Gamification of peer mobilizers to increase pre-exposure prophylaxis uptake among transgender women

BACKGROUND: Transgender women (trans women) are disproportionately affected by HIV and would benefit from additional prevention options; however, fewer than 10% of HIV-negative trans women at community clinics in Thailand access free HIV pre-exposure prophylaxis (PrEP) services. We introduced a 'gamified' peer-driven model, encouraging influential community members to competitively recruit transwomen to increase PrEP uptake.
DESCRIPTION: The Mae Koe ('community leader') project was implemented by Mplus Foundation, a community-based organization in Chiang Mai. Influential community 'leaders', including trans women, were purposively selected, trained about HIV prevention, and tasked with promoting HIV services in their community and via Facebook Live sessions, and recruiting trans women to initiate PrEP. Each leader was given a unique, trackable link to an online reservation platform. The leader earned one point for each referred client who either initiated PrEP or tested HIV positive. No monetary incentives were provided ' competitors were motivated by social recognition. The competition was promoted via a beauty pageant. Mplus reported point totals to each of the 'leaders' on a weekly basis, though clinic staff were reminded to follow protocols to protect client confidentiality. In the final red-carpet event, the leader who earned the most points was crowned the winner, and a special award was given to the leader referring the most transwomen clients.
LESSONS LEARNED: Between August and September 2021, 21 community leaders recruited 219 clients for HIV testing (including 96 trans women). The mean number of new clients recruited per leader was 2.81. There were 143 new PrEP users, including 65 trans women. Of the HIV-negative trans women participants, 71% initiated PrEP, accounting for 41.38% of Mplus' annual PrEP service delivery among this population. In just one month, the Mae Koe competition contributed 60% of annual PrEP uptake among trans women aged 15'19, and 48% among those aged 30'34; these groups had the highest HIV prevalence in program data over the most recent 12-month period (20% and 27%, respectively). Four trans women tested HIV positive.
CONCLUSIONS: This gamified peer-driven recruitment model is a promising strategy for initiating trans women on PrEP while managing privacy concerns and warrants further implementation and evaluation.

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