Affiliation:
1. Division of Infectious Diseases David Geffen School of Medicine, University of California Los Angeles Los Angeles USA
2. Partners in Hope Medical Center Lilongwe Malawi
3. Department of Global Health School of Public Health, Boston University Boston Massachusetts USA
4. Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town Cape Town South Africa
5. University of Malawi, College of Medicine Blantyre Malawi
6. Division of HIV, Infections Diseases & Global Medicine University of California San Francisco San Francisco California USA
7. Health Economics and Epidemiology Research Office, Faculty of Health Sciences University of Witwatersrand Johannesburg South Africa
Abstract
AbstractObjectivesMen in sub‐Saharan Africa (SSA) have lower rates of antiretroviral therapy (ART) initiation and higher rates of early default than women. Little is known about effective interventions to improve men's outcomes. We conducted a scoping review of interventions aimed to increase ART initiation and/or early retention among men in SSA since universal treatment policies were implemented.MethodsThree databases, HIV conference databases and grey literature were searched for studies published between January 2016 to May 2021 that reported on initiation and/or early retention among men. Eligibility criteria included: participants in SSA, data collected after universal treatment policies were implemented (2016–2021), quantitative data on ART initiation and/or early retention for males, general male population (not exclusively focused on key populations), intervention study (report outcomes for at least one non‐standard service delivery strategy), and written in English.ResultsOf the 4351 sources retrieved, 15 (reporting on 16 interventions) met inclusion criteria. Of the 16 interventions, only two (2/16, 13%) exclusively focused on men. Five (5/16, 31%) were randomised control trials (RCT), one (1/16, 6%) was a retrospective cohort study, and 10 (10/16, 63%) did not have comparison groups. Thirteen (13/16, 81%) interventions measured ART initiation and six (6/16, 37%) measured early retention. Outcome definitions and time frames varied greatly, with seven (7/16, 44%) not specifying time frames at all. Five types of interventions were represented: optimising ART services at health facilities, community‐based ART services, outreach support (such as reminders and facility escort), counselling and/or peer support, and conditional incentives. Across all intervention types, ART initiation rates ranged from 27% to 97% and early retention from 47% to 95%.ConclusionsDespite years of data of men's suboptimal ART outcomes, there is little high‐quality evidence on interventions to increase men's ART initiation or early retention in SSA. Additional randomised or quasi‐experimental studies are urgently needed.
Funder
Bill and Melinda Gates Foundation
Fogarty International Center
National Institutes of Health
National Institute of Mental Health
Subject
Infectious Diseases,Public Health, Environmental and Occupational Health,Parasitology
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