A more responsive, multi‐pronged strategy is needed to strengthen HIV healthcare for men who have sex with men in a decentralized health system: qualitative insights of a case study in the Kenyan coast

Elst, Elise van der; Mudza, Rita; Onguso, Justus M.; Kiirika, Leonard Muriithi; Kombo, Bernadette; Jahangir, Nassim; Graham, Susan M.; Operario, Don; Sanders, Eduard J.

doi:10.1002/jia2.25597

Cited by 11 publications

(5 citation statements)

References 22 publications

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“…Recent work in the Kenyan coast demonstrated an incidence of 5.1 (95% confidence interval [CI], 2.6–9.8) per 100 person-years (PY) among GBMSM and 20.6 (95% CI, 6.6–63.8) per 100 PY among TGW [ 1 ]. However, GBMSM and TGW are often not engaged in HIV prevention and care services [ 4 , 5 ].…”

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confidence: 99%

Peer Mobilization and Human Immunodeficiency Virus (HIV) Partner Notification Services Among Gay, Bisexual, and Other Men Who Have Sex With Men and Transgender Women in Coastal Kenya Identified a High Number of Undiagnosed HIV Infections

Dijkstra

Mohamed

Kigoro

et al. 2021

Open Forum Infectious Diseases

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Introduction HIV partner notification services (HPN), peer mobilisation with HIV self-testing and acute and early HIV infection (AEHI) screening among gay, bisexual, other men who have sex with men (GBMSM) and transgender women (TGW) were assessed for acceptability, feasibility and linkage to antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) services. Methods Between April-August 2019, peer mobilisers mobilised clients by offering HIV oral self-tests and immediate clinic referral for clients with AEHI symptoms. Mobilised participants received clinic-based rapid antibody testing and point-of-care HIV-RNA testing. Newly diagnosed participants including those derived from HIV testing services were offered immediate ART and HPN. Partners were recruited through HPN. . Results Of 772 mobilised clients, 452 (58.5%) enrolled in the study as mobilised participants. Of these, 16 (3.5%) were HIV newly diagnosed, including 2 (0.4%) with AEHI. All but two (14/16, 87.5%) initiated ART. 35 GBMSM and TGW were offered HPN and 27 (77.1%) accepted it. Provider referral identified a higher proportion of partners tested (39/64; 60.9% vs. 5/14; 35.7%) and partners with HIV (27/39; 69.2% vs. 2/5; 40.0%) than index referral. Of 44 enrolled partners, 10 (22.7%) were newly diagnosed, including 3 (6.8%) with AEHI. All 10 (100%) initiated ART. PrEP was initiated among 24.0% (103/429) mobilised participants and 28.6% (4/14) partners without HIV. Conclusions HPN, combined with a peer mobilisation-led self-testing strategy and AEHI screening for GBMSM and TGW, appears acceptable and feasible. These strategies, especially HPN provider referral, effectively identified undiagnosed HIV infections and linked individuals to ART and PrEP-services.

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confidence: 99%

Peer Mobilization and Human Immunodeficiency Virus (HIV) Partner Notification Services Among Gay, Bisexual, and Other Men Who Have Sex With Men and Transgender Women in Coastal Kenya Identified a High Number of Undiagnosed HIV Infections

Dijkstra

Mohamed

Kigoro

et al. 2021

Open Forum Infectious Diseases

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“…Most of our clients accepted the KP‐led service because it eliminated the logistical barriers to ART that many people living with HIV broadly experienced [24–26]: convenient transportation (92%), time‐saving (69%) and location near home (50%). Having friendly staff (44%) might overcome the gender‐based stigma that some MSM and TGW experience in the conventional healthcare setting [2, 4, 27–30]; however, reasons related to overcoming HIV‐based stigma were not mentioned. Unintended disclosure of HIV status is a common fear in other community‐based settings [24, 31], and some of our clients might decline the KP‐led service because they might not feel comfortable refilling ART at the CBO where their peers come for HIV testing and prevention services.…”

