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A Pilot Test of Game Changers, a Social Network Intervention to Empower People with HIV to be Prevention Advocates in Uganda

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Abstract

We conducted a pilot randomized controlled trial of Game Changers, a 6-session group intervention that empowers people with HIV to be HIV prevention advocates in their social networks. Ninety-nine people with HIV (51 intervention, 48 wait-list control) and 58 of their social network members (alters) completed baseline and 5- and 8-month post-baseline assessments. Results indicated high acceptability, demonstrated by participants’ and facilitators’ positive attitudes qualitatively and favorable ratings of intervention sessions quantitatively, and high feasibility (76% attended all intervention sessions). Intention-to-treat analyses indicated significantly increased HIV prevention advocacy among HIV-positive participants and alters [b (SE) = 0.4 (0.2), p = .017; b (SE) = 0.4 (0.2), p = .035]; reduced internalized HIV stigma [b (SE) =  − 0.3 (0.1), p = .012], increased HIV-serostatus disclosure [b (SE) = 0.1 (0.1), p = .051], and increased social network density among HIV-positive participants [b (SE) = 0.1 (0.03), p = .004]; and marginally reduced condomless sex among alters [OR (95% CI) = 0.3 (0.1–1.2), p = .08]. Positioning people with HIV as central to prevention has the potential to reduce stigma and improve prevention outcomes throughout social networks.

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References

  1. UNAIDS. AIDSinfo. Available from: https://aidsinfo.unaids.org/.

  2. UPHIA. Uganda population-based HIV impact assessment, UPHIA 2016–2017. https://afro.who.int/sites/default/files/2017-08/UPHIA%20Uganda%20factsheet.pdf.

  3. Avert. HIV and AIDS in Uganda. 2019. https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/uganda.

  4. Joint United Nations Programme on HIV/AIDS (UNAIDS). Ending AIDS: Progress towards the 90–90–90 targets. 2017. https://www.unaids.org/sites/default/files/media_asset/Global_AIDS_update_2017_en.pdf.

  5. AVAC. Uganda: A snapshot of PrEP scale-up, registration and resources for Uganda. 2018. https://www.prepwatch.org/country/uganda/.

  6. The National Forum of People Living with HIV Networks in Uganda (NAFOPHANU). 2013. The People Living with HIV/AIDS Stigma Index, Country Assessment, Uganda.

  7. Tumwine C, Nannungi A, Ssegujja E, et al. An exploratory study of HIV-prevention advocacy by persons in HIV care in Uganda. Afr J AIDS Res. 2011;10(4):427–33.

    PubMed  Google Scholar 

  8. Tumwine C, Mbona Tumwesigye N, Mugyenyi P, Wagner G. Psychosocial characterization of HIV clients with potential to be change agents for HIV prevention In Uganda. J Clin Res HIV AIDS Prev. 2012;1(1):3–11.

    Google Scholar 

  9. Wagner GJ, Ghosh-Dastidar B, Slaughter ME. Engagement in HIV prevention advocacy associated with increased consistent condom use among HIV clients in Uganda. AIDS Behav. 2015;19(7):1150–6.

    PubMed  PubMed Central  Google Scholar 

  10. Ssali S, Wagner G, Tumwine C, Nannungi A, Green H. HIV clients as agents for prevention: a social network solution. AIDS Res Treat. 2012;2012:815823.

    PubMed  PubMed Central  Google Scholar 

  11. Raja S, McKirnan D, Glick N. The treatment advocacy program-Sinai: a peer-based HIV prevention intervention for working with African American HIV-infected persons. AIDS Behav. 2007;11(5):S127–S137137.

    PubMed  Google Scholar 

  12. Kelly JA. Popular opinion leaders and HIV prevention peer education: resolving discrepant findings, and implications for the development of effective community programmes. AIDS Care. 2004;16(2):139–50.

    CAS  PubMed  Google Scholar 

  13. Maiorana A, Kegeles S, Fernandez P, et al. Implementation and evaluation of an HIV/STD intervention in Peru. Eval Program Plan. 2007;30(1):82–93.

    Google Scholar 

  14. Medley A, Kennedy C, O'Reilly K, Sweat M. Effectiveness of peer education interventions for HIV prevention in developing countries: a systematic review and meta-analysis. AIDS Educ Prev. 2009;21(3):181–206.

    PubMed  PubMed Central  Google Scholar 

  15. Latkin CA. Outreach in natural settings: the use of peer leaders for HIV prevention among injecting drug users' networks. Public Health Rep. 1998;113(Suppl 1):151–9.

    PubMed  PubMed Central  Google Scholar 

  16. Friedman SR, Maslow C, Bolyard M, Sandoval M, Mateu-Gelabert P, Neaigus A. Urging others to be healthy: "intravention" by injection drug users as a community prevention goal. AIDS Educ Prev. 2004;16(3):250–63.

