Men who have sex with men (MSM) in sub-Saharan Africa have 2-4 times higher HIV prevalence than the general male population. The proportion of HIV infections attributable to MSM in Kenya is 20%, yet MSM remain a hidden, vulnerable, and highly stigmatized population. With the success of the HPTN 052 trial, a find, test, link and retain in care (FTLR) model has renewed promise for HIV prevention, but is unlikely to decrease infections among MSM unless interventions are specifically adapted to and targeted for MSM in order to reach them. In this study, we will expand on previous work among MSM in Kisumu to find 700 men who report having anal or oral sex with another man in the last 6 months, and test them for HIV. We will link all HIV-positive men to PEPFAR-supported HIV care including antiretroviral therapy (ART), and evaluate the success of a model based on PEPFAR guidance to promote ART adherence, retention in care, and risk reduction. We will also link all HIV-negative men to a risk reduction program including HIV testing with ongoing counseling. Outcomes of the testing program include number of men not previously tested, number of new diagnoses, and number of HIV-positive men needing linkage to care. For the HIV-positive men, outcomes of the intervention component include time to linkage in care, time to staging, time to ART initiation, retention in care, and, for those who initiate ART, self-reported measures of adherence and virologic suppression. For the HIV-negative men, outcomes of the intervention will include retesting rates and risk behaviors while in follow-up. For both groups, risk reduction outcomes including reduction in number of partners and unprotected anal intercourse (UAI) will be analyzed. This study will provide the evidence necessary to guide PEPFAR programming for expansion of comprehensive HIV prevention among MSM in sub-Saharan Africa.

Public Health Relevance

Men who have sex with men (MSM) in Africa are two to four times more likely to be HIV- positive compared to same-aged men in the general population and effective prevention strategies are urgently needed to address this often hidden and highly vulnerable group, which accounts for up to 20% of all HIV infections in Kenya. This project aims to identify 700 MSM over the age of 18 years in Kisumu, Kenya, to test them for HIV, to link and retain those who are HIV-positive in HIV care, and to link and retain those who are HIV-negative in a care and risk reduction program that includes retesting 6 and 12 months post-enrollment. This study will provide the evidence on feasibility, acceptability, and expected outputs necessary to guide programming for expansion of counseling, testing, and comprehensive care and treatment as effective HIV prevention interventions adapted for MSM in sub-Saharan Africa.

National Institute of Health (NIH)
Coordinating Office of Global Health (COGH)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZGH1-SRC (99))
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Nyanza Reproductive Health Society
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