Khanyisa: Community-based interventions to increase HIV testing and treatment uptake among MSM

Men who have sex with men (MSM) are at high risk for HIV acquisition and transmission and face significant barriers in gaining access to health-care services. Nancy Phaswana-Mafuya, Stefan Baral and Travis Sanchez are leading a team of investigators embarking on an implementation science study that aims to improve HIV care outcomes of South African MSM living with HIV infection.

A range of evidence-based interventions aimed at improving the general health and wellbeing of MSM is available but their optimal implementation within existing service provision settings has not yet been demonstrated. Moreover, much of the programming and research to date has focused on the prevention of HIV acquisition with less attention to strategies to better support MSM living with HIV.

Implementation science is the study of methods to promote the integration of research findings and evidence into healthcare policy and practice. ‘Khanyisa: A new HSRC collaborative study to leverage community and peer-based approaches to impact the HIV treatment cascade among men who have sex with men in South Africa’ uses community-based approaches and other MSM to ensure that those on antiretroviral therapy (ART) adhere to treatment and achieve viral load suppression. Khanyisa means ‘light’ in Xhosa.

Khanyisa seeks to contribute to improvement of HIV care outcomes of South African MSM living with HIV infection by:
• implementing a package of interventions that reach MSM living with HIV infection, linking them to health services, initiating them on ART and supporting them in remaining in care and being adherent to their treatment regimens; and
• assessing uptake, feasibility, acceptability, and coverage (implementation science effectiveness trial) at each stage of the HIV continuum of care and treatment cascade that will ultimately be scalable within sub-Saharan African HIV care settings

Khanyisa’s methods
Khanyisa examines the effectiveness of the service package among MSM aged 18 years and older in six sites, namely: Port Elizabeth, Cape Town, Moloto, Pietermaritzburg, Springs and Letsitele. The project kicked off in June 2016.

MSM receive a service package that is staggered (single-step wedge design). A stepped-wedge trial is a form of randomised controlled trial that involves sequential but random rollout of an intervention over multiple time periods. The package includes point-of-care (POC) with medical diagnostic testing at Khanyisa ‘non-clinic’ sites, HIV testing, CD4 testing, treatment initiation and peer-navigation services.

Three sites, called immediate intervention sites, based in Port Elizabeth, Cape Town and Pietermaritzburg, are receiving immediate POC. The three delayed intervention sites, based in Moloto, Limpopo and Springs, currently receive POC HIV testing, linked to local clinics for standard care.

The delayed intervention sites will receive the comprehensive package six months later. All participants will be followed passively through National Health and Laboratory Services (NHLS) and clinic records for a period of 12 – 24 months after enrolment to determine the study’s primary HIV care outcome, which is suppressed HIV viral loads below 40 copies/ml within six months of initiating treatment).

Enrolment started in June 2016. Since inception the team has screened 1 123 MSM, tested 1 023 for HIV and identified 184 (18%) MSM living with HIV. Among MSM living with HIV, 133 (72%) were newly diagnosed.
The Centres for Disease Control and Prevention (CDC) funds the HSRC to conduct this study. The study is led by researchers from the HSRC, Johns Hopkins University, Emory University, National Institute of Chronic Diseases and the Desmond Tutu HIV Foundation.

Author: Professor Nancy Phaswana-Mafuya, research director, HIV/AIDS, STIs and TB research programme, HSRC; Dr Stefan Baral, associate professor, Johns Hopkins Bloomberg School of Public Health; Dr Travis Sanchez, associate professor, Rollins School of Public Health, Emory University, USA