Comprehensive HIV Prevention Package for MSM in Southern Africa: Pilot Study (Sibanye Health Project)
The purpose of this study is to evaluate the acceptability and uptake of a combination package of biomedical, behavioral and community-level HIV prevention interventions and services for men who have sex with men (MSM) in South Africa.
Behavioral: Condom choices
Behavioral: Condom-compatible lubricant choices
Behavioral: Couples HIV counseling and testing (CVCT)
Drug: Pre-exposure prophylaxis (PrEP) with FTC/TDF
Other: Staff and provider MSM and LGBT sensitization training
Behavioral: HIV Testing and Risk-reduction counseling
Behavioral: Linkage to care
|Study Design:||Allocation: Non-Randomized
Intervention Model: Crossover Assignment
Masking: Open Label
Primary Purpose: Prevention
|Official Title:||Comprehensive HIV Prevention Package for MSM in Southern Africa: Pilot Study|
- Retention in the cohort [ Time Frame: 12 months ] [ Designated as safety issue: No ]Will assess the ability of the study to retain participants for full study period. This will be measured by the proportion of enrolled participants who attend all subsequent study visits through the 12-month visit.
- Use of PrEP [ Time Frame: 6 months ] [ Designated as safety issue: No ]We will assess uptake of PrEP by study participants. This will be measured as the proportion of enrolled participants eligible for PrEP at the 3 and 6-month study visits who choose to initiate PrEP at those visits.
- Incident HIV infection [ Time Frame: 12 months ] [ Designated as safety issue: No ]This will be measured as the number of seroconversions during follow-up among those who are HIV-uninfected at baseline.
- Condom use [ Time Frame: 3 months ] [ Designated as safety issue: No ]Measured as the proportion of anal intercourse that is protected by condoms in the prior 3 months as self-reported reported in the questionnaire at each study visit.
- Lubricant use [ Time Frame: 3 months ] [ Designated as safety issue: No ]Measured as the proportion of condom-protected anal intercourse in the prior for 3 months for which condom-compatible lubricant is used as self-reported in the questionnaire at each study visit.
- VCT and CVCT uptake [ Time Frame: 12 months ] [ Designated as safety issue: No ]Measured as the number of times participants report HIV testing in the study period as part of the study visits and outside study visits compared to the number of time participants reported HIV testing in the year prior at baseline.
- Serodiscordant UAI [ Time Frame: 3 months ] [ Designated as safety issue: No ]Measured as self-reported unprotected anal intercourse in the last 3 months with a partner of positive or unknown HIV status as self-reported in the questionnaire at each study visit, pre- and post-intervention.
- Acceptability of PEP [ Time Frame: 12 months ] [ Designated as safety issue: No ]Measured as the proportion of men who report an eligible exposure who accept and initiate PEP.
- MSM-specific provider training [ Time Frame: 12 months ] [ Designated as safety issue: No ]Measured as the proportion of providers who are offered training who accept the training.
|Study Start Date:||February 2014|
|Estimated Study Completion Date:||April 2015|
|Estimated Primary Completion Date:||April 2015 (Final data collection date for primary outcome measure)|
Experimental: Comprehensive HIV prevention services
A comprehensive package of HIV prevention services, including condom provision, enhanced HIV testing options, and screening for and offering of pre-exposure prophylaxis (PrEP).
