International
The Owete Study: The effect of social network-based intervention to promote HIV testing and linkage to HIV services among fishermen in Kenya
Investigators: Carol Camlin (UCSF), Harsha Thirumurthy (Univ. of Pennsylvania)
In sub-Saharan Africa, highly mobile men like fishermen have low uptake of HIV testing, prevention and treatment. With the advent of HIV self-testing and the success of social network-based peer interventions among men, opportunities exist to test the efficacy of a combined intervention to increase mobile men’s engagement with HIV testing and linkage to HIV prevention and treatment. This study examined whether an HIV status-neutral, social network-based intervention could improve HIV testing and linkage to prevention and treatment among fishermen in Kenya. We mapped the male social networks of fishermen in three communities in western Kenya and identified distinct social networks (“clusters”) with a highly connected, network-central man (“promoter”) in each network. Clusters were randomized to an intervention group in which promoters were trained and offered multiple HIV self-tests to offer to cluster members, and transport vouchers to encourage those members to link to HIV treatment or pre-exposure prophylaxis (PrEP). In control clusters, promoters received HIV information and referral vouchers for a free self-test or provider-administered test in nearby clinics that they were encouraged to offer to cluster members. We compared self-reported HIV testing in the past three months and linkage to HIV services among participants in intervention and control clusters at a three-month follow-up visit using a cluster-adjusted two-sample test of proportions. A total of 934 men in 156 social network clusters were mapped. Of these, 733 completed baseline and 666 completed follow-up surveys. HIV testing via any modality at three months was higher in intervention compared to control clusters (66 vs. 31%). Self-reported HIV testing with self-tests at three months also was higher in intervention clusters (60 vs. 10%). Additionally, following testing, linkage to HIV treatment or PrEP among those who tested was higher in intervention clusters (67 vs. 16%). This social network-based, status-neutral intervention in Kenya significantly improved men’s HIV testing and linkage outcomes and is a promising way to engage hard-to-reach, highly-mobile populations such as fishermen.
Sukuma Ndoda (Stand up Man) HIV Self-Screening and Assisted Linkage Project for men in Johannesburg
Investigators: Sheri Lippman (UCSF), Jessica Grignon (I-Tech,UW)
HIV testing rates among men remain below national targets in South Africa. We provided HIV self-testing (HIVST) kits to community health workers (CHWs) at 6 clinics in low-income areas of Johannesburg to distribute to men in the area who had not recently tested for HIV. CHWs at three of the clinics registered participants in an automated short message service (SMS) follow-up system – asking participants if they tested and linking them to care if positive. CHWs at the other three clinics followed up with participants personally to encourage testing and linkage to care. Preliminary research findings (final analyses ongoing): Among 4,793 eligible men who enrolled in the project, 62% had never tested for HIV. Overall, 83% reported back through the automated system or personally to the CHWs: 75% used the kits and 8% did not. Testing uptake in the clinic catchment areas more than doubled, increasing from 4% of all eligible men when only clinic-based testing was available to 9.9% when both HIVST and clinic-based testing were available. Test use was higher for men followed by CHW personally (99% vs 68% in SMS); however, significantly more men reported positive results in the SMS group, compared to the personal follow-up group (6.4% vs 2.0%), yielding more ART initiation in the SMS group as compared to personal follow-up (23 vs 9; p<0.01).
Manas por Manas: Reducing Intersectional Stigma Among Transgender Women in Brazil to Promote Uptake of HIV Testing and PrEP
Investigators: Sheri Lippman (UCSF), Jae Sevelius (UCSF) Maria Amelia Veras (Brazilian PI)
Globally, trans women experience extreme social and economic marginalization due to intersectional stigma. Among trans women, gender- and race-based stigma intersect with certain social positions, such as engagement in sex work and substance use, creating a social context of increased vulnerability and HIV risk. In Brazil, trans women are the ‘most at risk’ group for HIV; in addition, HIV testing and pre-exposure prophylaxis (PrEP) among trans women is significantly lower than in other at-risk populations. Our team has developed the only trans-specific conceptual framework, gender affirmation theory, to describe intersectional stigma faced by trans women, to frame investigations into how intersectional stigma results in health disparities, and to develop and test interventions to address intersectional stigma among trans women. Informed by gender affirmation theory, we are testing a multi-level intervention to mitigate intersectional stigma and thereby increase HIV prevention uptake (HIV testing and PrEP use) by randomizing 400 Brazilian trans women to either the Manas por Manas intervention or a wait-list control.
Center of Excellence for Transgender Health Manas por Manas page.
