GH12-008: Expanding test and treat for HIV prevention in MSM in Kisumu, Kenya

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Men who have sex with men (MSM) in sub-Saharan Africa have 2-4 times higher HIV prevalence than the general male population. The proportion of HIV infections attributable to MSM in Kenya is 20%, yet MSM remain a hidden, vulnerable, and highly stigmatized population. With the success of the HPTN 052 trial, a find, test, link and retain in care (FTLR) model has renewed promise for HIV prevention, but is unlikely to decrease infections among MSM unless interventions are specifically adapted to and targeted for MSM in order to reach them. In this study, we will expand on previous work among MSM in Kisumu to find 700 men who report having anal or oral sex with another man in the last 6 months, and test them for HIV. We will link all HIV-positive men to PEPFAR-supported HIV care including antiretroviral therapy (ART), and evaluate the success of a model based on PEPFAR guidance to promote ART adherence, retention in care, and risk reduction. We will also link all HIV-negative men to a risk reduction program including HIV testing with ongoing counseling. Outcomes of the testing program include number of men not previously tested, number of new diagnoses, and number of HIV-positive men needing linkage to care. For the HIV-positive men, outcomes of the intervention component include time to linkage in care, time to staging, time to ART initiation, retention in care, and, for those who initiate ART, self-reported measures of adherence and virologic suppression. For the HIV-negative men, outcomes of the intervention will include retesting rates and risk behaviors while in follow-up. For both groups, risk reduction outcomes including reduction in number of partners and unprotected anal intercourse (UAI) will be analyzed. This study will provide the evidence necessary to guide PEPFAR programming for expansion of comprehensive HIV prevention among MSM in sub-Saharan Africa.