Time taken to escort men who have sex with men (MSM) for HIV testing in the peer group interventions in Sri Lanka

Abstract

Introduction: Sri Lanka has completed a phase of an HIV prevention project (from 2013 to 2015) for men who have sex with men (MSM) under the support of Global Fund. The intervention was to deliver an HIV prevention package (HPP) to MSM which included provision of six services (1. STI knowledge, 2. HIV knowledge, 3. MSM tailored leaflets, 4. Condom/dildo demonstration, 5. Provision of condoms, and 6. Clinic escort). MSM who received all 1, 2, 3, 4 and 5 services in the HPP are defined as “reached”. The final step is to escort the reached (who received initial 5 services) MSM to an STD clinic, and ones they are escorted they are defined as “escorted”. This HPP was delivered to MSM through peer educators (PE) scattered in four high populous districts in the country. Each PE has regular contact with another 6-15 peers forming a peer group (PG). However, in this model, a significant number of MSM does not take the escorting step (step 6). Therefore, the purpose of this paper is to analyze the time taken to escort and other associated factors for an MSM to be escorted to an STD clinic. Method: All the MSM peers (699 MSM) registered in 2013 and retained during the project till the end of December 2015 have been filtered out from the web-based monitoring and evaluation information management system (MEIMS) for analysis. Time-to escort analysis with Kaplan–Meier was performed to find out median escort time. Hypothesis testing for equality of survival distribution (Kaplan–Meier curve) was conducted to determine the differences in probabilities of first clinic escort for different socio-economic and demographic characteristics. Results: Estimated median time-to escort was 17 months (SD = 0.867). Escorting is less likely with non-youth MSM (≥25 years), educated MSM (> GCE O/L), rural MSM, Nachchi MSM (effeminate males), high frequent receptive MSM (≥7/week) and high duration MSM (≥10 years). Galle and Gampaha districts shows high performance in escorting compared to other districts Conclusions: More vulnerable and high risk segments of MSM population are less likely to be escorted for HIV testing in the current programme design. Current intervention need to strengthen with more focus strategies to address this programmatic gap. In addition, performance of PEs, field supervisors and coordinators has been observed to be a major factor in improving escort rate.