In large African antiretroviral therapy (ART) programs, disproportionately fewer men initiate ART, and at more advanced age and disease stage than women. Identifying and overcoming gender-specific barriers, at the individual and service delivery level, are critical to improving HIV/STI services for men. Previous research in Khayelitsha, a large, high HIV-prevalence township near Cape Town, found that despite increased male access to HIV counseling and testing (HCT), the proportion of men accessing treatment did not increase. MSF, the City of Cape Town and the Western Cape Provincial Department of Health, piloted two male services in Site B, Khayelitsha: Site B Male Clinic (SBMC) and a male after-hours clinic (MAC). Both facilities have all-male staff and offer HIV/STI services, including testing and treatment. SBMC is open daily 8:00-16:00 and MAC is open on Wednesdays 16:00-19:30. We compare the characteristics and outcomes of these two clinics.
Those on ART who initiated at another clinic are referred to as transfers-in (TFI) while known HIV-positives tested positive at another service before presenting. Summary statistics of patient characteristics and outcomes are presented, contrasting the two clinics where relevant.
Between June 2014 and June 2016, 14193 visits took place; median: 588/month (IQR: 509-659). Most (88%) of these visits took place at SBMC. Compared to MAC, patients at SBMC were more likely to seek STI treatment(45% vs 21%). Over half of the HCT occurred at an STI-related visit and HCT yielded a 6.2% positivity rate. The median CD4 counts were 376 (IQR:260-505) cells/µL at testing. Of those found eligible for ART, 91% (42/46) ever initiated at MAC compared to 69% at SBMC (203/295). Compared with SBMC, a far higher proportion of MAC patients presented as known HIV-positive or TFIs (64% vs 14%). TFIs at MAC were on ART longer (median:3.3yrs[IQR:2.1-5.2] vs 1.9yrs[IQR:1-2.4] at SBMC) with similar retention in care 6 months after TFI(86%). Among new initiates 6-month retention in care was 95%(35/37) at MAC and 88%(140/159) at SBMC.
STI care is an excellent opportunity to link men to HIV services. While SBMC had more patients, MAC attracted a different patient population, and had higher initiation and retention rates. Given these contrasting successes, further research should investigate whether aspects of both services could be rolled out to attract more men to HIV services.