in Ghana: Protocol for a cluster randomized controlled trial.
LaRon E Nelson, Laura Nyblade, Kwasi Torpey, Carmen H Logie, Han-Zhu Qian, Adom Manu, Emma Gyamerah, Francis Boakye, Patrick Appiah, DeAnne Turner, Melissa Stockton, Gamji M Abubakari, David Vlahov
Author Information
LaRon E Nelson: School of Nursing, Yale University, New Haven, CT, United States of America. ORCID
Laura Nyblade: RTI International, Washington, DC, United States of America.
Kwasi Torpey: Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana.
Carmen H Logie: Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
Han-Zhu Qian: Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, United States of America. ORCID
Adom Manu: Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana.
Emma Gyamerah: Educational Assessment & Research Center, Accra, Ghana.
Francis Boakye: Priorities on Rights & Sexual Health, Accra, Ghana.
Patrick Appiah: Youth Alliance for Health & Rights, Kumasi, Ghana.
DeAnne Turner: College of Nursing, University of South Florida, Tampa, FL, United States of America. ORCID
Melissa Stockton: Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States of America.
Gamji M Abubakari: Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, CT, United States of America.
David Vlahov: School of Nursing, Yale University, New Haven, CT, United States of America.
BACKGROUND: Men with have sex with men (MSM) in Africa face high levels of stigma due to elevated HIV exposure (actual or perceived), same-sex practices, and gender non-conformity. These stigmas are documented barriers to HIV prevention and treatment. Most stigma-reduction interventions have focused on single-level targets (e.g., health care facility level [HCF]) and addressed one type of stigma (e.g., HIV), without engaging the multiple intersecting stigmas that MSM encounter. Determining the feasibility and acceptability of multi-level intervention of reducing intersectional stigma and estimating its efficacy on increasing HIV testing are needed. METHODS: We proposed a mixed method study among MSM in Ghana. First, we will develop the intervention protocol using the Convergence Framework, which combines three interventions that were previously implemented separately in Ghana for reducing stigma at the HCF-level, increasing HIV testing at the peer group-level, and increasing peer social support at the individual-level. Then, we will conduct a cluster randomized controlled trial with four pairs of HCFs matched on staff size. HCFs within each pair are randomized to the HCF-level stigma-reduction intervention or control arm. MSM (n = 216) will be randomized to receive the group-level and individual-level interventions or standard of care control arm. MSM will be assigned to receive HIV testing at one of the HCFs that match their study assignment (intervention or control facility). The frequency of HIV testing between MSM in the study arms at 3 and 6 months will be compared, and the predictors of HIV testing uptake at the HCF, peer group and individual-levels will be assessed using multi-level regression models. DISCUSSION: These findings from this study will provide important evidence to inform a hybrid implementation-effectiveness trial of a public health intervention strategy for increasing HIV case detection among key populations in sub-Saharan African communities. Accurate information on HIV prevalence can facilitate epidemic control through more precise deployment of public health measures aimed at HIV treatment and viral load suppression, which eliminates risk of transmission. TRIAL REGISTRATION: This study was prospectively registered on ClinicalTrials.gov, Identifier: NCT04108078, on September 27, 2019.
Associated Data
ClinicalTrials.gov | NCT04108078
References
Int J Nurs Stud. 2003 Mar;40(3):321-32
[PMID: 12605954]
