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Implementation of a Comprehensive HIV Prevention Intervention for Men Who Have Sex with Men in Malawi: Assessment of Feasibility and Impact

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Implementation of a Comprehensive HIV Prevention Intervention for Men Who Have Sex with Men in Malawi: Assessment of Feasibility and Impact IMPLEMENTATION OF A COMPREHENSIVE HIV PREVENTION INTERVENTION FOR MEN WHO HAVE SEX wiTH MEN IN MALAwi: ASSESSMENT OF FEASIBILITY AND IMPACT IMPLEMENTATION OF A COMPREHENSIVE HIV PREVENTION INTERVENTION FOR MEN WHO HAVE SEX WITH MEN IN MALAWI: ASSESSMENT OF FEASIBILITY AND IMPACT October 2013 Authors: Andrea L. Wirtz, Gift Trapence, Vincent Jumbe, Dunker Kamba, Eric Umar, Sosthenes Ketende, Mark Berry, Susanne Stromdahl, Chris Beyrer, Stefan Baral Recommended citation: Wirtz AL, Trapence G, Jumbe V, Kamba D, Umar E, Ketende S, Berry M, Stromdahl S, Beyrer C, and Baral S. Implementation of a comprehensive HIV Prevention Intervention for men who have sex with men in Malawi: assessment of feasibility and impact. November 2013. Baltimore: USAID | Project Search: Research to Prevention. The USAID | Project SEARCH, Task Order No.2, is funded by the U.S. Agency for International Development under Contract No. GHH-I-00-07-00032-00, beginning September 30, 2008, and supported by the President’s Emergency Plan for AIDS Relief. The Research to Prevention (R2P) Project is led by the Johns Hopkins Center for Global Health and managed by the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP). Implementation of a Comprehensive HIV Prevention Intervention for MSM in Malawi ACKNOWLEDGEMENTS Many individuals played an important role in the design, conduct, and analysis of this research. Their contributions are all gratefully acknowledged. We would especially like to thank all the participants who so generously shared their stories with us. The study was implemented by USAID | Project SEARCH, Task Order No. 2: Research to Prevention (R2P). R2P is based at the Johns Hopkins University in Baltimore, Maryland, USA. The study and intervention were a collaboration between the Johns Hopkins School of Public Health Center for Public Health and Human Rights, the Malawi College of Medicine (CoM), and the Center for the Development of People (CEDEP). From the collaborative team, Stefan Baral (JHU), Gift Trapence (CEDEP), Andrea Wirtz (JHU) and Chris Beyrer (JHU) designed the study. The JHU team was also comprised of Mark Berry, Susanne Stromdahl, and Sosthenes Ketende. JHU provided scientific technical support during its implementation and analysis of baseline and intervention results. In Malawi, research design and data collection were led by CEDEP and CoM. The CEDEP team consisted of Gift Trapence (Director), Dunker Kamba, Ian Phiri, and Rodney Chalera. The CoM team was comprised of Eric Umar (PI), Vincent Jumbe, Rajab Mkakosya, Dan Banda, Nurse Grace Mwase, and Emma Chiomba. From USAID Malawi, Beth Deutsch, who provided important technical input and support for this project. From USAID Washington, Alison Cheng, Sarah Sandison, and Delivette Castor provided oversight, technical assistance, and feedback on earlier versions of the report. From R2P, Caitlin Kennedy and Deanna Kerrigan provided important insight and technical assistance to the project and this report. Others from R2P who contributed include Andrea Vazzano and Jessica Spielman. UNDP, UNAIDS, VSO, and UNFPA provided additional funding support for the baseline RDS recruitment and data collection. The USAID | Project SEARCH, Task Order No.2, is funded by the U.S. Agency for International Development under Contract No. GHH-I-00-07-00032-00, beginning September 30, 2008, and supported by the President’s Emergency Plan for AIDS Relief. PARTNER ORGANIZATIONS Department of Community Health Department of Community Health University of Malawi, College of Medicine University of Malawi, College of Medicine Private Bag 360, Chichiri, Blantyre 3 Private Bag 360, Chichiri, Blantyre 3 Center for Public Health and Human Rights Johns Hopkins Bloomberg School of Public Health 615 Wolfe St, Baltimore, MD 21205 Page 2 Implementation of a Comprehensive HIV Prevention Intervention for MSM in Malawi ACRONYMS AIDS Acquired Immunodeficiency Syndrome ART Antiretroviral Therapy CBO Community-based Organization CCL Condom Compatible Lubricants CCP Center for Communication Programs CDC Centers for Disease Control and Prevention CEDEP Center for the Development of People CHPI Combination HIV Prevention Intervention CoM College of Medicine CoMREC College of Medicine Research and Ethics Committee CPHHR Johns Hopkins School of Public Health Center for Public Health and Human Rights FPAM Family Planning Association of Malawi FSW Female Sex Worker HIV Human Immunodeficiency Virus HTC HIV Testing and Counseling JHU Johns Hopkins University LGBT Lesbian, Gay, Bisexual, and Transgender MNG Malawi National Government MSM Men Who Have Sex with Men NAC National AIDS Commission RCT Randomized Control Trial STI Sexually Transmitted Infection UAI Unprotected Anal Intercourse TPHA Treponema Pallidum Haemaglutination Assay USAID United States Agency for International Development WHO World Health Organization 95% CI 95% Confidence Interval Page 3 Implementation of a Comprehensive HIV Prevention Intervention for MSM in Malawi TABLE OF CONTENTS ACKNOWLEDGEMENTS ........................................................................................................... 2 ACRONYMS ........................................................................................................................... 3 TABLE OF CONTENTS .............................................................................................................. 4 EXECUTIVE SUMMARY ............................................................................................................ 6 Background and aims .................................................................................................................................. 6 Methods ....................................................................................................................................................... 6 Phase 1: Formative research ................................................................................................................. 6 Phase 3: Longitudinal research ............................................................................................................. 6 Key Findings ................................................................................................................................................ 7 Quantitative baseline data .................................................................................................................... 7 Qualitative research (formative and follow-up) ................................................................................... 7 Conclusions .................................................................................................................................................. 8 INTRODUCTION ..................................................................................................................... 9 Overview of the HIV epidemic in Malawi ................................................................................................... 9 Key Populations and MSM in Malawi ......................................................................................................... 9 HIV prevention interventions for MSM .................................................................................................... 10 Study objectives .......................................................................................................................................... 11 METHODS ........................................................................................................................... 12 Phase 1: Formative research ....................................................................................................................... 12 Participants and setting ...................................................................................................................... 12 Qualitative topics and conduct of interviews ..................................................................................... 13 Qualitative data analysis ..................................................................................................................... 13 Phases 2 Baseline research ......................................................................................................................... 13 Quantitative Survey Measures ............................................................................................................ 15 Biologic specimens .............................................................................................................................. 16 Quantitative data analysis .................................................................................................................. 17 Phase 3: Longitudinal research .................................................................................................................. 17 The CHPI intervention ......................................................................................................................... 17 Objectives of the CHPI ........................................................................................................................ 17 Study population and setting .............................................................................................................. 19 Intervention implementation ............................................................................................................. 19 Follow-up assessments and in-depth interviews ...............................................................................
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