Game Changers: A Program to Empower People Living with HIV in Uganda to Be Prevention Advocates

Overview

RAND conducted a randomized controlled trial (RCT) of a pilot program called Game Changers, a peer-led group intervention that aims to empower and mobilize people living with HIV to be agents for HIV prevention in their social networks. By decreasing stigma among people living with HIV and their social network members, as well as training them on key strategies to engage social network members in discussions around HIV, Game Changers provides participants with the tools to do prevention advocacy.

Background and Goals

Game Changers was developed in partnership with Infectious Diseases Institute (IDI), a public-private partnership in Kampala that provides care to people living with HIV, trains healthcare workers on HIV care and treatment, and conducts research to address the HIV epidemic. From 2016-2019, RAND and IDI conducted an RCT of Game Changers to test intervention effects on the primary outcomes of increased HIV testing, reduced sexual risk and decreased HIV stigma among social network members. The RCT also tested intervention effects on reduced internalized HIV stigma, increased HIV serostatus disclosure, and increased viral load suppression among people living with HIV.

Methodology and Results

The project surveyed 99 people living with HIV and 58 social network members at baseline and post-intervention (5 and 8 months), and also included an intervention facilitator and participant post-intervention focus groups. The program had high group attendance and retention (an average of 76% attended each session across 4 intervention groups), and program participants rated the program positively and reported that effective prevention advocacy had occurred. Results showed increased HIV prevention advocacy and disclosure of HIV status, and decreased internalized stigma among people living with HIV in the study. The pilot also showed promising results on social network members’ reduced sexual risk. The study sets the stage for a larger RCT, proposed to NIH in May 2020 that will expand the number of participants, refine and expand the program content, and integrate HIV pre-exposure prophylaxis (PrEP). In addition, in a new project, the program will be adapted for cervical cancer prevention in Uganda.