    PubMed  Google Scholar 

  17. Basu I, Jana S, Rotheram-Borus MJ, et al. HIV prevention among sex workers in India. J Aquir Immune Defic Syndr. 2004;36(3):845–52.

    Google Scholar 

  18. Rogers EM. Diffusion of innovations. 2nd ed. New York, NY: Free Press; 1983.

    Google Scholar 

  19. Broadhead RS, Heckathorn DD, Weakliem DL, et al. Harnessing peer networks as an instrument for AIDS prevention: results from a peer-driven intervention. Public Health Rep. 1998;113(Suppl 1):42–57.

    PubMed  PubMed Central  Google Scholar 

  20. Kelly JA, Murphy DA, Sikkema KJ, et al. Randomised, controlled, community-level HIV-prevention intervention for sexual-risk behaviour among homosexual men in US cities. Community HIV Prevention Research Collaborative. Lancet. 1997;350(9090):1500–5.

    CAS  PubMed  Google Scholar 

  21. Young SD, Zhao M, Tieu K, Kwok J, Gill H, Gill N. A social media-based HIV prevention intervention using peer leaders. J Consum Health Internet. 2013;17(4):353–61.

    PubMed  PubMed Central  Google Scholar 

  22. Mustanski B, Morgan E, D'Aquila R, Birkett M, Janulis P, Newcomb ME. Individual and network factors associated with racial disparities in HIV among young men who have sex with men: results from the Radar Cohort Study. J Acquir Immune Defic Syndr. 2019;80(1):24–30.

    PubMed  PubMed Central  Google Scholar 

  23. Sikkema KJ, Kelly JA, Winett RA, et al. Outcomes of a randomized community-level HIV prevention intervention for women living in 18 low-income housing developments. Am J Public Health. 2000;90(1):57–63.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Kim DA, Hwong AR, Stafford D, et al. Social network targeting to maximise population behaviour change: a cluster randomised controlled trial. Lancet. 2015;386(9989):145–53.

    PubMed  PubMed Central  Google Scholar 

  25. Valente TW. Network interventions. Science. 2012;337(6090):49–53.

    CAS  PubMed  Google Scholar 

  26. Valente TW, Palinkas LA, Czaja S, Chu K-H, Brown CH. Social network analysis for program implementation. PLoS ONE. 2015;10(6):e0131712.

    PubMed  PubMed Central  Google Scholar 

  27. Tsai AC, Bangsberg DR, Kegeles SM, et al. Internalized stigma, social distance, and disclosure of HIV seropositivity in rural Uganda. Ann Behav Med. 2013;46(3):285–94.

    PubMed  Google Scholar 

  28. Serovich JM. A test of two HIV disclosure theories. AIDS Educ Prev. 2001;13(4):355–64.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Gerich J. Effects of social networks on health from a stress theoretical perspective. Soc Indic Res. 2014;118(1):349–64.

    Google Scholar 

  30. Gallant MP. Social networks, social support, and health-related behavior. The Oxford handbook of health communication, behavior change, and treatment adherence. Oxford: Oxford University Press; 2013. p. 303–322.

    Google Scholar 

  31. Thoits PA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011;52(2):145–61.

    PubMed  Google Scholar 

  32. Cohen S. Social relationships and health. Am Psychol. 2004;59(8):676.

    PubMed  Google Scholar 

  33. King R, Katuntu D, Lifshay J, et al. Processes and outcomes of HIV serostatus disclosure to sexual partners among people living with HIV in Uganda. AIDS Behav. 2008;12(2):232–43.

    PubMed  Google Scholar 

  34. Miller AN, Rubin DL. Factors leading to self-disclosure of a positive HIV diagnosis in Nairobi, Kenya: people living with HIV/AIDS in the sub-Sahara. Qual Health Res. 2007;17(5):586–98.

    Google Scholar 

  35. Deribe K, Woldemichael K, Wondafrash M, Haile A, Amberbir A. Disclosure experience and associated factors among HIV positive men and women clinical service users in southwest Ethiopia. BMC Public Health. 2008;8(1):81.

    PubMed  PubMed Central  Google Scholar 

  36. Serovich JM, Reed SJ, Grafsky EL, Hartwell EE, Andrist DW. An intervention to assist men who have sex with men disclose their serostatus to family members: results from a pilot study. AIDS Behav. 2011;15(8):1647–53.

    PubMed  PubMed Central  Google Scholar 

  37. Bogart LM, Skinner D, Thurston IB, et al. Let's Talk!, A South African worksite-based HIV prevention parenting program. J Adolesc Health. 2013;53(5):602–8.

