A comparison of venue-based and peer-driven recruitment strategy performance: examining efficiency, range and reach among sexual minority men living with HIV in Ghana.

Engaging gay, bisexual, and other men who have sex with men (MSM) living with HIV in Ghana is challenging due to stigma, discrimination, and fear of legal and safety consequences. This study compared venue-based (VBR) and peer-driven recruitment (PDR) strategies among MSM living with HIV to evaluate efficiency, reach, and range. An analysis was performed using data from 225 MSM living with HIV recruited from January to August 2017 in four Ghanaian cities. The VBR enrolled 148 participants over approximately six months with a median weekly recruitment of 4, while PDR enrolled 77 participants in four weeks, averaging 20 per week (p = 0.0043). Demographics were similar between the two strategies; however, participants recruited via PDR reported higher incomes (p = 0.019). Participants recruited via the PDR had significantly higher odds of not previously being linked to HIV care (adjusted odds ratio = 2.03, 95% CI = 1.04-3.96, p = 0.037). The main challenge raised by peer recruiters was that of a potential breach of confidentiality. Findings suggest PDR may better address recruitment speed and engage MSM populations disconnected from formal HIV services. We endorse PDR strategies as effective, context-sensitive approaches for recruiting and engaging MSM and other stigmatized groups while underlining the need to ensure privacy and confidentiality.