Kudos to Marta Mulawa, professor, for the submission of a subcontract proposal on a UNC-CH NIH R01 application entitled: "A cluster-randomized controlled trial of a social network intervention to promote and distribute HIV self-test kits among social networks of young men in Dar es Salaam, Tanzania." This proposal requests funding for a five-year period with a start date of April 1, 2020.  

The overarching goal of this work is to conduct a cluster randomized trial to evaluate an approach to increase HIV testing among social networks of young men in Dar es Salaam, Tanzania. Men are underrepresented in HIV/AIDS testing and treatment services and experience greater AIDS-related mortality compared to women. HIV Self-Testing (HIVST), where individuals collect their own sample and perform a simple, rapid HIV antibody test in the absence of a provider, reduces some of the barriers men experience when seeking HIV testing. However, fully realizing the potential of HIVST to increase rates of HIV testing will require evidence-based strategies to reach young men at high risk who have not recently tested for HIV, a population crucial for ending the epidemic. Expanding HIVST among these high-risk men requires addressing the unique barriers and norms influencing their behaviors. Targeting social networks is an effective way to shift such norms to achieve sustained behavior change. Prior work by our team in Dar es Salaam, Tanzania identified social networks of young men who socialize regularly in stable peer groups locally referred to as “camps.”

The primary objective of the proposed study is to evaluate a social network-based HIV self-testing intervention (NetworkST) in which peer-nominated leaders are trained to promote and distribute HIV self-tests while simultaneously transforming HIV testing and gender norms as well as HIV-related stigma within their camp-based social networks. We will compare this to a more traditional, pharmacy-based distribution approach (PharmST). The proposed five-year study seeks to rigorously evaluate NetworkST, using a hybrid effectiveness-implementation design (Hybrid  Type I), with three specific aims: (1) evaluate the effectiveness of NetworkST, compared to PharmST, on HIV testing outcomes among men who have not recently tested for HIV; (2) identify the mediators and moderators of NetworkST’s effect on men’s HIV testing outcomes and (3) assess implementation outcomes and describe intervention processes for future scale-up using Proctor’s Implementation Framework. This cluster-randomized controlled trial will enroll a cohort of approximately 1,470 men within 70 camp-based social networks and will randomize networks to either 12 months of NetworkST + PharmST or PharmST alone. Behavioral assessments will be conducted at baseline, 3-, 6-, 12-, and 18-months follow-up. Key implementation outcomes including cost, fidelity, penetration and acceptability will be measured among men in both arms, and qualitative interviews will be conducted with peer leaders, camp members, and pharmacists to describe the experience distributing and using HIVST. If proven successful, our intervention approach can be adapted and scaled-up to reach high-risk young men in other global settings. 

Dr. Mulawa, the sub-contract PI at Duke, will contribute her expertise in social network intervention development, data collection, and analysis. She will play a leadership role on the team in designing the social network data collection modules, training the team in the collection of social network data, and leading the data analysis related to the structure of the camp-based social networks.