#SafeHandsSafeHearts: a randomized waitlist-controlled trial of an eHealth intervention to increase COVID-19 knowledge and protective behaviors and reduce psychological distress among LGBTQ+ people in India and Thailand

Title

Presenter

Venkatesan Chakrapani

Authors

P. Newman (1), V. Chakrapani * (2,3), S. Tepjan (4), P. Akkakanjanasupar (4), S. Rawat (3), N. Massaqoui (5), C. Williams (1), S. Waewklaihong (6), B. Mohan (3), G. Carl (6), S. Pengnonyang (6), S. Roungprakhon (7), N. Phanuphak (6)

Institutions

(1) University of Toronto, Factor-Inwentash Faculty of Social Work, Toronto, Canada, (2) Centre for Sexuality and Health Research and Policy, Chennai, India, (3) The Humsafar Trust, Mumbai, India, (4) VOICES-Thailand Foundation, Chiang Mai, Thailand, (5) University of Toronto Scarborough, Department of Health and Society, Scarborough, Canada, (6) Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand, (7) Rajamangala University of Technology Phra Nakhon, Computer Technology, Bangkok, Thailand

BACKGROUND: Lesbian, gay, bisexual, transgender, queer, and other sexual/gender minority (LGBTQ+) people are at heightened vulnerability for COVID-19 morbidity and mortality due to adverse social determinants of health, and pervasive health and mental health disparities. We tested a theory-based, culturally-tailored, peer-delivered eHealth intervention to increase COVID-19 knowledge and protective behaviors and reduce psychological distress among LGBTQ+ people in Bangkok and Mumbai.
METHODS: #SafeHandsSafeHearts is a multisite, pragmatic, randomized waitlist-controlled trial with 1:1 (immediate intervention group [IIG]: waitlist control [WLC]) allocation (ClinicalTrials.gov NCT04870723). Eligibility criteria: self-identified LGBTQ+, '¥18-years-old, resident in Bangkok or Mumbai. Participants recruited from LGBTQ+ listservs and social media completed mobile-optimized baseline, 2-week post-intervention, and 2-month follow-up surveys. The motivational interviewing- and psychoeducation-based intervention was implemented in 3 biweekly 45-minute online sessions by trained peer counselors. Primary outcome measures: COVID-19 knowledge and protective behavior (e.g., masking, physical distancing) scores based on US CDC items, PHQ-2 (depressive symptoms), and GAD-2 (anxiety symptoms). We used multilevel models, accounting for clustering at participant- and country-levels, to estimate outcomes.
RESULTS: From August 2021 to February 2022, participants (n = 650; median age=29.0 years; IQR=10) completed the baseline assessment and were randomized to IIG (n = 320; 49.2%) and WLC conditions (n = 330; 50.8%). 531 (81.7%) completed post-intervention and 452 (69.5%) completed follow-up assessments. Compared to WLC, the IIG had statistically significant improvements in COVID-19 knowledge scores at post-intervention (b=.34; 95% CI .18, .50; p<.001) and follow-up (b=.28; 95% CI .04, 51; p=.01), and COVID-19 protective behavior scores at post-intervention (b=1.12; 95% CI .39, 1.85; p<.01) and follow-up (b=1.00; 95% CI .51, 1.49; p<.001). Compared to WLC, the IIG had a statistically significant reduction in depression scores at post-intervention (b=-.18; 95% CI -.22, -.14; p<.001) and follow-up (b=-.23; 95% CI -.35, -.10; p<.001), with no significant reduction in anxiety scores.
CONCLUSIONS: Among LGBTQ+ adults in Bangkok and Mumbai, a tailored, peer-delivered eHealth intervention is effective in increasing COVID-19 knowledge and protective behaviors and reducing depression. The pragmatic multisite trial design and implementation during a pandemic supports the ecological validity of the findings and suggests #SafeHandsSafeHearts may be effective among LGBTQ+ adults in other middle- and high-income countries.