1673. Gendered Patterns of HIV, TB, and Other Primary Care Referrals in Rural South Africa

Abstract

BackgroundMen’s lack of engagement in healthcare hinders HIV efforts in sub-Saharan Africa. Masculine norms and lack of accessibility in a female-dominated healthcare system deter male health-seeking behavior. Community interventions combat the gender gap. In South Africa (SA), alcohol-based venues (ABV) are common locales for men. We created an ABV community health screening to determine the need.MethodsCommunity Health Workers targeted ABV in rural SA, offering screenings for HIV, TB, Isoniazid Preventive Therapy, STI, hypertension, diabetes, circumcision, with referral to primary care services (PCS) for any positive screenings. Participants completed questionnaires, including socioeconomic (SE), healthcare use, and alcohol use evaluated by AUDIT scores. Multivariable logistic regression identified factors associated with referral to PCS.ResultsFrom July 2018 to March 2019, 1356 were screened, 74% were men, median age was 30 (IQR 22–46), 26% employed and 30% had running water. Men are more likely to have never gone to a PCS compared with women (15.9% vs. 9.7%, P = 0.004) and have lengthier time since the last clinic visit (1.4 years vs. 0.6 years, P < 0.001). Men are significantly more likely than women to report hazardous drinking (49% vs. 28%, P < 0.001) Overall, positive screenings were noted in 537 (53.9%) community members, and χ 2 analysis show men more likely to require referrals after screening (P = 0.08). Multivariate analysis shows among men, referrals were associated with older age, hazardous drinking, any health concerns; while higher SE was protective. For women, only age and health concerns were associated with referral. Similarly, alcohol contributed to HIV and TB referrals for men, while higher SE was protective of TB referrals for men (Table 1).ConclusionABV males in this rural community, although disengaged from health care, required more referrals than women. HIV, TB, and any referrals for men screened at ABV in rural SA were associated with lower SE and hazardous drinking, highlighting the challenges that this population faces in seeking health care. Differentiated and targeted community-based services may facilitate care for these hard to reach men in sub-Saharan Africa. Next steps include determining clinical outcomes of referrals. Disclosures All authors: No reported disclosures.