A Digital Crowdsourced Intervention to Reduce HIV Stigma and Promote HIV Testing among Adolescents and Young Adults in Kazakhstan: Results of the JasSpark Randomized Controlled Trial

Background: Kazakhstan has a high incidence of HIV, especially among adolescents and young adults (AYA). High HIV stigma among AYA contributes to low HIV testing uptake. Crowdsourcing is an innovative community-based intervention development approach that engages AYA in partnership with researchers to develop stigma-reduction interventions. We examined the effects of an AYA-developed digital crowdsourced intervention on reducing HIV stigma among AYA exposed to the intervention as compared to conventional public health materials.Methods: AYA ages 16-24 in Almaty, Kazakhstan, were recruited online. The main outcome was HIV stigma, with HIV self-testing uptake as a secondary outcome. AYA were exposed to intervention or control materials once a week for five weeks; outcomes were measured at 1 month and 3 months follow-up. We conducted multilevel linear mixed models to compare changes over time by arm and sex.Results: We recruited 216 AYA (Females:116/Males:100). AYA in the intervention arm had significantly lower HIV testing stigma at 3-months post-baseline (adjusted mean change (AMC) -0.72 [-1.06, -0.38]) than AYA in the control arm (AMC -0.17 [-0.52, 0.18]; p=0.026). Female AYA in the intervention arm had significantly lower HIV stigma at 1-month (AMC -4.90 [-7.27, -2.54]) and 3-months post-baseline (AMC -5.14 [-7.49, -2.79]) than females in the control arm (0.04 [-2.56, 2.63]) and AMC -0.66 [-3.28, 1.97]; p=0.023, p=0.025). There was no significant difference between intervention and control arms for male AYA. Trends indicated that intervention arm AYA (total sample) were more likely to order an HIV test during follow-up than control arm AYA (OR: 1.68, [95% CI: 0.85, 3.32]; p=0.14).Conclusions: The AYA-developed crowdsourced intervention decreased total HIV stigma, and HIV testing stigma among female AYA. Further research is needed to explore potential reasons for sex differences in crowdsourced interventions. Crowdsourced interventions may be a promising way to engage communities to develop interventions to decrease HIV stigma.