Addressing Gaps in Men's Health Literacy and Health Seeking in Mozambique: A Case for Differentiated Care for HIV and CVD

与世界其他地区一样，在南部非洲，男子比妇女更有可能推迟寻求保健和放弃保健。有证据表明，男子在结核病和艾滋病毒的保健方面存在差距，在糖尿病和高血压等非传染性疾病的保健方面也日益存在差距，这些疾病在本区域呈上升趋势。然而，由于全球卫生议程强调妇女和儿童，男子的健康差距被忽视，关于他们在寻求保健方面的认识、决策和行动的区域数据有限。在这个项目中，我们专注于莫桑比克艾滋病毒阳性男性的心血管疾病（CVD）病例，在这个国家，贫困，冲突和工作移民影响了男性的健康和他们对疾病的脆弱性。我们的项目旨在为制定“差异化”护理战略提供数据，即满足男性健康需求并适应当地系统流程和资源限制的护理模式。莫桑比克的传染病负担很高，非传染性疾病负担也越来越重，男性对传染病和非传染性疾病的认识、控制和治疗水平较低。我们的项目设在马普托的一个大城市地区，将使用一系列定性和定量方法来探讨男子的健康知识和寻求健康的各个方面。对莫桑比克男子健康干预措施的文献审查和绘图将审查目前的方法和假设。以设施为基础的观察和采访卫生提供者和男性患者与艾滋病毒和心血管疾病将看看他们的途径护理是如何受到社会，结构和系统相关因素的影响。一项基于社区的调查和一项嵌套定性研究将使用不同的措施来比较关于健康知识、自我感觉健康和家庭对男子寻求健康行为的影响的数据。来自这些不同来源的数据将用于开发护理男子的过程和途径模型。最后，我们将与我们的项目合作伙伴，研究人员和利益相关者在健康和性别领域进行磋商，分享研究结果，并讨论这些可能如何为加强男性参与艾滋病毒和心血管疾病服务的战略提供信息。我们期望为系统应对男性艾滋病毒/心血管疾病并发症提供及时的见解。此外，我们的伙伴关系将提供一个坚实的跨学科平台，以制定一个更大的提案，可以执行和评估卫生系统战略，以解决南部非洲区域男性移民和跨界流动的长期健康需求。

As in other parts of the world, men are more likely to delay health care seeking and drop out of care than women in Southern Africa. There is evidence for men's gaps in health care for tuberculosis and HIV, and increasingly for non-communicable diseases (NCD) such as diabetes and hypertension which are on the rise in the region. However, due to emphasis on women and children in the global health agenda, men's health gaps have been neglected and there is limited regional data on their awareness, decision-making, and actions with regards to seeking health care. In this project, we focus on the case of cardiovascular disease (CVD) in HIV-positive men in Mozambique, a country where poverty, conflict, and migration for work have influenced men's health and their vulnerability to disease. Our project aims to contribute data for the development of 'differentiated' care strategies, that is models of care that are responsive to men's health needs and adapted to local systems processes and resource constraints. Mozambique has a high burden of infectious diseases (ID) as well as a growing burden of NCD, and men have lower levels of awareness, control, and uptake of treatment for both ID and NCD. Our project is based in a large urban district of Maputo and will use a range of qualitative and quantitative methods to explore aspects of men's health literacy and health-seeking. A literature review and mapping of men's health interventions in Mozambique will examine current approaches and assumptions. Facility-based observations and interviews with health providers and male patients with HIV and CVD will look at how their pathways to care are influenced by social, structural, and systems-related factors. A community-based survey and a nested qualitative study will use different measures to compare data on health literacy, self-perceived health and household influences on men's health seeking behaviour. Data from these different sources will be used to develop models of processes and pathways to care for men. Finally, we will consult with our project partners, researchers and stakeholders in the fields of health and gender to share findings and discuss how these can potentially inform strategies to strengthen men's engagement with HIV and CVD services. We expect to deliver timely insights for the systems response to HIV/CVD co-morbidity in men. Further, our partnership will provide a solid interdisciplinary platform for the development of a larger proposal that can implement and evaluate health systems strategies to address the chronic health needs of male migrants and mobility across borders in the Southern African region.