Participants’ accrual and delivery of HIV prevention interventions among men who have sex with men in sub-Saharan Africa: a systematic review

Abstract

Background: Across sub-Saharan Africa (SSA), HIV disproportionately affects men who have sex with men (MSM) compared with other men of the same age group in the general population. Access to HIV services remains low among this group although several effective interventions have been documented. It is therefore important to identify what has worked well to increase the reach of HIV services among MSM.Methods: We searched MEDLINE, POPLINE and the Web of Science databases to collect published articles reporting HIV interventions among MSM across sub-Saharan Africa. Covidence was used to review the articles. The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) - CRD42017060808.Results: The search identified 2627 citations, and following removal of duplicates and inclusion and exclusion criteria,only 15 papers were eligible for inclusion in the review. The articles reported various accrual strategies, namely: respondent-driven sampling, known peers identified through hotspot or baseline surveys, engagement with existing community-based organizations, and through peer educators contacting MSM in virtual sites. Some programs, however, combined some of these accrual strategies. Peer-led outreach services were indicated to reach and deliver services to more MSM. A combination of peer outreach and mobile clinics increased uptake of health information and services. Health facilities, especially MSM-friendly facilities attract access and use of services by MSM and retention into care.Conclusions: There are various strategies for accrual and delivering services to MSM across SSA. However, each of these strategies have specific strengths and weaknesses necessitating combinations of interventions and integration of the specific context to inform implementation. If the best of intervention content and implementation are used to inform these services, sufficient coverage and impact of HIV prevention and treatment programs for MSM across SSA can be optimized.Keywords: HIV intervention, Accrual, Delivery, Men who have sex with men, sub-Saharan Africa

Adherence to quarterly HIV prevention services and its impact on HIV incidence in men who have sex with men in West Africa (CohMSM ANRS 12324 – Expertise France)

“…Importantly, repeat HIV testing was well accepted by participants and was performed systematically at each visit. The good adherence observed in the study was likely related to the favourable study context, speci cally the fact that the study clinics were MSM-friendly, and that peer-educators were very involved in enrolment and retention of MSM in the programme, as well as counselling and psychosocial support [16]. Adherence support for MSM included a reminder telephone call 15 days after an outstanding follow-up visit.…”

The feasibility of recruiting and retaining men who have sex with men and transgender women in a multinational prospective HIV prevention research cohort study in sub‐Saharan Africa (HPTN 075)

“…The legal status and social marginalization experienced by MSM/TGW in SSA has prompted questions about the feasibility of engaging them in research. The HPTN 075 study had high rates of participant accrual across four sites through a mix of direct and indirect recruitment approaches, including peer outreach, participant and key informant referral, and venue‐based recruitment combined with findings from prior cross‐sectional studies of MSM in SSA [35]. This indicates that it is possible to address recruitment and enrolment challenges in this population.…”

Using virtual sites for population size estimates of men who have sex with men in urban Tanzania: a feasibility study

“…Venue-based techniques only may be limited and potentially underestimate the size of MSM populations. A systematic review of strategies used to reach MSM in SSA found that virtual platforms increasingly become essential alternatives for networking and nding new male partners due to increasing hostility (27). Similarly, HIV prevention experts have called for increased use of virtual platforms to reach MSM with HIV prevention packages and engage them across the continuum of care (28,29).…”