    PubMed  PubMed Central  Google Scholar 

  38. Kegeles SM, Hays RB, Pollack LM, Coates TJ. Mobilizing young gay and bisexual men for HIV prevention: a two-community study. AIDS. 1999;13(13):1753–62.

    CAS  PubMed  Google Scholar 

  39. Moore CG, Carter RE, Nietert PJ, Stewart PW. Recommendations for planning pilot studies in clinical and translational research. Clini Transl Sci. 2011;4(5):332–7.

    Google Scholar 

  40. Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017;17(1):88.

    PubMed  PubMed Central  Google Scholar 

  41. Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.

    PubMed  Google Scholar 

  42. Gilbert P. Compassion focused therapy: distinctive features. New York: Routledge/Taylor & Francis Group; 2010.

    Google Scholar 

  43. Gilbert P, Irons C. Focused therapies and compassionate mind training for shame and self-attacking. Compassion: conceptualisations, research and use in psychotherapy. New York: Routledge; 2005. p. 263–325.

    Google Scholar 

  44. Kolts RL. CFT made simple: a clinician's guide to practicing compassion-focused therapy. Oakland, CA: New Harbinger Publications; 2016.

    Google Scholar 

  45. Gilbert P, Procter S. Compassionate mind training for people with high shame and self-criticism: overview and pilot study of a group therapy approach. Clin Psychol Psychother. 2006;13(6):353–79.

    Google Scholar 

  46. Bogart LM, Dale SK, Daffin GK, et al. Pilot intervention for discrimination-related coping among HIV-positive Black sexual minority men. Cult Divers Ethnic Minor Psychol. 2018;24(4):541–51.

    Google Scholar 

  47. Hogan B, Carrasco JA, Wellman B. Visualizing personal networks: working with participant-aided sociograms. Field Methods. 2007;19(2):116–44.

    Google Scholar 

  48. Burt RS. Brokerage and closure. An introduction to social capital. Oxford: Oxford University Press; 2005.

    Google Scholar 

  49. Hedges LV, Citkowicz M. Estimating effect size when there is clustering in one treatment group. Behav Res Methods. 2015;47(4):1295–308.

    PubMed  Google Scholar 

  50. EgoWeb 2.0. computer software, https://egoweb.info.

  51. Kalichman SC, Simbayi LC, Cloete A, Mthembu PP, Mkhonta RN, Ginindza T. Measuring AIDS stigmas in people living with HIV/AIDS: the Internalized AIDS-Related Stigma Scale. AIDS Care. 2009;21(1):87–93.

    PubMed  Google Scholar 

  52. Solorio R, Norton-Shelpuk P, Forehand M, et al. Tu Amigo Pepe: evaluation of a multi-media marketing campaign that targets young Latino immigrant MSM with HIV testing messages. AIDS Behav. 2016;20(9):1973–88.

    PubMed  Google Scholar 

  53. Campbell K, Lee B. Name generators in surveys of personal networks. Soc Netw. 1991;13(3):203–21.

    Google Scholar 

  54. McCarty C. Measuring structure in personal networks. J Soc Struct. 2002;3:1.

    Google Scholar 

  55. McCarty C, Bernard H, Killworth P, Shelley GA, Johnsen EC. Eliciting representative samples of personal networks. Soc Netw. 1997;19(4):303–23.

    Google Scholar 

  56. Mustanski B, Birkett M, Kuhns LM, Latkin CA, Muth SQ. The role of geographic and network factors in racial disparities in HIV among young men who have sex with men: an egocentric network study. AIDS Behav. 2015;19(6):1037–47.

    PubMed  PubMed Central  Google Scholar 

  57. McCarty C, Kilworth PD. Impact of methods for reducing respondent burden on personal network structural measures. Soc Netw. 2007;29:300–15.

    Google Scholar 

  58. Wasserman S, Faust K. Social network analysis: methods and applications. New York, NY: Cambridge University Press; 1994.

    Google Scholar 

  59. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32(6):705–14.

    CAS  PubMed  Google Scholar 

  60. Ryan GW, Bernard HR. Data management and analysis methods. In: Denzin N, Lincoln Y, editors. Handbook of qualitative research. 2nd ed. Thousand Oaks: Sage Publications; 2000. p. 769–802.

    Google Scholar 

  61. Ryan GW, Bernard HR. Techniques to identify themes. Field Method. 2003;15(1):85–110.

    Google Scholar 

  62. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20(1):37–46.

    Google Scholar 

  63. Bakeman R, Gottman JM. Observing interaction: an introduction to sequential analysis. New York: Cambridge University Press; 1997.

