Population Services International, Johannesburg, South Africa.
School of Nursing and Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.
Glob Health Sci Pract. 2022 Feb 28;10(1). doi: 10.9745/GHSP-D-21-00498.
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.
在撒哈拉以南非洲，艾滋病毒护理连续体中仍然存在性别差异。男性接受检测、被联系和保留的比例低于女性。男性经历更多的治疗中断，导致更高的病毒学失败率和死亡率增加。同伴支持是一种提高男性参与和保留艾滋病毒治疗的方法。我们评估了南非“Coach Mpilo”同伴支持试点项目中男性在艾滋病毒护理中的参与率和早期保留率。
我们在 2020 年 3 月至 9 月期间在三个地区开展了一项试点项目：埃兰泽尼和格特斯班德（姆普马兰加）和乌古（夸祖鲁-纳塔尔）。我们邀请艾滋病毒感染者接受一名经过治疗稳定的同伴支持者的一对一辅导。我们分析了参与者自我报告的人口统计学、参与和保留艾滋病毒治疗的数据。我们使用总结统计数据描述了基线特征，并总体报告了参与率和早期保留率，以及按检测历史（新诊断和以前诊断）进行的报告。
在 4182 名艾滋病毒感染者中，大多数为以前诊断（n=2461，64%），参与率较高（n=3848，92%）。以前诊断的男性中短期保留率为 80%（n=1979），新诊断的男性为 88%（n=1213）。2020 年 9 月，3848 名参与者中有 95%（n=3653）报告正在积极接受艾滋病毒治疗，包括持续治疗者和中断治疗后返回治疗者。在登记后经历治疗中断的参与者中，大多数（82%，n=464）在 2 个月内返回治疗。
改善男性与艾滋病毒治疗的联系和保留率对他们的健康和治疗预防至关重要。该试点项目提供了初步证据，证明了以同伴为导向的支持模式是可以接受的，在接受抗逆转录病毒治疗的早期阶段保留了很大一部分男性，并且支持男性在治疗中断后返回治疗。这些有希望的结果需要进一步调查，以评估其影响、可扩展性和成本效益。
