Leveraging community and peer-based approaches to impact the HIV treatment cascade among men who have sex with men (MSM) in South Africa
The proposed set of interventions comprehensively addresses multiple levels of HIV risk at different stages of the HIV treatment cascade for men who have sex with men (MSM) in South Africa. To accomplish this, we propose to study community- and peer-based interventions focused on  finding people who are unaware of their HIV status;  increasing the linkage to care and treatment initiation for those eligible; and  achieving viral suppression through adherence support. We will use a delayed onset design, with three communities and associated clinics being initiated early and three similar communities being delayed. The collaborative team has broad experience in HIV epidemiology, prevention, programming, and implementation science (IS). This proposal addresses several areas of PEPFAR’s interest in IS, including evaluating the impact of structural approaches to HIV prevention, a focus on key populations, and a focus on the needs of people living with HIV. The results will provide baseline data about opportunities to improve outcomes for MSM living with HIV, data that will improve measures of key elements of engagement, and qualitative data that can guide development of future, tailored interventions.
The primary objectives of this research are:
1. To implement community-driven strategies to diagnose MSM unaware of their HIV status and engage men with previous HIV diagnoses in care.
2. To compare completion of CD4 staging and return of CD4 results among HIV-infected MSM staged by point-of-care (POC) CD4 or standard clinic-based CD4 testing.
3. To compare time to ART initiation among ART-eligible MSM receiving the intervention versus those receiving the standard of care.
4. To assess the utility of peer-based adherence support for achieving and sustaining suppressed viral load among treatment-eligible HIV-infected MSM.
5. To measure fidelity and feasibility of intervention implementation including peer-based adherence support and decentralization of ART programs.
Stefan Baral, MD