Abstract
Gender disparities persist across the HIV care continuum in sub-Saharan Africa. Men are tested, linked, and retained at lower rates than women. Men experience more treatment interruptions, resulting in higher rates of virological failure and increased mortality. Peer support is an approach to improving men's engagement and retention in HIV treatment. We assessed uptake and early retention in HIV care among men in the 'Coach Mpilo' peer support pilot project in South Africa. We conducted a pilot project from March 2020 to September 2020 in 3 districts: Ehlanzeni and Gert Sibande (Mpumalanga) and Ugu (KwaZulu-Natal). Men living with HIV were invited to receive one-on-one coaching from a peer supporter who was stable on treatment. We analyzed participants' self-reported data on demographics, uptake, and retention in HIV treatment. We described baseline characteristics using summary statistics and reported uptake and early retention proportions overall and by testing history (newly and previously diagnosed). Among 4,182 men living with HIV, most were previously diagnosed (n=2,461, 64%) and uptake was high (92%, n=3,848). Short-term retention was 80% (n=1,979) among men previously diagnosed and 88% (n=1,213) among newly diagnosed. In September 2020, 95% (n=3,653/3,848) of all participants reported being active on HIV treatment, including those retained consistently and those who had interrupted and returned to care. Among participants experiencing treatment interruption after enrolling, the majority (82%, n=464) returned to treatment, largely within 2 months. Improving linkage to and retention in HIV treatment among men is essential for their health and for treatment as prevention. This pilot project provided preliminary evidence that a peer-led support model was acceptable, retained a high proportion of men in the early stages of ART, and supported men returning to care after treatment interruption. These promising results require further investigation to assess impact, scalability, and cost-effectiveness.
Highlights
Gender disparities persist across the HIV care continuum in sub-Saharan Africa
In South Africa, 78% of men and 89% of women living with HIV knew their HIV status and 67% of men versus 72% of women diagnosed with HIV were on Uptake and Retention in HIV Treatment Among Men www.ghspjournal.org
Coach Mpilo is a variation on the peer mentor model, employing men living with HIV who have overcome their own barriers and become stable on HIV treatment as coaches of newly diagnosed men and other men struggling to reach treatment stability
Summary
Gender disparities persist across the HIV care continuum in sub-Saharan Africa (SSA).[1]. Coach Mpilo is a variation on the peer mentor model, employing men living with HIV who have overcome their own barriers and become stable on HIV treatment as coaches of newly diagnosed men and other men struggling to reach treatment stability. Linking and retention remain a serious challenge for ART programs in SSA.[8] Through formative research, we identified a strong desire among men living with HIV for peer support. We assessed uptake of the project and its impact on short-term retention in HIV treatment in 2 groups of men living with HIV in South Africa: men newly diagnosed with HIV and not yet, or recently, initiated onto ART, and men who were previously diagnosed and had experienced a treatment interruption or required adherence support
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