Table 6 CMO Configurations

CMOc 1:

Solidarity between KP groups (Fig. 6)

If community-based ART model is designed to provide ART to all the 4 KP groups (MSM, FSW, PWID, & TG) in the same location (C), then members of the various KP groups will not stigmatise and discriminate one another (either within or between KP groups) (O) and will have unhindered access to ART (O) because of the shared understanding (M) and perception that all KPs are at substantial risk of HIV infection and victims of criminalization laws, stigma, and discrimination in the community regardless of their group (M). This can result in solidarity (M) among KP individuals leading to better engagement with the HIV care and treatment programme (O)and cost savings (O)

Nil

Interviews: IDI—1 & 5)

CMOc 2:

KP friendly environment/Safe space (Fig. 7)

If Comprehensive HIV services are provided to members of KP in a conducive environment that is safe, non-stigmatizing, non-discriminatory, and friendly (C)

then access to antiretroviral treatment (O) and adherence to drug and/or clinic appointments (O) will improve because they (KP) feel safe- psychological safety (M) and have trust (M) in the programme and healthcare providers. Also, privacy and confidentiality are preserved

As a result, KP are motivated (M) and encouraged (M) to remain in care (O) and to achieve optimal viral load suppression (O)

[34,35,36,37] [38,39,40] [41] [42] [43] [44] [45] [19]

Interviews:IDI-1–9, IDI-11, 12, 13)

4 peer reviewed articles, 4 guidelines, and 2 programme reports

CMOc 3:

Communty ART outreaches to address geographic and structural barrier to ART (Fig. 8)

If KP individual could receive ART through community ART team in hotspots or outreach venues in locations where there are no OSS or DIC (C) then KP will have early accesss to ART(↓transportation cost, travel & waiting time)- (O), clients satisfaction, increased ART uptake and medication adherence (O) because of the level of trust in the expertise of cART team (M), the quality of care provided (M), psychological safety (M), and feeling of self-importance (M)

Resulting in improved retention in care, viral load coverage and suppression

[38,39,40] [41] [42] [43] [19] [46, 47]

Interviews: IDI 1 – 5, 7- 9, 12, 13

4 peer reviewed articles, 3 guidelines, and 2 programme reports

CMOc 4:

Peer support through participation in community support group meetings (Fig. 9)

If KP individuals actively participate in support group meetings through peer education and interpersonal communication (also benefits from ART refill and viral load sample collection during meetings) (C) then awareness and knowledge of HIV/AIDS will increase (O) and a change in attitude towards medication adherence (O)

Because of group learning (M), Group identity (M), -Mutual support/solidarity (M)

self-efficacy (M),

Resulting in improved medication adherence, retention on ART, and viral suppression

[48][40] [41] [42] [43]

Interviews: 1DI- 1,2, 4, 6, 8, 9, 10, 11, 13

1 peer reviewed article, 3 guidelines, and 1 programme report

CMOc 5:

KP community engagement and participation (including peer support) (Fig. 10)

If KP individuals (A) are actively engaged to participate in the planning and implementation of HIV services (i.e. outreach planning, peer support, HTS, ART refill) (I) – in the community-based ART model for KP (C) then ART uptake and medication adherence will improve (O) because of meaningful KP community participation (M), privacy and confidentiality(M). KP clients will develop trust in the healthcare providers (M), feel safe (M), and buy into the programme (M)

As a result, KPs will perceive services to be KP friendly (M) and they are motivated and encouraged (M) to remain in care (retention in care) (O). Thus, achieving optimal viral load suppression (M)

[34, 36] [38,39,40] [41] [42] [43] [44]

Interviews: IDI-1–9, IDI-11

3 peer reviewed articles, 5 guidelines, and 2 programme reports

CMOc 6:

Capacity building and technical support/mentoring and supportive supervision (Fig. 11)

If continuous training and mentoring (KP sensitization, HIV case management and comprehensive ART training) in the KP-CBART programme are offered to the heathcare providers (lay health workers and professional medical staff) and law enforcement agents (C) then this will increase awareness and knowledge among providers’ knowledge, a change in attitude towards KPLHIV and Healthcare providers will provide culturally sensitive and appropriate HIV services (M) to members of KP (A) because they are empowered (M) to provide quality HIV services to KP individuals (self-efficacy) (M)

Resulting in improved ART uptake (O), medication adherence (O), and reduction of reduced stigma and discrimination (O)

[35, 38,39,40, 49] [41] [42] [43]

Interviews: IDI 1 – 10, 13)

3 peer reviewed articles, 4 guidelines, and 2 programme reports

CMOc 7:

Programme ownership and sustainability (fig. 12)

If the CBART programme (actors) engages with the key stakeholders (such as the policy makers, law enforcement agents (government), HIV Agencies, KP networks, and PLHIV network) through advocacy and sensitization about the KP programme (C) then there will be increase in awareness and knowledge of HIV (O), and a change in attitude towards of KP (O) , b ecause stakeholders buy into the programme

Resulting in programme ownership and sustainability (O), formulation of KP friendly policy implementation (O), and reduction in stigma and discrimination /harassment by police (O), and prioritization of HIV programme for KP (O)

[38,39,40] [43, 44] [41] [42]

Interviews: IDI-1, 4, 7, 8, 10, 12

4 guidelines and 2 programme reports