Behavioral: Condom choices
Men will receive the condom package that includes an assortment of styles, sizes, features and colors at their baseline visit, and will be able to get more condoms for free at any time after that visit by coming to a study clinic during clinic hours, or during a scheduled study visit.Behavioral: Condom-compatible lubricant choices
Men will receive condom-compatible lubricant that will include different types of lubricant (e.g., silicone-based) and different packaging (individual sachets or flat, discreet packages) at their baseline study visit, and participants will be able to access enhanced condom-compatible lubricant at any time after that visit by coming to a study clinic during clinic hours, or during a scheduled study visit.Behavioral: Couples HIV counseling and testing (CVCT)
Participants will be invited to schedule couples voluntary HIV counseling and testing (CVCT) appointments with a clinic counselor at any point after they complete their baseline study visit.Drug: Pre-exposure prophylaxis (PrEP) with FTC/TDF
For men who meet eligibility criteria, PrEP with Emtricitabine/Tenofovir Disoproxil Fumarate (FTC/TDF) will be made available beginning one month into the study. Men who express interest and meet eligibility criteria at their baseline visit can initiate PrEP at 1 month if they test negative for HIV. For men with extenuating circumstances, whose risk profile changes, of those who become more comfortable with the PrEP intervention through enrollment in the study, PrEP will be available to initiate at the 4 month visit. Men who accept PrEP will be required to have clinic visits, in addition to the regularly scheduled study visits, one month after starting PrEP and at least every 3 months afterward to monitor blood creatinine, AST/ALT and phosphorus levels.Other: Staff and provider MSM and LGBT sensitization training
The training for clinicians will focus on specific sexual health issues for MSM, including taking sexual histories in a non-judgmental way, physical examination techniques including anal examinations, and collection of rectal swabs for STI testing. Trainings will include topics about stigma, sexual identity and coming out, anal sex, STIs, and mental health. Training on LGBT sensitization will be provided for medical providers and staff in target clinics.Behavioral: HIV Testing and Risk-reduction counseling
Risk-reduction counseling will be provided to all men at baseline and additionally at 3, 6, and 12 month visits, with an additional counseling session for men on PrEP at their initiation visit (either month 1 or 4), their 1-month follow-up visit (either month 2 or 5) and at their 9 month visit. Risk reduction counseling will be client-centered counseling, according to CDC's Fundamentals of HIV Prevention Counseling protocol.Behavioral: Linkage to care
Men will be linked to needed services including HIV care and treatment for positives identified at baseline or during the study, including antiretroviral medications, and mental health services. At the end of their baseline visit, participants will receive service referral handouts for HIV care and treatment, mental health services, and other resources, as appropriate. Men who test positive for STIs will be treated at the clinic site.
Hide Detailed Description
This pilot study is a longitudinal cohort study of approximately 200 MSM, with a prospective follow-up period of 1 year for each participant. MSM will be recruited through community events, venues where MSM are known to congregate, online, and by participant referral. Following consent, a baseline visit will include a self-administered baseline survey, a clinical exam including an assessment for circumcision and STIs, and testing for HIV and other STIs, creatinine, AST/ALT and phosphorus levels, and drug screening.
An HIV prevention package will be offered to participants starting at baseline, which will include condom choices, condom-compatible lubricant choices, risk-reduction counseling, linkage to care, and couples voluntary counseling and testing (CVCT). HIV-negative men can be screened for eligibility for pre-exposure prophylaxis (PrEP) with Emtricitabine/Tenofovir Disoproxil Fumarate (FTC/TDF), which will be made available for eligible men beginning at the 1-month or 4-month study visit. Throughout the study, PEP for men with an exposure at high risk for HIV transmission will be made available.
Men who test positive for HIV at baseline or during the study will be referred and actively linked to appropriate care and treatment services and will continue to be a part of the study. Men who test positive for STIs at baseline or during the study will receive treatment at the study clinic. Participants will complete follow-up visits at 3, 6, and 12 months that will include self-administered behavioral surveys and HIV testing, and STI testing at 6 and 12 months.
Men who are eligible and interested in initiating PrEP can return for a PrEP initiation visit, which will include rapid HIV testing, at two time points: 1 month after enrollment and 4 months after enrollment. Men who initiate PrEP will have additional clinic visits for creatinine, AST/ALT, phosphate, protein and glucose level testing and rapid HIV testing the month following PrEP initiation (month 2 for those initiating PrEP at 1 month and month 5 for those initiating PrEP at 4 months) and every 3 months thereafter. If a participant on PrEP tests positive for HIV, they will discontinue PrEP but continue to be followed for their remaining study visits.
