Crowdsourcing to Reduce HIV Stigma Among Adolescents and Young Adults in Kazakhstan

Reducing HIV Stigma to Increase HIV Testing Among Adolescents and Young Adults in Kazakhstan Using a Crowdsourcing Approach

This project will assess whether a digital crowdsourced intervention can reduce HIV stigma and promote HIV self-testing among adolescents and young adults (AYA). NIH has emphasized the need for research on interventions to reduce HIV-associated stigma and its impact on the prevention and treatment of HIV/AIDS, particularly in low and middle income countries (LMICs). The proposed study has the highest public health significance: it uses a community-based participatory approach to engage local AYA to develop a digital crowdsourced HIV stigma reduction and self-testing intervention to reduce HIV stigma and increase HIV testing.

Study Aim 1: To develop a crowdsourced digital HIV stigma reduction and self-testing intervention targeting AYA in Kazakhstan. Using a community-based participatory approach that engages local adolescents and young adults (AYA) and youth organizations, we will launch a national crowdsourcing contest in which AYA will design multimedia content to reduce HIV stigma in order to promote HIV testing among peers.

Study Aim 2: To pilot test this crowdsourced HIV stigma reduction and self-testing intervention in a preliminary efficacy trial. We will assess the intervention's feasibility and acceptability and obtain preliminary estimates of its effects on decreasing HIV stigma (primary outcome) and increasing HIV testing (secondary outcome) among AYA in Kazakhstan who received the intervention compared to individuals who did not. Participants (n=168) will be randomized 1:1 to: 1) receive the winning multimedia crowdsourced HIV stigma reduction content and a link for HIV self-testing, or 2) receive standard Kazakhstan Ministry of Health HIV informational materials and a link for HIV self-testing.

Study Overview

• Status: Completed
• Conditions: HIV Testing; Stigma, Social
• Intervention / Treatment: Behavioral: Digital Crowdsourced Intervention to Reduce HIV Stigma among Adolescents and Young Adults

Detailed Description

This project will assess whether a digital crowdsourced intervention can reduce HIV stigma and promote HIV self-testing among adolescents and young adults (AYA). Globally AYA are at increased risk for HIV acquisition. In Eastern Europe and Central Asia (EECA), new HIV infections among 15-24 year old AYA are expected to increase 28% by 2030. In Kazakhstan, one in four HIV infections occur among AYA. Despite the growing HIV burden among AYA in Kazakhstan, this population has some of the lowest HIV testing rates in the country, largely due to stigma. Yet few efforts in Kazakhstan address HIV stigma and the role it plays as a barrier to HIV testing. Digital technologies and crowdsourcing campaigns (i.e., engaging groups of AYA online to address public health challenges and share solutions) are scalable, cost-effective tools that can increase HIV testing services and reduce HIV stigma in low and middle income countries (LMICs) and other resource- constrained settings. Crowdsourcing may be particularly successful among AYA, given their high levels of social media use and technological literacy. Complementing the crowdsourcing approach, mailing HIV rapid test kits can enable AYA to avoid the stigma associated with attending the AIDS Center and overcome transportation barriers.

• Study Type: Interventional
• Enrollment (Actual): 216
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Kazakhstan
  • Almaty, Kazakhstan, 050040
    • Columbia University Global Health Research Center of Central Asia

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 24 years (Child, Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Age 16-24
• Report previous sex with another individual
• Reside in Kazakhstan

Exclusion Criteria:

• Not willing to provide consent or not able to understand study procedures

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: Randomized
• Interventional Model: Single Group Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Crowdsourced Intervention; The digital crowdsourced intervention will be presented to participants in the intervention arm.	Behavioral: Digital Crowdsourced Intervention to Reduce HIV Stigma among Adolescents and Young Adults; Adolescents and young adults will participate in a crowdsourcing contest to create digital materials to reduce HIV stigma in order to increase HIV testing. Entries will be judged by a community judging panel and expert judging panel. Winning entries will be selected for the digital intervention and presented to participants in the intervention arm.
No Intervention: Standard of Care; Standard HIV informational materials currently used by the Kazakhstan Ministry of Health will be presented to participants in the control arm.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Score Change in Total HIV Stigma Scale	The scale/questionnaire is comprised of 17 items on a 5-point Likert scale (score range from 17-85). Higher scores indicate higher levels of stigma. Outcome will be assessed in mean score change from baseline to 3 months follow-up.	Baseline and 3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Change in Perceived HIV Test Stigma	This is a subscale of the Total HIV Stigma scale. It contains 2 items, each on a 1-5 point Likert scale, with a range of 5-10. Higher values indicate higher levels of HIV stigma.	Baseline and 3 months
Mean Change in Perceived HIV Healthcare Stigma Subscale	This is a subscale of the Total HIV Stigma Scale. It contains two items, each on a 1-5 point Likert scale, with a range of 5-10. Higher values indicate higher levels of HIV healthcare stigma.	Baseline and 3 months
Mean Change in Fear & Judgement HIV Stigma Sub-scale	This is a subscale of the Total HIV Stigma Scale. It consists of 5 items, each on a 1-5 point Likert scale, with a range of 5-25. Higher values indicate higher levels of fear & judgement HIV stigma.	Baseline and 3 months
Mean Change in Perceived Community HIV Stigma Subscale	This is a subscale of the Total HIV Stigma Scale. It consists of 8 items, each on a 1-5 point Likert-scale, with a range of 6-40. Higher values indicate higher levels of perceived community HIV stigma.	Baseline and 3 months
Uptake of HIV Self-test	The number of participants who ordered an HIV self-test kit after baseline and by the 3-month follow-up. It is a dichotomous outcome (yes/no).	After baseline and by the 3 month follow-up period

Collaborators and Investigators

• Sponsor: Columbia University
• Collaborators: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); National Institutes of Health (NIH); Fogarty International Center of the National Institute of Health
• Investigators: Principal Investigator: Alissa Davis, PhD, Columbia University

Study record dates

Study Major Dates

• Study Start (Actual): January 24, 2023
• Primary Completion (Actual): August 22, 2023
• Study Completion (Actual): August 22, 2023

Study Registration Dates

• First Submitted: October 25, 2021
• First Submitted That Met QC Criteria: October 25, 2021
• First Posted (Actual): November 4, 2021

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: November 21, 2024
• Last Verified: November 1, 2024

More Information

Terms related to this study

• Keywords: HIV stigma
• Other Study ID Numbers: AAAT7871; R21TW012017 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Data will be shared with researchers who request access to the data and obtain appropriate IRB approval.
• IPD Sharing Time Frame: Data will become available to outside investigators after the study investigative team has cleaned and analyzed the data and written their proposed papers.
• IPD Sharing Access Criteria: Have a proposed plan for data analysis Completed human subjects training Obtained Institutional Review Board approval to access and analyze the data
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No