Yaba guy che "for the guys": Intervention co-development to increase men's HIV service use

在赞比亚，与其他撒哈拉以南非洲国家一样，男子比妇女更不可能获得艾滋病毒服务，包括艾滋病毒检测服务，这是获得预防服务和艾滋病毒护理连续体的门户。因此，男性比女性更不可能知道自己的艾滋病毒阳性状态，因此男性在感染的后期阶段开始艾滋病毒治疗(ART)，因此一旦开始接受ART，发病率和死亡率就会更高。在不知道自己的艾滋病毒状况的情况下，艾滋病毒阳性男子更有可能将艾滋病毒传播给性伴侣。男子参与艾滋病毒服务的障碍是复杂和多方面的，并在国家一级至个人一级运作。这些问题包括如何为医疗服务提供资金、提供和推广医疗服务，导致医疗机构被视为“女性空间”；与男性气概有关的有害性别规范，限制男性使用艾滋病毒相关服务，并影响他们对同龄人使用艾滋病毒相关服务的看法；以及男性的工作流动性，限制他们使用在常规工作时间运行的医疗设施的能力。为了改善男子参与艾滋病毒服务，包括艾滋病毒预防和治疗服务，需要一种全系统的办法来了解和解决这些相互作用的服务使用障碍。通过参与性定性研究和众包，这项早期研究将与赞比亚卢萨卡一个城市社区的男子密切合作，以：1)建立男子认为对其服务使用最不利的艾滋病毒检测服务的障碍以及与预防和护理的联系；2)共同开发一种多组成部分的干预措施，以消除服务使用的障碍。多成分干预旨在解决与如何以及在哪里提供艾滋病毒检测服务有关的障碍，改变与艾滋病毒检测吸收相关的规范，并为艾滋病毒预防服务的使用建立社会支持，特别是医疗男性包皮环切术，以及启动和接受抗逆转录病毒疗法。同时，我们将使用时间地点抽样来评估这种替代抽样方法是否可以用于在整群随机试验中评估多成分干预的影响。干预措施将通过与居住在研究社区的男性和其他利益相关者(包括地区卫生经理和医护人员)举行一系列研讨会来完成，并在进入整群随机试验之前获得这些群体的支持。

In Zambia, as in other sub-Saharan African countries, men are less likely than women to access HIV services, including HIV testing services, which acts as a gateway to prevention services and the HIV care continuum. As a consequence, men are less likely than women to know their HIV positive status, men initiate HIV treatment (ART) at later stages of infection, thus experiencing higher levels of morbidity and mortality once initiated on ART. Without knowledge of their HIV status, HIV positive men are more likely to transmit HIV to their sexual partners. The barriers to men's engagement in HIV services are complex and multifaceted, and operate at national- through to individual-level. These include how healthcare services are funded, delivered and promoted, leading to healthcare facilities being seen as "female-spaces"; harmful gender norms related to masculinity, restricting men's use of HIV-related services and influencing their perceptions regarding their peers use of HIV-related services, and men's mobility for work, limiting their ability to access health facilities operational during conventional working hours. To improve men's engagement with HIV services, including HIV prevention and treatment services, a systems-wide approach to understanding and addressing these interacting barriers to service use is needed. Through participatory qualitative research and crowdsourcing, this early phase study will work closely with men in an urban community in Lusaka, Zambia, to: 1) establish the barriers to HIV testing services and linkage to prevention and care that men perceive to be most inhibitive to their service use, and 2) co-develop a multi-component intervention to address barriers to service use. The multi-component intervention is intended to address barriers related to how and where HIV testing services are delivered, to transform norms related to HIV testing uptake and establish social support for use of HIV prevention services, in particular medical male circumcision, and initiation and uptake of ART.In parallel, we will use time location sampling to assess whether this alternative sampling method, often used to reach "hidden populations", could be used to evaluate the impact of the multi-component intervention in a cluster randomised trial. The intervention will be finalised through a series of workshops with men residing in the study community and other stakeholders, including district health managers and healthcare workers, with support from these groups obtained before progression to a cluster randomised trial.