“Anza mapema” is a Kiswahili word meaning “start early”. For the project Anza mapema, the name implies taking an early opportunity to get to know one’s HIV/STI status and begin treatment appropriately. It also denotes early interventions to avert possible infection for those not already infected.
Suitability to join the study comprise the following: all men who report oral or anal sex with a man in the past six months, 18 years of age and above and residents of Kisumu, Kenya, irrespective of HIV infection status. Additionally, ability to provide informed consent, agreeing to HIV test, not participating in any HIV intervention or vaccine study, and plan to remain in the study area for at least one year.
Kenyan guidelines for accessing and treating key populations are adhered to, providing linkage to a targeted, comprehensive prevention and care programme whose goal is to test Kenyan men who have sex with men (MSM) for HIV and connect them to medical care and peer support groups. The aims are to reduce time to Anti-retroviral Therapy (ART) initiation, promote adherence to treatment, and increase retention in care where HIV-negative MSM are retained in a peer-led non-ART risk reduction programme. Additionally, there is promotion of uptake and adherence to Pre- exposure prophylaxis (PrEP) among a subset of high risk HIV negative men.
The study began in August 2015 and is set to be completed by September 2017. About 700 men in Kisumu, Kenya have joined the study. We successfully completed enrolment within the first six months due to an elaborate peer network through training of 23 peer education outreach workers using the NASCOP peer navigator training manual, an on-line MSM sensitivity and general health issues training. Each participant is followed up to twelve months from enrolment or from PrEP initiation, during which structured HIV behavioral assessments, medical examinations, and collection of biological samples for STI/HIV tests are conducted. Participants who do not complete 12 months of follow-up are contacted to explore reasons for no longer participating. Approximately 30 clinicians and peer outreach staff are interviewed to get their views on unmet needs and program improvement.
We screened 1,012 men, out of which 764 (75%) were eligible and 711 (92%) enrolled part of which 635 (89%) were HIV negative men. Follow up is ongoing with an overall retention rate of 80% across all the four study quarterly visits.