    Google Scholar 

  64. Kalton G. Ultimate cluster sampling. J R Stat Soc. 1979;142(2):210–22.

    Google Scholar 

  65. Turan B, Smith W, Cohen MH, et al. Mechanisms for the negative effects of internalized HIV-related stigma on antiretroviral therapy adherence in women: the mediating roles of social isolation and depression. J Acquir Immune Defic Syndr. 2016;72(2):198–205.

    CAS  PubMed  PubMed Central  Google Scholar 

  66. Burnham KE, Cruess DG, Kalichman MO, Grebler T, Cherry C, Kalichman SC. Trauma symptoms, internalized stigma, social support, and sexual risk behavior among HIV-positive gay and bisexual MSM who have sought sex partners online. AIDS Care. 2016;28(3):347–53.

    PubMed  Google Scholar 

  67. Stirratt MJ, Remien RH, Smith A, et al. The role of HIV serostatus disclosure in antiretroviral medication adherence. AIDS Behav. 2006;10(5):483–93.

    PubMed  Google Scholar 

  68. Simbayi LC, Kalichman SC, Strebel A, Cloete A, Henda N, Mqeketo A. Disclosure of HIV status to sex partners and sexual risk behaviours among HIV-positive men and women, Cape Town. South Africa Sex Transm Infect. 2007;83(1):29–34.

    CAS  PubMed  Google Scholar 

  69. Li L, Wu Z, Liang L-J, et al. Reducing HIV-related stigma in health care settings: a randomized controlled trial in China. Am J Public Health. 2013;103(2):286–92.

    PubMed  PubMed Central  Google Scholar 

  70. Ashida S, Heaney CA. Differential associations of social support and social connectedness with structural features of social networks and the health status of older adults. J Aging Health. 2008;20(7):872–93.

    PubMed  Google Scholar 

  71. Wellman B. Applying network analysis to the study of support. Soc Netw Soc Support. 1981;4:171–200.

    Google Scholar 

  72. Dozier M, Harris M, Bergman H. Social network density and rehospitalization among young adult patients. Psychiatr Serv. 1987;38(1):61–5.

    CAS  Google Scholar 

  73. Hirsch BJ. Natural support systems and coping with major life changes. Am J Comm Psychol. 1980;8(2):159–72.

    Google Scholar 

  74. Berkman LF, Glass T, Brissette I, Seeman TE. From social integration to health: Durkheim in the new millennium. Soc Sci Med. 2000;51(6):843–57.

    CAS  PubMed  Google Scholar 

  75. Latkin CA, Davey-Rothwell MA, Knowlton AR, Alexander KA, Williams CT, Boodram B. Social network approaches to recruitment, HIV prevention, medical care, and medication adherence. J Acquir Immune Defic Syndr. 2013;63(0 1):S54–S5858.

    PubMed  PubMed Central  Google Scholar 

  76. Schneider JA, Zhou AN, Laumann EO. A new HIV prevention network approach: sociometric peer change agent selection. Soc Sci Med. 2015;125:192–202.

    PubMed  Google Scholar 

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Acknowledgements

This research was supported by the National Institute of Mental Health (R34 MH111460, P30 MH058107). JKBM received additional support from the National Institutes of Health Global Health Equity Scholars Fellowship Program (FIC D43TW010540) and the Africa Research Excellence Fund (RF-157-0024-F-MATOV). We are grateful to the members of the IDI Community Advisory Board and the National Forum of People Living with HIV Networks in Uganda (NAFOPHANU) for their input on intervention development and interpretation of the results; to Joan Nampiima for assistance with data collection, data cleaning, and general study management; to Julia Gasuza for assistance with study coordination and data collection; and to Kuraish Mubiru, Richard Serunkuuma, and Anne Peace Baguma for intervention facilitation.

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  1. RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA

    Laura M. Bogart, Glenn J. Wagner, Harold D. Green, Erik D. Storholm, David J. Klein, Terry Marsh & Sarah MacCarthy

  2. Makerere University School of Public Health, Kampala, Uganda

    Joseph K. B. Matovu

  3. Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda

    Joseph K. B. Matovu & Andrew Kambugu

  4. University of Indiana Bloomington School of Public Health, Bloomington, IN, USA

    Harold D. Green

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  1. Laura M. Bogart
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Correspondence to Laura M. Bogart.

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All procedures performed were in accordance with the ethical standards of the institutional review boards of the RAND Corporation and Makerere University, as well as the Ugandan National Council for Science and Technology, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Bogart, L.M., Matovu, J.K.B., Wagner, G.J. et al. A Pilot Test of Game Changers, a Social Network Intervention to Empower People with HIV to be Prevention Advocates in Uganda. AIDS Behav 24, 2490–2508 (2020). https://doi.org/10.1007/s10461-020-02806-4

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