AEGIDA: Results of a Pilot Randomized Trial of an HIV Self-Testing Intervention for Women Who Exchange Sex and Use Substances in Kazakhstan

Abstract

HIV self-testing (HST) is a user-controlled approach to increasing HIV testing and status knowledge, the gateway to biomedical prevention and treatment. HST is a promising option for key populations facing stigma-related barriers to testing in primary and specialty (e.g., HIV, substance use) healthcare clinics. We conducted a pilot efficacy trial of AEGIDA, a 4-session intervention designed for women who exchange sex and use substances, in Kazakhstan, where there is a growing HIV epidemic. Between November 2022 and August 2023, we used community-engaged approaches to recruit and screen 305 HIV-negative cisgender and transgender women (47% eligible). Ninety participants were enrolled and randomized in a 2:1 assignment to the active (AEGIDA) or a time-attention control (didactic self-screening information) condition with 6 months of follow-up. AEGIDA's theoretically grounded sessions included evidence-based techniques to reduce internalized intersectional stigma and build HST skills to increase HIV testing (e.g., motivational interviewing, peer education, and cognitive restructuring). Sessions were delivered face-to-face and via videoconference, with a closed Instagram page for active condition participants to access content on demand. The intent-to-treat analysis found that participants randomized to AEGIDA were over 4 times more likely to complete a recent HIV test (1 + test in the prior three months; aOR = 4.08, 95% CI: 1.22,13.62) at 6-month follow-up compared to control participants. The intervention had no significant impact on consistent HIV testing (1 + test per three months over the six-month follow-up period; aOR = 2.02, 95%CI: 0.69-5.88). Overall, the AEGIDA intervention demonstrated feasibility and acceptability, and preliminary efficacy to increase recent HIV testing. NCT Information NCT06150937.