Peer-led community HIV/syphilis testing with linkage within seven days for MSM and transgender women in Indonesia: a mixed-methods process evaluation

We evaluated a peer-led, community-based service (CBS) model providing integrated HIV/syphilis testing and referral for men who have sex with men (MSM) and transgender women (TGW) in South Sulawesi, Indonesia. Trained community health workers (CHWs) delivered finger-prick HIV RDTs and, where available, dual HIV/syphilis tests through three outreach modalities: door-to-door outreach, "static community posts", and mobile hotspot events. Primary outcomes were acceptability, feasibility , first-time testing, syphilis testing coverage, and linkage to confirmatory testing and ART within ≤7 days. Among 423 clients, acceptability was high, and most were first-time testers. HIV reactivity was 2.8% (12/423); all were referred, confirmed, and initiated ART within ≤7 days. Syphilis testing coverage was 83.0% with lower coverage in Bulukumba reflecting documented commodity/workflow constraints. In 70 observed encounters, checklist items 1-8 demonstrated complete procedural adherence; item 9 highlighted a need for documentation/SOP clarification for corrective actions when deviations occur. Qualitative findings converged with quantitative results: participants valued privacy, convenience, and peer trust, while stakeholders emphasized the need to stabilize test-kit supply, clarify corrective-action procedures, and strengthen client-level time-stamping for scale-up. Findings support scaling up differentiated, peer-led community testing for MSM and TGW with standardized quality assurance, and reliable syphilis test supply.