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More men now referring themselves to HIV testing services through behavioral and biomedical interventions

Owete study is a Randomized Control Trial (RCT) that tests a combination of behavioral and biomedical interventions. The test intends to check if these two interventions can improve the HIV prevention and care cascade among men in Bondo sub-county fishing community. The study started in 2019 with preparations before being slowed down by the sudden occurrence of the Coronavirus pandemic in 2020.
Fortunately, it later picked up much later the same year to be where it is today.
Since then, the team has managed to enroll1,500 men, from a target of 1,800 men into the study.
The study employs two or three intervention strategies. First, it looks at the social network-based approach. According to the study coordinator, in this approach, highly socially connected men were recruited and trained to distribute HIV Self-Testing (ST) kits and provide linkage support to men in their
social networks. This social network would later receive these interventions through highly socially connected men. Secondly, it uses small financial incentives to determine whether this approach, along with small financial incentives in the form of transport vouchers increases men's self-testing and linkage to uptake of Antiretroviral Therapy (ART) and Pre- Exposure Prophylaxis (PrEP).

He narrated further that the Owete study has partnered with specific facilities in the community where the men are expected to receive ART and PrEP within three months of testing.

The highly socially connected men, also known as promoters, distribute ST kits and vouchers to their social network members. The social network members test and link themselves with the result of the test in the facilities for confirmatory tests. If the results are positive, they are linked to care, If they are negative, they are linked to PrEP.

Secondly, the study is out to check if this approach can increase viral suppression among men who are taking ART within the facilities. Additionally, he added, “And also, we want to check if this approach will lead to PrEP adherence for those who initiate PrEP.”

He said men who are 18 years and above and living in the Bondo sub-county of Siaya County were eligible for the study. “We were supposed to have worked in Rarieda sub-county Bondo and Alego Usonga because we had targeted to initially see 1,000 men but later on increased to 1,800. We later
realized the target can be gotten within the Bondo sub-county on three beaches. So currently we work within Bondo sub-county in three beaches namely, Uhanya, Honge and WichLum beaches.” He said adding that they specifically target highly mobile men in high-priority settings.

“These are the fishermen. Fishermen are really mobile when the fish catch is low, they move from one beach to another. Getting them to come for HIV prevention and care services is usually very difficult” According to the study Coordinator, researches that have been done along the beaches show that only 50% of men have tested for HIV and know their status. “So because the nature of their work involves a lot of mobility, that is why we are targeting them with these interventions. Basically, it is the fishing community along Lake Victoria that has the mobility issue.” He narrated.

 

Uhanya Beach in Siaya County - One of the implementation Sites for Owete Study

The nature of this population informed the conducting of this study. The Coordinator said that it was hoped that through these interventions, they would encourage the men to seek the services. During the interview, the Coordinator happily noted that although they are still collecting data, and
findings are not yet out, through the interventions, more men are now accessing HIV testing services. “We are receiving several people referring themselves for HIV testing. After they have tested themselves in the community, we encourage them to come to the facilities to confirm their status because they have tested themselves.” So they come to the facilities to confirm their status using the other test methods. After confirming, we encourage the health care workers to enroll them into care services, especially those who turn positive. Those who turn negative, we encourage to enroll into PrEP services because they are a high-risk population.”

The men participants receive the services from the health facilities around their beaches. “We engaged the Ministry of Health (MoH) who allowed us to work within those facilities.” He said after the men test themselves they are linked to facility in-charges. Whenever they visit, they are given priority since they own transport vouchers which are redeemed at the facility. There are those who prefer further facilities whose staff have also been engaged. Similarly, when they walk in with the vouchers, they are served accordingly.The Owete study is funded by the National Institute of Mental Health (NIMH) through the University of California, San Francisco (UCSF) in the United States (U.S). It collaborates with UCSF, the University of
Pennsylvania, and Duke University. It also collaborates with the Kenya Medical Research Institute (KEMRI) and Impact Research and Development
Organization (IRDO). Other collaborators include the Center for Health Solutions (CHS), MoH, and the Beach Management Units (BMU).

The Coordinator concurred with the fact that a number of Serious Adverse Events (SAEs) have been reported since the study began. He said
most of the SAEs had resulted from natural occurrences. There are participants who had died while on HIV care and treatment, others were
lost to follow-up and died from defaulting medication. Two participants died from cancer, two were murdered, and two more drowned. He sadly
indicated a number of deaths resulting from drowning along the beaches may not have been reported. He continued to disclose that the deaths are
however not study-related.

Since the beginning of the study, the team has accrued several achievements. They managed to train all the promoters whose role included distributing ST kits to respective social network members.
Participants have been recruited, randomized, and enrolled in the study. 1,500 men from a target of 1,800 have been enrolled. Other activities
currently ongoing include follow-up surveys and linkage of participants in the respective facilities, data collection, and refresher training of the promoters.

The study uses both qualitative and quantitative methods of data collection. The qualitative method involves In-depth Interviews (IDI), Focus Group Discussions (FGDs), and Key Informant Interviews (KII). The quantitative method involves the use of a hand-held computer tablet, operating a Research Electronic Data Capture (REDCap) system.

The Coordinator said the study, which started on 2019, will go on for the next five years. It has a team of 22 Field Research Assistants (FRAs).

In his closing remarks, the Coordinator expressed gratitude on behalf of his team to their Principle Investigators (PIs). “They are very supportive.” He said. He continued to acknowledge the Local Independent Review Boards IRBs as well as the UCSF IRB for their continuous support and guidance. He
also appreciated Dr. Kawango Agot, the Director of IRDO for her support with logistics needs. Finally, he appreciated his team for their excellent work ethics, as well as the Regulatory department

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