SNS to Increase HIV Testing Uptake and Linkage to Double Cascade Services Among Adolescent MSM and TGW in Thailand

Social Network Strategy to Promote HIV Testing and Linkage to HIV Services Among Young Men Who Have Sex With Men and Transgender Women in Thailand

UNAIDS aims to end AIDS by 2030 using "90-90-90" diagnosis-treatment-viral suppression targets. Thailand has achieved elimination of HIV mother-to-child transmission, but continues to see new infections among adolescent men who have sex with men (YMSM) and transgender women (YTGW). Reaching and engagement of key populations to HIV services remains a major challenge, with differentiated care needed to address this. Investigators propose a study on outreach for HIV at-risk adolescents using peer-led social network strategies (SNS), linkage to facility-based HIV self-testing, and same day HIV prevention or treatment. The study will focus on the 15-19 year age group who have the highest HIV incidence in Thailand (6.9-10 per 100 person years, PY), but will also include young adults aged 20- 24 years of age, due to their frequently intertwining sex networks and very similar HIV incidence of 4.9-7.2 per 100 PY.

Eight hundred adolescent and young adult (AYA) MSM and TGW aged between 15-24 years will be recruited into a double HIV cascade care system. AYA aged between 15-24 years will be trained as recruiters to approach and refer their peers, 'network members' (NMs) to our adolescent clinic. NMs will be offered a choice of either blood-based or oral fluid-based HIV self-testing. HIV positive cases will be offered same-day antiretroviral therapy (SDART) and high-risk adolescents will be offered same day preexposure prophylaxis (PrEP). The project will be conducted at adolescent differentiated care services previously established by CIPHER grants in Thailand, located at King Chulalongkorn Memorial Hospital (KCMH), Bangkok. It will inform both Thailand and other Asia-Pacific region countries with similar epidemic patterns through an implementation research lens on strategies to engage YMSM and YTGW into HIV services, which investigators believe will make high-impact contributions to our collective ultimate goal of ending AIDS.

Recruiters

Inclusion Criteria:

• ages 15-24 years
• assigned male gender at birth
• self-defined gender identity of either MSM or TGW
• any one of the following: living with HIV, using HIV pre-exposure prophylaxis, receiving intermittent HIV testing for ongoing HIV risk
• good rapport with King Chulalongkorn Memorial Hospital (KCMH) Adolescent Health Clinic, knowledgable on HIV and comfortable discussing HIV with peers

Network Members

Inclusion Criteria:

• ages 15-24 years
• assigned male gender at birth
• self-defined gender identity of either MSM or TGW
• self-reported oral and/or anal sex with a man in the past 12 months and at risk of HIV infection (multiple sex partners in the preceding 6 months and/or inconsistent condom use)
• no history of HIV testing or last HIV test > 3 months prior to study entry

Exclusion Criteria:

• Known to be living with HIV