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

Micheni, Murugi; Kombo, Bernadette; Secor, Andrew; Simoni, Jane M.; Operario, Don; Elst, Elise van der; Mugo, Peter Mwangi; Kanungi, Jennifer; Sanders, Eduard J.; Graham, Susan M.

doi:10.1089/apc.2016.0213

Cited by 52 publications

(58 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Perceived and anticipated stigmatisation against homosexuals has been reported in Malawi, Namibia, Zambia, Zimbabwe, as well as in Mozambique [7]. Although MSM-friendly, tailormade health services such as clinics for men, door-to-door follow up from peers and after hour clinics are offered, MSM still encounter barriers in access [8]. According to the United Nations Programme on AIDS (UNAIDS), discrimination in health care settings reduces the quality of life of individuals who experience it [9].…”

Section: Introductionmentioning

confidence: 99%

Access to health services for men who have sex with men and transgender women in Beira, Mozambique: A qualitative study

Gamariel¹,

Isaakidis

Tarquino³

et al. 2020

PLoS ONE

View full text Add to dashboard Cite

Objectives HIV prevalence and incidence are higher among key populations including Men who have Sex with Men (MSM) and transgender women in low and middle income countries, when compared to the general population. Despite World Health Organisation guidelines on the provision of services to key populations recommending an evidence-based, culturally relevant and rights-based approach, uptake of HIV services in many resource-limited and rights-constrained settings remains low. Mé decins Sans Frontières (MSF) has been offering health services for MSM and transgender women in Beira, Mozambique since 2014 using a peer-educator driven model, but uptake of services has not been as high as expected. This qualitative study aimed to learn more about these key populations in Beira, their experiences of accessing MSM-and transgender-friendly services and their use of face-to-face and virtual networks, including social media, for engagement with health care. Methods In-depth interviews were carried out with MSM and transgender women who were 1) enrolled in, 2) disengaged from or 3) never engaged in MSF's programme. Purposive and snowball sampling were used to recruit the different groups of interviewees. Interviews were conducted in Portuguese, transcribed and translated into English before being coded and manually analysed using a thematic network framework. Results Nine transgender women and 18 cisgender MSM participated in the study. Interviewees ranged in age from 19 to 47 years, with a median age of 29. Three main themes emerged from the data: perceptions of stigma and discrimination, experiences of the peer-educator driven model and the use of face-to-face and virtual platforms for communication and engagement,

show abstract

Section: Introductionmentioning

confidence: 99%

Access to health services for men who have sex with men and transgender women in Beira, Mozambique: A qualitative study

Gamariel¹,

Isaakidis

Tarquino³

et al. 2020

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…However, in their findings from providers interviews in Western Kenya, Genberg et al [76] found that health system factors impact patient engagement in HIV care due to work environment that constrained providers ability to deliver high-quality HIV care and encouraged negative patient-provider relationships. Studies among other key population groups such as men who have sex with men have shown that access to HIV care is impeded by HIV-related stigma, lack of access to friendly health services, economic and social challenges due to stigma, difficult relationships with care providers, and discrimination at the clinic and in the community [77].…”

Section: Discussionmentioning

confidence: 99%

“It is always better for a man to know his HIV status” – A qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya

