Increasing Male HIV Service Access in Zambia

Implementing Partner: JSI Research & Training Institute Inc. (JSI)/USAID
DISCOVER-Health Project

A male client on ART accessing HIV services (ARVs and condoms) in an integrated clinic setting (Peter Singogo clinic)

Description/Activities: The MCS findings: Conducted in 2017/18 among males 20-34 years old, the MCS revealed that these men fear HIV diagnosis and living with HIV, and feel shut out of the health system. The cycle of fear and exclusion, fed and compounded by limited access to credible health and HIV information, exerts a powerful push for these men to delay HIV care and treatment, until overt/serious illness leaves them with no option, but to seek health care.

Town Center Health Post (established and supported by USAID DISCOVER-Health), which is located in a busy city market with a lot of male traders.

The Intervention: USAID DISCOVER-Health addressed some of the health system barriers the men face to make HIV services more accessible, and increased the availability of credible HIV/health information including the following broad aspects:

  • Male providers: Recruited more male providers across all HIV services to accommodate the strong preference for male providers.
  • Room for men: Designated a room or time-slot men’s clinic to create space for men in busy clinics that are often over-crowded with women and children –simply putting a ‘Men’s Clinic in Progress’ sign on a door is very effective in creating space for men. Also put signage outside clinics specifying that integrated male health services are available, including HIV services.
  • DSD: Provided differentiated HIV service delivery. We introduced satellite sites in areas where men are more likely to be found e.g. busy city markets, taxi ranks, and bus stops; and introduced weekend and evening clinics especially for men who are unable to take time off to access services.
  • Provider re-orientation: trained both lay providers and health care workers to deliver respectful services and assure privacy of client information.
  • HIV Literacy: supported and provided general HIV information and specific messaging about the menu of HIV interventions available for men.

Town Center Health Post clients awaiting service.

Under specific program areas:

  • HTS and linkage: we made HIVST widely available to men and scaled-up index case testing of women living with HIV (WLHIV). Assigned primarily male lay providers to support HTS and linkage activities. Linkage to ART, VMMC, PrEP, condoms, as appropriate
  • ART: All newly initiated clients are put on TLD. Based on program data that showed high dropouts during the first 2-4 months, we intensified pre-ART counseling and ensured regular contact by the case manager (trained community health workers that are the primary points of contact with the ART clients).
  • Adherence /Retention: assigned a case manager (male wherever
    possible/preferred) to provide support through the treatment journey, including providing adherence support and maintenance of viral suppression once achieved.

What Makes the Intervention Unique/Different: The approach taken to: hear what the man said in the MCS; address some of the barriers they face with empathy and respect; and continually use program data to make mid-course corrections to improve services and programs

Impact Data (as it relates to men):

  • The overall number of males >15 initiated on ART in FY18 and FY19 is 7,906 and 9,243 (17% increase). The % increase in the 15-39 years age group is 14% (from 5,339 to 6,076).
  • The linkage rate for males has also increased from 90% in FY18 to 97% in FY19 (and to 99% so far in FY20)
  • The Copperbelt Province had one of the highest increase rates in ART initiations for men (34%) from 2,799 new males initiated in FY18 to 3,738 in FY19.

Below are some data from selected Copperbelt Province facilities that demonstrate the impact of the interventions:

DistrictFacilityTX_NEW FY18TX_NEW FY19% increaseTX_NEW FY20 (as of March 31, 2020)
NdolaPeter Singogo468380%46
ChingolaNdungu HP4193127%61