Reducing Stigma and Enhancing HIV Prevention Among MSM in the Georgian Republic - In the Georgian Republic, 1 in 5 men who have sex with men (MSM) have undiagnosed HIV. Only 44% of MSM with HIV are diagnosed, 84% of those are linked to care, and 92% of those on ART achieve viral suppression. Despite UNAIDS goals for 95% diagnosis, treatment, and suppression by 2025, gaps persist due to limited routine testing, stigma, low awareness of testing and PrEP, and late-stage diagnoses. To address these issues, evidence-based videos and educational content from prior randomized controlled trials (RCTs) will be adapted for Georgian MSM. Digital health interventions, including videos, offer discreet and accessible HIV testing content. This approach aims to reduce stigma and increase testing uptake, informed by theories like social learning and cognitive theories (SLT/SCT). The ADAPT-ITT model will guide adaptation, while CFIR will address intervention and individual characteristics, supported by feedback from Georgian stakeholders and a Community Advisory Group (CAG). This intervention represents the first online HIV testing trial in Georgia, implemented with Equality Movement, Tanadgoma, and the National AIDS Center. The study Aims are: Aim 1a: Identify barriers and facilitators to HIV testing among Georgian MSM using CFIR and ADAPT-ITT. Interviews with 40 stakeholders will explore stigma and systemic norms impeding testing. Aim 1b: Adapt video content and educational quizzes using iterative feedback to ensure cultural relevance, producing mock-ups with local videographers. Aim 2a: Conduct a 1:1 pilot RCT with 300 MSM, comparing intervention and delayed arms to evaluate testing uptake, linkage to prevention or care, and HIV knowledge. Participants will complete online surveys (b, 3, 6, 9, 12 months) and view SLT/SCT-informed intervention videos and educational quizzes. Men can order HIV test kits through Equality Movement’s online portal. Aim 2b: Assess HIV stigma's mediating role in intervention effects, hypothesizing reduced anticipated and internalized stigma will increase testing and care linkage. We will assess efficacy through repeated measures, mediation, paradata, and process measures in relation to HIV testing uptake and stigma reduction. Impact: Successful implementation and scale- up of this intervention could reduce HIV transmission rates among Georgian MSM and serve as a model for other countries and stigmatized populations.
