Strategies to improve antiretroviral therapy (<scp>ART</scp>) initiation and early engagement among men in<scp>sub‐Saharan</scp>Africa: A scoping review of interventions in the era of universal treatment

Dovel, Kathryn; Hariprasad, Santhi; Hubbard, Julie; Cornell, Morna; Phiri, Khumbo; Choko, Augustine; Abbott, Rachel; Hoffman, Risa M.; Nichols, Brooke E; Gupta, Sundeep; Long, Lawrence

doi:10.1111/tmi.13880

Cited by 4 publications

(2 citation statements)

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“…We developed an interview guide based on the ACE framework as well as the literature on interventions to improve engagement in care among new or returning ART clients in sub-Saharan Africa [ 36 , 37 ]. The interview guide included open-ended questions about stakeholders’ HIV-related priorities, perceptions of factors influencing noninitiation or attrition immediately following initiation, challenges and solutions for financing and implementing relevant interventions, and desired data to inform decision-making.…”

Section: Methodsmentioning

confidence: 99%

Stakeholder Priorities for ART Initiation and Early Retention Interventions in Malawi: A Qualitative Study Comparing International and National Perspectives

Hariprasad,

Phiri,

Thorp

et al. 2023

Preprint

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Background New or returning ART clients are often ineligible for differentiated service delivery (DSD) models, though they are at increased risk of treatment interruption and may benefit greatly from flexible care models. Stakeholder support may limit progress on development and scale-up of interventions for this population. We qualitatively explored stakeholder perceptions of and decision-making criteria regarding DSD models for new or returning ART clients in Malawi. Methods We conducted in-depth interviews with internationally based stakeholders (from foundations, multilateral organizations, and NGOs) and Malawi-based stakeholders (from the Malawi Ministry of Health and PEPFAR implementing partners). The interviews included two think-aloud scenarios in which participants rated and described their perceptions of 1) the relative importance of five criteria (cost, effectiveness, acceptability, feasibility, and equity) in determining which interventions to implement for new or returning ART clients and 2) their relative interest in seven potential interventions (monetary incentives, nonmonetary incentives, community-based care, ongoing peer/mentor support and counseling, eHealth, facility-based interventions, and multimonth dispensing) for the same population. The interviews were completed in English via video conference and were audio-recorded. Transcriptions were coded using ATLAS.ti version 9. We examined the data using thematic content analysis and explored differences between international and national stakeholders. Results We interviewed twenty-two stakeholders between October 2021 and March 2022. Thirteen were based internationally, and nine were based in Malawi. Both groups prioritized client acceptability but diverged on other criteria: international stakeholders prioritized effectiveness, and Malawi-based stakeholders prioritized cost, feasibility, and sustainability. Both stakeholder groups were most interested in facility-based DSD models, such as multimonth dispensing and extended facility hours. Nearly all the stakeholders described person-centered care as a critical focus for any DSD model implemented. Conclusions National and international stakeholders support DSD models for new or returning ART clients. Client acceptability and long-term sustainability should be prioritized to address the concerns of nationally based stakeholders. Future studies should explore the reasons for differences in national and international stakeholders’ priorities and how to ensure that local perspectives are incorporated into funding and programmatic decisions.

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Section: Methodsmentioning

confidence: 99%

Stakeholder Priorities for ART Initiation and Early Retention Interventions in Malawi: A Qualitative Study Comparing International and National Perspectives

Hariprasad,

Phiri,

Thorp

et al. 2023

Preprint

Self Cite

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“…There is extensive synthesis of what works for men's use of HIV testing services [12][13][14][15][16] and growing evidence around linkage [17][18][19] and retention 20 to HIV treatment services. There is some evidence about strategies that work to reduce sexual risk behavior among adolescent and young men.…”

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confidence: 99%

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

Dovel,

Hubbard,

Zembe

et al. 2023

Preprint

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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).

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This is how the world finally ends the HIV/AIDS pandemic

Nkengasong,

Reid,

Katz

2023

Nature

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Strategies to improve antiretroviral therapy (ART) initiation and early engagement among men insub‐SaharanAfrica: A scoping review of interventions in the era of universal treatment

Cited by 4 publications

References 72 publications

Stakeholder Priorities for ART Initiation and Early Retention Interventions in Malawi: A Qualitative Study Comparing International and National Perspectives

Stakeholder Priorities for ART Initiation and Early Retention Interventions in Malawi: A Qualitative Study Comparing International and National Perspectives

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

This is how the world finally ends the HIV/AIDS pandemic

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