et al. 2020

View full text Add to dashboard Cite

HIV testing services are an important component of HIV program and provide an entry point for clinical care for persons newly diagnosed with HIV. Although uptake of HIV testing has increased in Kenya, men are still less likely than women to get tested and access services. There is, however, limited understanding of the context, barriers and facilitators of HIV testing among men in the country. Data are from in-depth interviews with 30 men living with HIV and 8 HIV testing counsellors that were conducted to gain insights on motivations and drivers for HIV testing among men in the city of Nairobi. Men were identified retroactively by examining clinical CD4 registers on early and late diagnosis (e.g. CD4 of �500 cells/mm, early diagnosis and <500 cells/mm, late diagnosis). Analysis involved identifying broad themes and generating descriptive codes and categories. Timing for early testing is linked with strong social support systems and agency to test, while cost of testing, choice of facility to test and weak social support systems (especially poor inter-partner relations) resulted in late testing. Minimal discussions occurred prior to testing and whenever there was dialogue it happened with partners or other close relatives. Interrelated barriers at individual, healthcare system, and interpersonal levels hindered access to testing services. Specifically, barriers to testing included perceived providers attitudes, facility location and set up, wait time/ inconvenient clinic times, low perception of risk, limited HIV knowled ge, stigma, discrimination and fear of having a test. High risk perception, severe illness, awareness of partner's status, confidentiality, quality of services and supplies, flexible/extended opening hours, and pre-and post-test counselling were facilitators. Experiences between early and late testers overlapped though there were minor differences. In order to achieve the desired impact nationally and to attain the 90-90-90 targets, multiple interventions addressing both barriers and facilitators to testing are needed to increase uptake of testing and to link the positive to care.

show abstract

“…KP may be easiest to reach in community settings; however, viral loads are typically done within clinical facilities. Furthermore, KP programmes typically refer those living with HIV to standard ART clinics that may not be sensitized to providing KP‐competent services, thereby resulting in substantial drops in linkage to care following HIV diagnosis . Decentralized models which offer HIV testing, ART provision and management including viral load monitoring, STI screening and treatment, and TB treatment in a stigma‐free venue would likely have better HIV service outcomes for KP .…”

Section: Discussionmentioning

confidence: 99%

HIV viral load monitoring among key populations in low‐ and middle‐income countries: challenges and opportunities

et al. 2017

View full text Add to dashboard Cite

IntroductionKey populations bear a disproportionate HIV burden and have substantial unmet treatment needs. Routine viral load monitoring represents the gold standard for assessing treatment response at the individual and programme levels; at the population‐level, community viral load is a metric of HIV programme effectiveness and can identify “hotspots” of HIV transmission. Nevertheless, there are specific implementation and ethical challenges to effectively operationalize and meaningfully interpret viral load data at the community level among these often marginalized populations.DiscussionViral load monitoring enhances HIV treatment, and programme evaluation, and offers a better understanding of HIV surveillance and epidemic trends. Programmatically, viral load monitoring can provide data related to HIV service delivery coverage and quality, as well as inequities in treatment access and uptake. From a population perspective, community viral load data provides information on HIV transmission risk. Furthermore, viral load data can be used as an advocacy tool to demonstrate differences in service delivery and to promote allocation of resources to disproportionately affected key populations and communities with suboptimal health outcomes. However, in order to perform viral load monitoring for individual and programme benefit, health surveillance and advocacy purposes, careful consideration must be given to how such key population programmes are designed and implemented. For example, HIV risk factors, such as particular sex practices, sex work and drug use, are stigmatized or even criminalized in many contexts. Consequently, efforts must be taken so that routine viral load monitoring among marginalized populations does not cause inadvertent harm. Furthermore, given the challenges of reaching representative samples of key populations, significant attention to meaningful recruitment, decentralization of care and interpretation of results is needed. Finally, improving the interoperability of health systems through judicious use of biometrics or identifiers when confidentiality can be maintained is important to generate more valuable data to inform monitoring programmes.ConclusionsOpportunities for expanded viral load monitoring could and should benefit all those affected by HIV, including key populations. The promise of the increasing routinization of viral load monitoring as a tool to advance HIV treatment equity is great and should be prioritized and appropriately implemented within key population programmatic and research agendas.

show abstract

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

Cited by 52 publications

References 37 publications

Access to health services for men who have sex with men and transgender women in Beira, Mozambique: A qualitative study

Access to health services for men who have sex with men and transgender women in Beira, Mozambique: A qualitative study

“It is always better for a man to know his HIV status” – A qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya

HIV viral load monitoring among key populations in low‐ and middle‐income countries: challenges and opportunities

Contact Info

Product

Resources

About