Section: Discussionmentioning

confidence: 99%

Acceptability and retention of the key population‐led HIV treatment service for men who have sex with men and transgender women living with HIV in Thailand

et al. 2023

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Introduction In Thailand, where the HIV epidemic is concentrated among key populations (KPs), particularly men who have sex with men (MSM) and transgender women (TGW), an HIV service delivery model tailored to KPs was piloted. This study evaluated the acceptability and retention of clients who accepted and declined the KP‐led HIV treatment service. Methods A retrospective cohort study was conducted using secondary data from three community‐based organizations (CBOs) and three hospitals in Thailand. KP lay providers were trained to lead HIV treatment service in which MSM and TGW living with HIV received counselling and a 3‐month antiretroviral therapy (ART) supply at CBOs. Thai MSM and TGW who were at least 18 years, on ART for at least 6–12 months, without co‐morbidities/co‐infections, and virally suppressed were eligible and offered the service. Those who declined received ART via other service models offered by the hospitals and served as a comparison group. Results Of 220 clients screened between February 2019 and February 2020, 72% (159/220) were eligible of which 146 were MSM and 13 were TGW. Overall, 45% (72/159) accepted the KP‐led service. Of those who declined, 98% (85/87) preferred to see the physician at the hospital. After 12 months of follow‐up, among those accepted, 57% were in care at the CBO, 32% were referred back to and in care in other service models offered by the hospital, 10% were successfully transferred out to other hospital and 1% were lost to follow‐up (LTFU); among those declined, 92% were in care in any service models offered by the hospital, 5% were successfully transferred out to other hospital, 2% were LTFU and 1% died ( p ‐value<0.001). Conclusions Despite moderate acceptability and retention in care at the CBO among the clients accepting the KP‐led service, almost all clients were engaged in care overall. Multiple service models that meet the preferences and needs of KPs living with HIV should be available to optimize engagement in care.

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“…Of the 94 articles referring to rights, 11 mentioned the right to health, either broadly or less often with mention of specific elements of the right to health. However, even when articles were more specific, authors did not always define the right to health in a comprehensive manner, as in an article in JIAS that referred to the right to inclusive healthcare and necessary and appropriate health services 10 -components of the right to health that more fully include rights of non-discrimination and the availability, accessibility, acceptability and of high quality of healthcare. 11 Nine articles referenced reproductive rights for serodiscordant couples or women living with HIV and family planning.…”

Section: What Rights?mentioning

confidence: 99%

Human rights and HIV: rhetoric or determinants?

Hinman,

Amon

2023

BMJ Glob Health

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International donors and UN agencies emphasise the importance of human rights as a key determinant of HIV vulnerability and of access, uptake and retention in HIV prevention and treatment services. Yet, the extent to which HIV researchers are incorporating rights into their research, the specific rights being examined and the frequency of research assessing rights-based approaches, is unknown.MethodsWe examined all articles published in the five highest impact-factor HIV journals: (1) Lancet HIV; (2) AIDS and Behavior; (3) AIDS; (4) Journal of the International AIDS Society (JIAS); and (5) Journal of Acquired Immune Deficiency Syndromes (JAIDS), between 1 January 2017 and 31 December 2022, for reference to ‘human right(s)’ or ‘right(s)’. We analysed articles to assess: (1) what populations were identified in relation to specific human rights concerns; (2) what specific rights were mentioned; (3) whether researchers cited specific legal frameworks; and (4) if and what types of rights-based interventions were examined.ResultsOverall, 2.8% (n=224) of the 8080 articles reviewed included a mention of ‘human right(s)’ or ‘right(s)’. Forty-two per cent of these (n=94) were original research articles. The most common key population discussed was men who have sex with men (33 articles), followed by sex workers (21 articles) and transgender people (14 articles). Of the 94 articles, 11 mentioned the right to health and nine referenced reproductive rights. Few articles identified a specific authority—whether in national, regional or international law—for the basis of the rights cited. Fourteen articles discussed rights-based interventions.ConclusionDespite global recognition of the importance of human rights to HIV outcomes, few HIV researchers publishing in the top five cited HIV journals include attention to human rights, or rights-based interventions, in their research. When rights are mentioned, it is often without specificity or recognition of the legal basis for human rights.

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A more responsive, multi‐pronged strategy is needed to strengthen HIV healthcare for men who have sex with men in a decentralized health system: qualitative insights of a case study in the Kenyan coast

Cited by 11 publications

References 22 publications

Peer Mobilization and Human Immunodeficiency Virus (HIV) Partner Notification Services Among Gay, Bisexual, and Other Men Who Have Sex With Men and Transgender Women in Coastal Kenya Identified a High Number of Undiagnosed HIV Infections

Peer Mobilization and Human Immunodeficiency Virus (HIV) Partner Notification Services Among Gay, Bisexual, and Other Men Who Have Sex With Men and Transgender Women in Coastal Kenya Identified a High Number of Undiagnosed HIV Infections

Acceptability and retention of the key population‐led HIV treatment service for men who have sex with men and transgender women living with HIV in Thailand

Human rights and HIV: rhetoric or determinants?

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