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  • Author
    Katherine Holland
  • Discovery PI

    Kathryn Dovel

  • Project Co-Author

    K. Holland, M. Mphande, J. Hubbard, I. Robson, E. Chikuse, L. Kamtsendero, C. Lemani, J.J van Oosterhout, M. Ramesh, S. Phiri, K. Dovel

  • Abstract Title

    Identifying core components of a male-specific person-centered care intervention for scale-up in Sub-Saharan Africa and other low-resource settings

  • Discovery AOC Petal or Dual Degree Program

    Global Health

  • Abstract

    Background: Men living with HIV (MLHIV) experience high rates of treatment interruption (TI), resulting in increased morbidity, mortality, and viremia. Person-centered care (PCC) tailored to men can improve men’s ART engagement. Identifying locally contextual, core components of PCC counseling is necessary for effective implementation and scale-up. We conducted a qualitative sub-study with MLHIV to identify core components of a male-specific PCC counseling curriculum in Malawi.
    Methods: Two parent trials (IDEaL and ENGAGE; Clinicaltrials.gov #s NCT05137210/NCT04858243) enrolled MLHIV ≥15 years not currently in care (either never initiated ART or experiencing TI >28 days). The trials aimed to improve six-month retention among men experiencing TI using a male-specific PCC intervention. Of 1,309 men enrolled, a random subset of 97 MLHIV were selected for qualitative in-depth interviews (IDIs) at 3- (n=36) and 9-months (n=61) to assess core components of the intervention. Data were analyzed using thematic and content-based analysis in Atlas.ti v.9.
    Results: Of 97 MLHIV interviewed, median age was 38, median time since ART initiation 4-months, 89% were actively on ART at interview. Participants identified core service components related to access, quality, and support. Efficient services, undivided healthcare worker (HCW) attention and respect, privacy, and persistent tracing efforts were considered critically impactful for male-PCC. MLHIV wanted to feel that HCWs “never give up on them” as if “they were family”. Some wanted ongoing relationships with HCWs. Men also expressed need for male-tailored HIV messaging which highlights ART’s contributions to men’s goals and societal roles and acknowledges that lifelong adherence is difficult, requiring self-compassion. Incorporating graphics depicting MLHIV living normal, healthy lives into counseling tools was also impactful for men (Figure).

    Fig. Core components of a person-centered counseling intervention targeting men experiencing treatment interruption in Malawi
    Easy Access to Services (service location and timing) Quality Services (client preferences and satisfaction) Supportive Services (psychological and logistical)
    Efficient Services (that take into consideration men's busy lives while retaining efficacy) Undivided HCW Attention & Respect (that gives men the time and space to tell their story and express their needs) Persistent Tracing Efforts (rooted in a HCW "not giving up" on the client and wishing "like a family" for the client's well-being)
      Private Counseling Environemnts (that give men the ability to "speak freely") Ongoing Relationships with HCWs (that are longitudinal and bidirectional)
      Tailored Messaging (individualized counseling focused on men's goals/societal roles AND positive visual aids) Emphasized Self-Compassion (HCW acknowledges adherence challenges and promotes an environment of self-compassion)

    Conclusions: MLHIV need services that prioritize access, quality, and support tailored to their male experiences. Additional research is needed to assess how an intervention with these core components can be taken to scale.

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