Uptake and Short-Term Retention in HIV Treatment Among Men in South Africa: The Coach Mpilo Pilot Project

Mbuzeleni Hlongwa; Morna Cornell; Shawn Malone; Paris Pitsillides; Kristen Little; Nina Hasen

doi:10.9745/GHSP-D-21-00498

Key Findings

Uptake of the Coach Mpilo intervention was high at both the community level and in health care facilities among newly and previously diagnosed men, which was surprising, given the well-documented barriers to men HIV testing and linking to care in sub-Saharan Africa.
Short-term retention in HIV treatment was high in newly and previously diagnosed men and increased by approximately 20%.
Of the 16% of men who had at least 1 treatment interruption, almost all men (95%) subsequently returned to antiretroviral therapy within 2 months.

Key Implications

This study provides important new information on men returning to care after treatment interruption, about whom little is known.
This model has the potential to be scalable and sustainable because coaches can be recruited from the community, quickly trained, and do not require major infrastructural or operational support from clinics.

ABSTRACT

Introduction:

Gender disparities persist across the HIV care continuum in sub-Saharan Africa. Men are tested, linked, and retained at lower rates than women. Men experience more treatment interruptions, resulting in higher rates of virological failure and increased mortality. Peer support is an approach to improving men’s engagement and retention in HIV treatment. We assessed uptake and early retention in HIV care among men in the ‘Coach Mpilo’ peer support pilot project in South Africa.

Methods:

We conducted a pilot project from March 2020 to September 2020 in 3 districts: Ehlanzeni and Gert Sibande (Mpumalanga) and Ugu (KwaZulu-Natal). Men living with HIV were invited to receive one-on-one coaching from a peer supporter who was stable on treatment. We analyzed participants’ self-reported data on demographics, uptake, and retention in HIV treatment. We described baseline characteristics using summary statistics and reported uptake and early retention proportions overall and by testing history (newly and previously diagnosed).

Results:

Among 4,182 men living with HIV, most were previously diagnosed (n=2,461, 64%) and uptake was high (92%, n=3,848). Short-term retention was 80% (n=1,979) among men previously diagnosed and 88% (n=1,213) among newly diagnosed. In September 2020, 95% (n=3,653/3,848) of all participants reported being active on HIV treatment, including those retained consistently and those who had interrupted and returned to care. Among participants experiencing treatment interruption after enrolling, the majority (82%, n=464) returned to treatment, largely within 2 months.

Conclusions:

Improving linkage to and retention in HIV treatment among men is essential for their health and for treatment as prevention. This pilot project provided preliminary evidence that a peer-led support model was acceptable, retained a high proportion of men in the early stages of ART, and supported men returning to care after treatment interruption. These promising results require further investigation to assess impact, scalability, and cost-effectiveness.

Received: July 8, 2021.
Accepted: December 22, 2021.
Published: February 28, 2022.

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