Evaluation of peer-to-peer HIV counseling in Myanmar: a measure of knowledge, adherence, and barriers

In Myanmar, an Asian country with one of the highest HIV-1 prevalence rates, counseling prior to initiating antiretroviral therapy (ART) is standard care, either by a healthcare worker (standard counselor, SC) or trained counselor who is also living with HIV (peer counselor, PC). PC is commonly utilized in Myanmar and other resource-limited settings. However, its benefit over SC is unclear. We conducted a cross-sectional survey of people living with HIV (PLWH), who completed either only PC or only SC before treatment initiation across four cities in Myanmar. Participants were evaluated for HIV knowledge, stigma, antiretroviral adherence, barriers to care, social support satisfaction and attitudes regarding both counseling processes. Bivariate analyses and multivariable mixed effects modeling were conducted to compare differences in these measures among PC and SC participants. Among 1006 participants (49% PC; 51% SC), 52% were females and median age was 37 years in those receiving PC and 40 years in those receiving SC. More than 70% of participants in both groups achieved up to grade school education. The average duration since HIV diagnosis was 4.6 years for PC and 5.7 years for SC participants. HIV knowledge and attitudes regarding counseling were good in both groups and more PC participants credited their HIV counselor for knowledge (75% vs 63%, p < 0.001). Compared to SC, PC participants had lower enacted stigma (Incidence Rate Ratio (IRR) 0.75, Confidence Interval (CI) [0.65, 0.86]), mean internalized stigma (-0.24, CI [-0.34, -0.14]), and risk of antiretroviral therapy non-adherence (Odds Ratio 0.59, CI [0.40, 0.88]), while reporting higher levels of barriers to care (9.63, CI [8.20, 11.75]). Our findings demonstrate potential benefits of PC compared to SC, and support the utilization of PC to enhance HIV health outcomes within the unique societal and geographical context of Myanmar, and possibly beyond.