Population and procedures
The Peer Study was a pilot cluster randomized controlled trial (RCT) that evaluated the impact of HIVST and STISS on peer‐delivered PrEP to TGW in Kampala, Uganda, between October 2020 and July 2022 (ClinicalTrials.gov: NCT04328025). Using Research Electronic Data Capture (REDCap) software [All TGW were enrolled at the research clinic where they started PrEP, attended quarterly clinic visits and were followed for 12 months. At each study visit, they received HIV and STI testing, free treatment for TGW peers identified during formative research were trained in intervention delivery by study staff for 2 weeks for the peer delivery intervention. The training curriculum was derived from formative research results and included HIV self‐test use and interpretation of results, self‐collection of oro‐pharyngeal, rectal and urine specimens using visual guides for self‐collected swabs, HIVST and STISS kit delivery, PrEP refills and linkage of TGW who tested positive into HIV care. Participants were introduced to TGW peers at enrolment and phone numbers were mutually shared with permission. Peers were given study phones for calling participants, and pre‐paid voice/data bundles were loaded monthly. Each month between quarterly visits, trained peers phoned TGW in their group to schedule individual visits at a place of their convenience (e.g. home, shelter, workplace) in the months between quarterly visits. The peer intervention consisted of: (1) delivery of additional HIV self‐test kits and PrEP refills; (2) teaching TGW how to use STI self‐sampling kits to self‐collect oro‐pharyngeal, rectal and urine specimens, with same‐day specimen delivery to the research clinic; and (3) psychosocial support for PrEP adherence, HIVST with intimate partners and peer counselling (emotional and social support, self‐efficacy and social inclusion) following national guidelines [