Men who test positive for HIV at follow-up visits will have blood drawn for initial CD4 and HIV viral load testing, and will have CD4 testing at 6 and 12 months and HIV viral load testing at 3, 6, and 12 months. Data on service utilization, condom use, lubricant use, HIV and STI testing outside the study site, and other outcomes will be collected via monthly SMS text message surveys during the study period.
The study population will be men aged 18 years and older who self-report that they had anal intercourse with men in the past year, are current residents of the study city, are willing to provide contact information, and have a phone.
The sample will consist of approximately 200 MSM, 100 in each Cape Town and Port Elizabeth, South Africa. All 200 men will be followed for one year, and approximately 20% of the study population at each site can be HIV-infected at baseline. Additional men who are HIV-positive at baseline will be enrolled in the baseline visit but not followed prospectively, and not counted as part of the 100 men in that study site.
The prevention package will be offered throughout the study and will include condom choices with an assortment of styles, sizes and features, condom-compatible lubricant choices with discreet packaging, risk reduction counseling, linkage to care, couples voluntary HIV counseling and testing (CVCT), and PrEP for eligible men beginning one month after enrollment. Condom choices, lubricant choices, and CVCT will be available to participants at drop-in visits at any time.
Throughout the study, post-exposure prophylaxis (PEP) for men with an exposure at high risk for HIV transmission will be available as standard of care.
Community-level interventions will occur through training of health care providers to deliver sexual health services to MSM and LGBT sensitization, LGBT training for study staff and other staff of the clinical sites, and community mobilization efforts to improve health literacy and uptake of prevention services among MSM.
Recruitment activities will be conducted for 3 months or until 100 MSM have been recruited in each study city. After enrollment, MSM will have a follow-up period of 1 year for each participant.
This study has four primary objectives:
- Determine acceptability of the HIV prevention package.
- Determine uptake of individual elements of the HIV prevention package.
- Determine incidence of HIV, STIs and UAI.
- Understand HIV risk and prevention behaviors among MSM.
- Emory University, Atlanta, GA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- University of California, Los Angeles, Los Angeles, CA
- Desmond Tutu HIV Foundation, Cape Town, South Africa (Enrollment & Clinic site)
Human Sciences Research Council (HSRC), Port Elizabeth, South Africa (Enrollment site)
- Kwazakhele Community Health Centre, Port Elizabeth, South Africa (Clinic site)
- Sandford Community Health Centre, Port Elizabeth, South Africa (Clinic site)
- West End Community Health Centre, Port Elizabeth, South Africa (Clinic site)
|Contact: Patrick S Sullivan, DVM, PhDfirstname.lastname@example.org|
|United States, Georgia|
|Rollins School of Public Health|
|Atlanta, Georgia, United States, 30322|
|United States, Maryland|
|Johns Hopkins School of Public Health|
|Baltimore, Maryland, United States, 21205|
|Desmond Tutu HIV Foundation||Not yet recruiting|
|Cape Town, South Africa|
|Human Sciences Research Council||Not yet recruiting|
|Port Elizabeth, South Africa|
|Principal Investigator:||Patrick S Sulivan, DVM, PhD||Rollins School of Public Health|
|Principal Investigator:||A.D. McNaghten, PhD, MHSA||Rollins School of Public Health|
|Principal Investigator:||Stefan Baral, MD, MPH, CCFP||Johns Hopkins School of Public Health|
|Principal Investigator:||Linda-Gail Bekker, MBChB, PhD||Desmond Tutu HIV Foundation|
|Principal Investigator:||Nancy (Refilwe) Phaswana-Mafuya, PhD||Human Sciences Research Council|
|Principal Investigator:||Rob Stephenson, MSc, PhD||Rollins School of Public Health|
|Principal Investigator:||Chris Beyrer, MD, MPH||Johns Hopkins School of Public Health|