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Table 1 Summary of studies reporting accrual and delivery strategies of HIV interventions among MSM in SSA

From: Participants’ accrual and delivery of HIV prevention interventions among men who have sex with men in sub-Saharan Africa: a systematic review

Author/Study country Study Aims Study Design Study population characteristics Participant Accrual Delivery strategy Uptake/Results
(Adebajo et al., 2015) [30]
To evaluate the effect of three strategies in increasing uptake of HIV counseling and testing (HCT) among male most-at-risk population Cross-sectional Media age
Arm I: 28 years, Inter quartile range (IQR) 22–36 years
Arm II: 30 years, IQR 24–40 years
Arm III: 28 years, IQR 24–34 years
Not explicit Arm1: Key opinion leaders (KOLs) referring MSM to health facilities for HTC -facility based
Arm2: KOL referring MSM to nearby HTC team - community based
Arm 3: mobile M-MARPs peers conducting the HTC -community based
Arm1: 1988 MSM reached
Arm2: 14,726 MSM reached
Arm3: 14,895 MSM reached
Proportion of new HIV diagnosis were: Arm1 = 8%, Arm2 = 3%, and Arm3 = 13%
(Baral et al., 2015) [31]
To evaluate the utility of respondent-driven sampling as an implementation tool for engaging MSM in HIV intervention Prospective cohort Participants with tertiary education decreased from 28% in the first 10 waves to 9% in wave 26 (P < 0.001)
Mean age also decreased among participants from earlier waves to that of later waves (P < 0.001)‡
Respondent-driven sampling (RDS) HIV prevention and care services were provided at a dedicated facility established by the community-based organization- facility based MSM were more likely to report having tested for HIV in waves 0–4 (82.9%) than in waves 20–26 (47.7%)
80% of MSM correctly reported their HIV status in earlier waves, while only 25% correctly reported their status in later waves.
(Batist, Brown, Scheibe, Baral, & Bekker, 2013) [21]
South Africa
To reach MSM in five Cape Town townships, disseminate HIV-prevention information and supplies, and promote the use of condoms and HIV services. Prospective cohort (Pilot) Median age 24.5 years, IQR of 21–29 years
82.3% of participants were gay identified
10.4% self-identified as bisexual
Use of known peers to bring friends or Known peers identifying friends through hotspots or baseline survey contacts The intervention activities like training, debates and condom and lubricant provision were conducted in safe spaces - community based
Where required, the MSM were referred to MSM-friendly facilities for further care-facility based
Participants reported increased access to HIV prevention services i.e., condom and lubricant use.
Reported reduced feelings of loneliness and social isolation
(CHARURAT et al., 2015) [28]
To examine acceptability of a treatment as prevention (TasP) strategy among HIV-infected MSM using a Trusted Community Centre providing comprehensive HIV prevention and treatment services to MSM in Abuja, Nigeria. Prospective cohort 52.4% above 25 years
82.1% had at least senior secondary or higher education
69.0% self-identified as bisexual
31% self-identified as gay or homosexual
68.8% not on antiretroviral therapy (ART)
Respondent-driven sampling (RDS) HIV related services were provided at a dedicated facility (trusted community center) -facility based Of 186 HIV positive individuals, 128 (68.4%) were not on ART and were offered TasP.
Individuals who were not on ART at the time of enrolment were more likely to have not disclosed their sexual identity to health care providers (70.1% vs. 45.6%, P, 0.01) and to have not discussed HIV with their closest friends (81.2% vs.62.5%, P = 0.01).
(Geibel, King’ola, Temmerman, & Luchters, 2012) [32]
Evaluate the impact of a peer-driven HIV intervention on male sex workers who sell sex to men in Mombasa, Kenya. Prospective cohort Baseline
Median age 26 years, IQR 22–31 years
58.3% self-identified as bisexual
Median age 23 years, IQR 21–27 years
56.1% self-identified as bisexual
Pool of MSM who had participated in a previous baseline study The HIV prevention and care related services were offered at a drop-in-center (DIC) (dedicated facility) established by International Centre for Reproductive Health (ICRH) Kenya. This DIC also acted as a safe space- facility based Increased consistent condom use with both paying clients (35.9%e50.2%, p < 0.001) and non-paying male partners (27.4%e39.5%, p¼0.008).
Peer educator contact was also associated with improved HIV knowledge and use of water-based lubricants.
(Graham et al., 2015) [23]
To promote care engagement and antiretroviral therapy (ART) adherencefor MSM in coastal Kenya Prospective cohort (Pilot) All participants were aged between 24 and 42 years
Education years between 4 and 14 years
Local CBOs, health providers, and informal peer outreach Research-based health facility provided HIV related prevention and care services facility based Of 10 ART-naïve participants who enrolled in the pilot, eight completed follow-up with no adverse events reported.
