JMIR Publications

ABSTRACT

Background:

Despite great efforts in HIV prevention worldwide, HIV testing uptake among men who have sex with men (MSM) remains suboptimal. The effectiveness of digital crowdsourced multi-level intervention in improving HIV testing is still unclear.

Objective:

The aim of this study was to evaluate the effect of a digital crowdsourced multi-level intervention in improving HIV testing uptake among MSM in China.

Methods:

We conducted a two-arm, cluster randomized controlled trial among MSM in 11 cities in Shandong province, China, from August 2019 to April 2020. Participants were men with HIV-seronegative or unknown serum status, had anal sex with men in the past 12 months, and had not been tested for HIV in the past three months. Participants were recruited through a gay-dating app and community-based organizations from pre-selected cities, and those cities were matched into five blocks (two clusters per block) and further be randomly assigned (1:1) to received digital crowdsourced multi-level intervention (intervention arm) or routine intervention (control arm). The digital multi-level intervention was developed through crowdsourced open calls tailored for MSM, consisting of digital intervention images and videos, the strategy of providing HIV self-testing services through digital tools, and peer-moderated discussion within WeChat groups. The primary outcome was self-reported HIV testing uptake in the previous three months. Intention-to-treat approach was used to examine the cluster-level effect of digital crowdsourced multi-level intervention in the 12-month study period using generalized linear mixed models and to examine the individual-level effect using linear mixed models.

Results:

A total of 935 MSM were enrolled (404 intervention participants and 531 control and) and 751 participants (80.3%) completed at least one follow-up survey. Most participants were younger than 30 years old (601 [64.3%]), single (681 [72.8%]), had college degree or higher (629 [67.3%]), and had HIV testing history (785 [84.0%]). Overall, the proportion of testing for HIV in the past three months at 3-, 6-, 9-, and 12-mo follow-ups were higher in the intervention arm (49.8%, 55.6%, 71.9%, and 64.3%, respectively) compared with the control arm (43.8%, 43.6%, 51.1%, and 48.4%, respectively), with statistically significant differences at the 6-, 9-, 12-mo follow-ups. At cluster-level, the proportion of participants having tested for HIV increased 11.62% (95% CI 0.74%-22.50%, P=.045) with the digital crowdsourced multi-level intervention. At individual-level, participants in the intervention arm had 69% higher odds for testing for HIV in the past three months compared with control participants, but the result was not statistically significant (RR=1.69, 95% CI 0.87-3.27, P=.108).

Conclusions:

The digital crowdsourced multi-level intervention effectively improved HIV testing uptake among Chinese MSM. Our findings highlight that digital crowdsourced multi-level interventions should be made more widely available in HIV prevention and other public health issues. Clinical Trial: Chinese Clinical Trial Registry: ChiCTR1900024350; http://www.chictr.org.cn/showproj.aspx?proj=36718.