The ultimate objective of this research is to provide evidence-based strategies to improve treatment of HIV+ men. Treatment as prevention (TasP) can only work through a three step process: (1) Testing a significant proportion of the population, (2) linkage to care and (3) maintaining in care a significant proportion of HIV+ individuals to the point of viral suppression. The benefits of increased testing, linkage to and maintenance in care for men would be enormous. We propose a study that combines structural and individual level interventions and integrates the results to address our overall objective of maintenance in care to the point of viral suppression.
Aim 1 : In a cluster-randomized study, we will investigate whether male-centered mobilization and testing increases the population-level percentage of men who have been tested (within the last 12 months) by more than 10 absolute percentage points.
Aim 2 : In the individually-randomized design, we will investigate whether POC CD4 testing and individualized case management improves linkage to care (immediately following diagnosis) and viral suppression (12 months later) over POC CD4 testing alone and standard of care.
Aim 3 : Integrate the results of the two trial components (Aims 1 and 2) to evaluate the joint effect of the interventions on the percentage of HIV+ men who are effectively tested, linked to care and maintained with undetectable VL. The benefits of increased testing, linkage to and maintenance in care for men would be enormous. Men would remain healthier longer, could work and support their families, contribute to rather than deplete household economic resources, raise their children, and they would be less likely to transmit HIV to female partners
Men in sub-Saharan Africa are less likely than women to get tested for HIV, less likely to present for treatment, less likely to be maintained in treatment, moe likely to have detectable viral load (VL), more likely to transmit HIV with unprotected intercourse and more likely to progress to AIDS and die sooner from HIV. As such, community-based HIV counseling and testing strategies that are responsive and attractive to men are urgently required. This research will evaluate innovative strategies to test for HIV and diagnose black African men and successfully link them to care and maintain them in care, which may reduce their likelihood of transmitting HIV and have a beneficial impact on their individual health, as wel as the well-being of their partners, children, families, and communities.
