Using molecular, statistical, and economic evaluation to describe the benefit of integrated stigma mitigation intervention (ISMI) to potentiate the effectiveness of existing HIV prevention, treatment, and care services for key populations
The proposed study will measure impacts of a scalable package of integrated stigma mitigating interventions (ISMI) for key populations, including men who have sex with men (MSM) and female sex workers (FSW). Employing a non-randomized prospective cohort design in Dakar, Senegal, outcomes will include coverage of HIV and health services and, for participants living with HIV, adherence to antiviral therapy (ART) and viral load (VL) measures. A multifaceted approach will employ behavioral and web-based community interventions in order to support biomedical services deployed in Dakar through the Ministry of Health. The premise relies on the continuum of HIV care for key populations that asserts the most effective process for diagnosis, linkage and retention to care for populations at highest risk of HIV acquisition and transmission is availability of testing services and access to treatment. These services in complex, highly stigmatized setting are often outside the reach of key populations, and this program will measure the effect of ISMI using a prospective cohort design over a two year period. Concurrently, economic evaluation and quality of life assessment will be utilized to assess the cost-effectiveness of the integrated approach to stigma mitigation. There is significant potential for sustainable HIV interventions and stigma reduction for key populations in this context and elsewhere in SSA, and this project was developed in partnership with local investigators and key community stakeholders in Senegal. The proposed work addresses several USAID implementation science priorities, including evaluating impact and cost-effectiveness of structural approaches to HIV prevention(I.3.1), a focus on key populations (I.3.2), the needs of people living with HIV(I.3.3.b), and use of mHealth measures through a web-based platform(I.3.3.c). The proposed research project also builds on the identified priority of the Senegalese National AIDS Committee and Ministry of Health to research best practices to increase coverage of HIV prevention, treatment, and care services among the two highest risk populations for HIV in Senegal, MSM and FSW.
Global Health Mentor: Stefan Baral, MD