Development and pilot testing of an intervention to promote care engagement and adherence among HIV-positive Kenyan MSM

Abstract

Objectives In many African settings, MSM are a stigmatized group whose access to and engagement in HIV care may be challenging. Our aim was to design a targeted, culturally appropriate intervention to promote care engagement and antiretroviral therapy (ART) adherence for MSM in coastal Kenya, and describe intervention safety, feasibility, and acceptability based upon a small pilot study. Design Based on qualitative work including in-depth interviews with HIV-positive MSM and focus groups with providers, we developed a tailored intervention and conducted a pilot test to refine intervention materials and procedures. Methods The Shikamana intervention combines modified Next-Step Counseling by trained providers, support from a trained peer navigator, and tailored use of SMS messaging, phone calls, and discrete pill carriers. Providers, including counselors and clinicians, work together with peer navigators as a case management team. Results Forty HIV-positive MSM aged 19–51 participated in intervention development and testing. Six counselors, three clinical officers, and four MSM peers were trained in intervention procedures. Of 10 ART-naïve participants who enrolled in the pilot, eight completed follow-up with no adverse events reported. One participant was lost to follow-up after 2 months and another failed to initiate ART despite ongoing counseling. No adverse events were reported. Staff feedback and exit interviews rated the intervention as feasible and acceptable. Conclusion This adherence support intervention tailored for Kenyan MSM was well tolerated, feasible, and acceptable in the pilot phase. A randomized controlled trial of a scaled-up programme to estimate intervention efficacy is ongoing.

Health Provider Views on Improving Antiretroviral Therapy Adherence Among Men Who Have Sex with Men in Coastal Kenya

“…40 Provider training in patient-centered care and motivational interviewing, as well as mental health screening, are also intervention components. 40 Partnering of peer navigators with health teams may help mobilize social capital for otherwise marginalized patients and promote a shared ownership in a health promotion model that includes MSM in the care delivery team.…”

Predictors of Retention in HIV Care Among Youth (15–24) in a Universal Test-and-Treat Setting in Rural Kenya

“…Investigation of additional interventions that function to increase social support, such as peer navigation 21,22 and those leveraging the existing social networks of youth are urgently needed. Understanding the role that social support plays will provide important insight into how these social connections can be employed to improve engagement in care.…”

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

“…The assessment showed that over half of the studies (n = 9/15) had a high-risk of bias in terms sampling [20][21][22][23][24][25][26][27][28]. These studies had reached their participants through local Non-Governmental Organizations (NGOs), time-venue sampling or had included convenient samples.…”