Interventions to improve men’s engagement in HIV and other key services in sub-Saharan Africa: a scoping review

Abstract

Background Men in sub-Saharan Africa (SSA) continue to have worse health outcomes across HIV, STI and TB-HIV co-infections as compared to women. Improving service coverage is critical for population health and HIV epidemic control. In HIV, for example, recent models show that improving mens HIV testing and treatment coverage could reduce HIV incidence among women in the region by half. There is potential to combine and optimize services across HIV, STI and TB-HIV co-infections, yet little is known about effective interventions to improve mens outcomes across health services. Methods We conducted a scoping review of interventions to understand what interventions work for men, and any synergies in interventions that work across health services. We specifically focused on interventions aimed to improve service utilization in the following service domains: condom use; pre-exposure prophylaxis (PrEP); STI testing and treatment; HIV testing, initiation, and retention; and TB testing and treatment among those living with HIV (co-infected). Articles and abstracts had to include sex disaggregated data or solely focus on mens health service outcomes. We searched PubMed, Medline, Cochrane Central Register of Controlled Trials, the CABI Global Health databases and major international conference abstracts. We included studies from SSA, published between January 1, 2009 to Dec 31, 2022, quantitative data on at least one of the selected service domains, disaggregated data for the general male population (not solely key populations), an intervention study (report outcomes for at least one non-standard service delivery strategy) with a comparison group, and available in English. We describe the type of interventions evaluated and synthesize overarching themes of what works for reaching men. Findings We identified 15,595 intervention articles and included 71 in the scoping review, representing 109 unique interventions. Over a quarter of interventions targeted male partners and only 7 exclusively targeted men. Nearly half of interventions had HIV testing as their primary outcome. Only a handful of interventions included outcomes related to condom use, STI or TB co-infection services. No interventions examined the effect on PrEP use among general male populations. Community services were the most common interventions tested 38% of all interventions), followed by community outreach (n=19; 17%) and incentives (n=16; 15%) and facility services (n=15, 14%). Counseling and peer support had the least number of interventions evaluated (n=8, 7%). We were unable to identify cross-cutting strategies to reach men across HIV and related health services in sub-Saharan Africa, largely because there is little evidence outside HIV testing interventions. The limited evidence available points to the fact that men need convenient, actively reached out to men as clients, and improved mens experiences with health services. The same principles may be apply to all services intended to reach men, including sexual health and TB co-infection services, although the evidence is limited. Conclusion This review highlights the need for additional research on cross-cutting strategies to improve mens engagement in HIV and related health services. The limited evidence available suggests that convenient services, actively engaging men, and providing positive experiences with health services largely improve service utilization. Additional evidence is needed for PrEP use and non-HIV services (such as STI and TB co-infection).