Amsterdam 2015
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| Abstract #2381 - Cape to Casablanca: MSM in Africa | ||||
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Session: 20.7: Cape to Casablanca: MSM in Africa (Parallel) on Wednesday @ 16.30-18.00 in C104 Chaired by Theo Sandfort, Mike Ross Authors: Presenting Author: Prof Timothy Lane - University of California San Francisco, United States |
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| Additional Authors: | ||||
| Aim: South Africa is currently experiencing a high-prevalence, high-incidence HIV epidemic among men who have sex with men (MSM). At least 33% of MSM are infected, with incidence estimated from 6% to 20% annually. Nationally, the proportions of MSM who test for HIV regularly (i.e. at least once every six months), and HIV-positive MSM who timely link themselves to care (i.e. voluntarily seeking care within 30 days of HIV-diagnosis) are unknown, but believed to be sub-optimal. Barriers to timely linkage include perceived and experienced HIV- and MSM-related stigma in clinical environments. Interventions that increase regular testing and timely linkage are critical to reversing the trajectory of the MSM HIV epidemic. Project Boithato is an MSM community-mobilization intervention implemented in rural Mpumalanga province that aims to increase regular HIV testing and timely linkage to care among MSM. We present results from the Mpumalanga Men’s Study (MPMS), an impact evaluation of Boithato’s HIV testing and linkage endpoints. | ||||
| Method / Issue: The MPMS is three serial cross-sectional bio-behavioral surveys of two MSM communities in Gert Sibande (Boithato intervention) and Ehlanzeni (comparison) districts conducted at baseline, and followed up 12- and 18-months after Project Boithato’s launch. MPMS recruited 1466 MSM participants between September 2012 and March 2015, and documented HIV infection among 408 MSM. To characterize testing behavior in the study communities, we comparing proportions of regular testers among HIV-negative and status unknown MSM in each community at 12- and 18-months using a z-test for significance. To identify demographic and HIV-testing history variables associated with timely linkage to care, we conducted multiple logistic regression analysis with backwards stepwise elimination (p<.10 for inclusion) for the121 HIV-positive MSM with a self-reported linkage outcome across all waves of the survey. All results are presented as proportions and adjusted Odds Ratios (aOR) with 95% confidence intervals (CI). | ||||
| Results / Comments: We observed a greater proportion of regular testing in Gert Sibande (the Boithato intervention community) than in Ehlanzeni at 12 months [49.8% (95%CI 44.1%-55.6%) v 24.1% (95%CI 20.2%-28.0%) p<.001] and 18 months [45.4% (95%CI 39.6%-51.2%) v. 30.7% (95%CI 26.3%-35.1%) p<.001] respectively. In pooled analysis of HIV-positives, 31.9% [95% CI 27.4%-36.4%) MSM were regular testers who had received an HIV-negative result within the 12 months prior to their diagnosis. We found that testing HIV-positive in Gert Sibande, the Boithato intervention community (aOR 3.8, 95% CI 1.7-8.5, p<.01) was independently associated with timely linkage to care a history of regular testing showed a marginally significant association with timely linkage (aOR 2.0, 95% CI 0.9-4.5, p=.08). | ||||
| Discussion: Although the number of MSM testing regularly and timely linking to care are sub-optimal, MPMS results demonstrate that Boithato’s approach to mobilizing MSM communities for HIV prevention encourages regular testing, and has potential for positive impact on timely linkage to care. Further community-level intervention research to encourage optimal linkage, retention, and antiretroviral adherence in this high-incidence MSM HIV epidemic is urgently needed. | ||||
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