An Internet-Based, Peer-Delivered Messaging Intervention for HIV Testing and Condom Use Among Men Who Have Sex With Men in India (CHALO!): Pilot Randomized Comparative Trial

Abstract

Background Leveraging internet-based communication tools (eg, messaging apps, SMS text messaging, and email) may be an effective avenue for delivery of HIV prevention messages to men who have sex with men (MSM) in India, but there are limited models for such internet-based interventions. Objective The CHALO! pilot was an online educational and behavioral intervention aimed to determine the feasibility, acceptability, and preliminary impact of a peer-delivered, internet-based messaging intervention for HIV testing and consistent condom use for MSM in India. The messages addressed barriers to HIV testing and condom use and were theoretically based on the information-motivation-behavioral skills model. Methods Between February and March 2015, we recruited, enrolled, and randomized 244 participants via online advertisements on mobile dating apps and Facebook. Eligible men (18 years or older, sexually active with other men, and self-reported HIV-negative or unknown status) were randomized to receive educational and motivational messages framed as either approach (ie, a desirable outcome to be achieved) or avoidance (an undesirable outcome to be avoided) over 12 weeks via internet-based messaging platforms. Participants completed online surveys at baseline and immediately postintervention. Results Participants were similar across arms with respect to sociodemographic and behavioral characteristics. Over 82.0% (200/244) of participants were retained (ie, viewed final messages), and 52.3% (130/244) of them completed the follow-up survey. Of those completing the follow-up survey, 82.3% (107/130) liked or strongly liked participating in CHALO!. The results showed a significant increase in self-reported HIV testing in the past 6 months from baseline to follow-up (41/130, 31.5% to 57/130, 43.8%; P=.04). When including those who reported intentions to test, this percentage increased from 44.6% (58/130) at baseline to 65.4% (85/130) at follow-up (P<.01). When examining intentions to test among those without prior HIV testing, intentions increased from 32% (16/50) of the sample at baseline to 56% (28/50) of the sample at follow-up (P=.02). Condom use during anal sex did not significantly change from baseline to follow-up. HIV testing and condom use did not significantly differ between approach and avoidance conditions at follow-up. Conclusions As one of the first studies of an online HIV prevention intervention for Indian MSM, CHALO! was feasible to implement by a community-based organization, was acceptable to participants, and demonstrated potential to improve HIV testing rates.

Using Digital Communication Technology to Increase HIV Testing Among Men Who Have Sex With Men and Transgender Women: Systematic Review and Meta-Analysis

“…The recall period for these studies varied, with one study reporting lifetime HIV testing history and the remaining studies using recall periods that ranged from 3 months to 3 years. A total of 10 studies used an RCT design [ 46 - 49 , 51 , 54 - 58 ]. The specific study design used by the remaining 3 studies was a prospective cross-sectional study with nonequivalent control group [ 50 ], a prospective single-group cross-sectional study [ 52 ], and a prospective cross-sectional matched-pair randomized trial design [ 53 ].…”

“…Due to the lack of individual-level randomization and nonequivalence of control groups, we calculated relative risk for these 3 studies using reported HIV testing uptake at preintervention baseline and postintervention endpoints in the intervention arm only. One RCT described two intervention arms and did not present disaggregated findings; therefore, this study was treated as a single cohort, and relative risk was calculated based on HIV testing uptake at baseline and endpoint [ 51 ].…”

“…Promoting HIV testing uptake was identified as the primary aim of all 13 studies. Five studies had multiple primary aims: mutual disclosure of HIV status with sexual partners (ie, asking and disclosing HIV serostatus [ 49 ]), STI testing [ 46 ], intention to test [ 47 , 51 ], and reduction of unprotected anal intercourse [ 49 , 50 ] (data not reported).…”

“…Of the 7 studies that used social media, 5 delivered interventions using Facebook [ 50 , 51 , 55 , 57 , 58 ]. All of these studies used closed or private Facebook groups to promote HIV testing, using a range of accompanying features and modalities using internet popular opinion leaders to disseminate HIV-related information and engage in conversations about HIV testing, prevention, and risk behavior [ 50 ]; using trained peer educators to deliver HIV prevention and testing information and promote HIV testing uptake [ 55 , 58 ], including through the provision of HIV self-tests [ 57 ]; delivering weekly videos promoting HIV testing alongside moderated group discussion [ 47 ]; and sending HIV prevention and HIV testing promotion messages (in conjunction with messages sent by WhatsApp and email) [ 51 ].…”

“…Most interventions (n=8) were categorized as interactive for their ability to allow user engagement, for example, through social media platforms, responses on messaging platforms or through email, or via a website. Interventions involving online peer educators interacting with participants through social media platforms were typically longer in duration, ranging from 12 weeks [ 51 , 57 , 58 ] to 12 months [ 53 ]. The frequency of exposure to online peer educators was user-determined, that is, participants were free to choose how often, if at all, they interacted with online peer educators.…”