Adaptation and feasibility of Many Men Many Voices (3MV), an HIV prevention intervention to reduce social barriers and increase HIV self-testing among young men residing in Ghanaian slums - Young men ages 18-25 who have sex with men bear a disproportionate share of HIV burden in Ghana, contributing over 60% of cases within a population with approximately 18% prevalence, compared to 2% in the general population. HIV testing remains suboptimal, driven by stigma, confidentiality concerns, negative healthcare experiences, limited knowledge, and peer norms that discourage engagement. In densely populated urban slum communities, these barriers are intensified by social and economic constraints that further elevate exposure and limit access to services. Although evidence-based interventions such as Many Men, Many Voices (3MV) have demonstrated effectiveness in the United States, their core mechanisms, including peer influence, stigma reduction, and behavior change, have not been tested in settings characterized by constrained service infrastructure, high-density informal settlements, and limited access to confidential testing. HIV self-testing (HIVST) offers a private and convenient alternative and has increased testing uptake in prior studies; however, use among young men in Ghanaian slums remains constrained by low awareness, limited availability, and low confidence in self-administration. These contextual differences necessitate systematic adaptation rather than direct transfer. To address these gaps, this study adapts 3MV into LAFIYA (wellness), targeting stigma, confidentiality, service navigation, and peer norms while promoting HIVST uptake in a setting where these barriers are more structurally entrenched. Guided by the ADAPT-ITT framework, we will (1) assess determinants of HIV testing and HIVST use, (2) adapt 3MV for urban informal settlement contexts, and (3) conduct a pilot pre-post study (n=60) to evaluate acceptability, feasibility, appropriateness, and preliminary effects on HIVST uptake and behavioral drivers. This work is not a simple extension of U.S. evidence but a test of whether established behavioral intervention mechanisms remain effective under different structural conditions. By isolating how stigma, confidentiality, and decentralized service delivery operate in low-resource, high-density environments, the study generates implementation insights that are directly relevant to underserved communities in the United States where similar barriers persist, including fragmented access to care and reliance on non-clinical testing strategies. Findings on peer-led delivery and HIVST integration will inform scalable approaches to increase testing uptake across settings and will directly guide a subsequent clustered randomized trial to evaluate effectiveness and sustainability.
