Randomized Controlled Trial of Game Changers, a Social Network Intervention for HIV Prevention in Uganda

In Uganda, where HIV prevalence remains above 5% among those aged 15 and older, we conducted a randomized controlled trial of Game Changers, an 8-session peer-facilitated group intervention that empowers people living with HIV (PLHIV) to engage in HIV prevention advocacy with their social network members ("alters"). A total of 210 index PLHIV participants (105 intervention, 105 control) and 599 alters were enrolled; assessments were conducted at baseline and 6-, 12-, and 18-months post-baseline. Intention-to-treat repeated measures regressions indicated significant intervention effects on reduced internalized stigma and increased HIV prevention advocacy, prevention advocacy self-efficacy, and disclosure among index participants. In within-intervention group analyses, alters exposed to prevention advocacy showed higher likelihoods of HIV testing and condom use. Game Changers had direct psychosocial benefits for index participants, and indirect benefits for improved HIV prevention behaviors among alters. Implementation research is needed to determine conditions under which Game Changers is most effective.