(Möller et al., 2015) [20]
To describe changes in sexual risk behavior among Kenyan MSM who receivedregular risk reduction counseling (RRC). Prospective cohort study - using a HIV-1 negative and HIV-1 positive MSM Median age 25.2 years, IQR 21.5–29.7 years
53.8% had primary or no formal education
Use of known peers to bring individuals via personal networks and from known hotspots Not clear from the article. Participants (HIV-1 negative & HIV-1 positive) reported decreased number of sexual partners and unprotected anal intercourse
(Mulongo et al., 2015) [29]
DR Congo
To reduce the risk and impact of HIV in the DRC through community- and facility-based prevention, counseling and testing,and treatment strategies aimed at high-risk populations by increasing access and utilization of HIV intervention and care services Case study Not specified in the paper Venue-based recruitment sessions
Virtual sites and text messaging platforms
HIV related services were offered through mobile venue-based outreach service- Community based
The referrals were done to a key population-friendly health facility and other local facilities for further care- facility based
Was able to reach 2621 MSM with targeted prevention messaging in 2013, and provided testing and counseling to 4366 MSM from October 2012 to June 2014.
(Singh et al., 2012) [24]
Assess acceptability of venue-based approach for providing VCT Cross-sectional 78.6% had at least 25 years
75.6% had primary or no formal education
Use of known peers (community informants) to recruit MSM from known hotspots Services were offered in mobile outreach clinics at or near the venues -community based
Facility based services were offered to those who tested HIV positive - facility based
HIV prevalence was higher in this study compared to individual’s sampled in the 2008–2009 KDHS, suggesting the appropriateness of venue-based sampling in reaching stigmatized populations
(Wirtz et al., 2015) [27]
Testing the feasibility of providing a combination HIV preventionintervention (CHPI) for MSM in Malawi. Prospective study, Before and after evaluation 57.3% aged between 18 and 25 years
65.0% had completed secondary or higher education
68.9% self-identified as gay or homosexual
Respondent-driven sampling and through MSM identified during a previous baseline study Services were provided at a dedicated facility created by a community-based organization (CBO)- facility based
Referrals were done to MSM-friendly local hospitals and to Johns Hopkins antiretroviral therapy and sexually transmitted infection clinic.- facility based
The MSM-friendly facilities had received sensitization training -facility based
Improved reported condom use at last sex (from 62.5% at baseline to 77.0% at follow-up 3).
Increased disclosure of sexual orientation from 25% in follow-up 1 to 55% in follow-up 3.
(Williams, Carney, Plüddemann, & Parry, 2014) [26]
South Africa
To provide a descriptive summary of programmatic work targeting substance-related HIV riskbehavior among MSM in South Africa. Cross-sectional 78.6% aged at least 25 years
75.6% had completed secondary or higher education
Engagement with a local NGO and Peer outreach Community-based outreach - community based 3475 drug-using MSM were reached through community outreach.
745 MSM tested for HIV and received results.
239 MSM were referred from HTC to other services
(Williams, Carney, & Parry, 2016) [25]
South Africa
To test whether an intervention aimed at MSM who use substances (alcohol and other drugs) could affect risky substance use and sexual behavior. Cross-sectional Median age 27 years, IQR 18–49 years
Median number of years of education 12, IQR 7–13 years
Engagement with a local NGO and Peer outreach Mobile community-based outreach and provision of information on HIV/AIDS, substance use, and safer sex practices-community based Contributed to reduction in in the proportion who used cannabis and ecstasy including use of drugs during sex (knowledge about risk reduction strategies increased)
(Dramé, Crawford, Diouf, Beyrer, & Baral, 2013) [22]
To assess the feasibility of implementing a community-driven HIV prevention study in Senegal. Prospective cohort Mean age 28 years and 50% of participants ranged between 23 and 32 years
47.9% had secondary or university education
Through engagement with a CBO and through peers to accrue and retain MSM in Senegal for 15 months Used mobile clinics to provided syndromic diagnosis and treatment of STI at the site (or on-site) community based
Referral for treatment and follow-up were done to local health facilities- facility based
HIV prevalence at baseline was 36.0% (43/114), with cumulative HIV prevalence at study end being 47.2% (51/108).
(Green, Girault, Wambugu, Clement, & Adams, 2014) [11]
To assess the level of coverage of HIV prevention program using traditional peer-based approaches versus social media outreach. Case study Mean age of peer recruiters 25.5, standard deviation 6.9 years
55.4% of participants were age group 18–25 years
Virtual sites based approaches and Venue-based contacts Web-based 15,440 MSM reached through social media approaches.
12,804 MSM reached through peer-based outreach.
The total reach was about 92% of MSM in Ghana.
(Girault et al., 2015) [33]
To assess the feasibility of using a social network strategy in complementing a peer outreach approach in referring high-risk MSM to HTC services Cross-sectional study Not specified in the paper Respondent-driven sampling (RDS) Local government owned health facilities in the study setting - facility based 166 MSM reached and referred to HTC in 3 months.
62.7% reported no recent exposure to peer educators.
61.5% unaware of recent HIV status.