title: Development and pilot testing of an intervention to promote care engagement and adherence among HIV-positive Kenyan MSM.
abstract: OBJECTIVE
  In many African settings, MSM are a stigmatized group whose access to and engagement in HIV care may be challenging. Our aim was to design a targeted, culturally appropriate intervention to promote care engagement and antiretroviral therapy (ART) adherence for MSM in coastal Kenya, and describe intervention safety, feasibility, and acceptability based upon a small pilot study.
  
  
  METHODS
  Based on qualitative work including in-depth interviews with HIV-positive MSM and focus groups with providers, we developed a tailored intervention and conducted a pilot test to refine intervention materials and procedures.
  
  
  METHODS
  The Shikamana intervention combines modified Next-Step Counseling by trained providers, support from a trained peer navigator, and tailored use of SMS messaging, phone calls, and discrete pill carriers. Providers, including counselors and clinicians, work together with peer navigators as a case management team.
  
  
  RESULTS
  Forty HIV-positive MSM aged 19-51 participated in intervention development and testing. Six counselors, three clinical officers, and four MSM peers were trained in intervention procedures. Of 10 ART-naïve participants who enrolled in the pilot, eight completed follow-up with no adverse events reported. One participant was lost to follow-up after 2 months and another failed to initiate ART despite ongoing counseling. No adverse events were reported. Staff feedback and exit interviews rated the intervention as feasible and acceptable.
  
  
  CONCLUSIONS
  This adherence support intervention tailored for Kenyan MSM was well tolerated, feasible, and acceptable in the pilot phase. A randomized controlled trial of a scaled-up programme to estimate intervention efficacy is ongoing.
authors.affiliation: aDepartment of Medicine bDepartment of Global Health cDepartment of Epidemiology, University of Washington, Seattle, Washington, USA dCentre for Geographic Medicine Research - Coast, Kenya Medical Research Institute, Kilifi, Kenya eDepartment of Psychology, University of Washington, Seattle, Washington, USA fNuffield Department of Medicine, University of Oxford, Headington, UK gDepartment of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Graham
authors.forename: Murugi
authors.initials: M
authors.lastname: Micheni
authors.forename: Bernadette
authors.initials: B
authors.lastname: Kombo
authors.forename: Elisabeth M
authors.initials: EM
authors.lastname: Van Der Elst
authors.forename: Peter M
authors.initials: PM
authors.lastname: Mugo
authors.forename: Esther
authors.initials: E
authors.lastname: Kivaya
authors.forename: Frances
authors.initials: F
authors.lastname: Aunon
authors.forename: Bryan
authors.initials: B
authors.lastname: Kutner
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
authors.forename: Jane M
authors.initials: JM
authors.lastname: Simoni
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D003376:Counseling; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control*; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010379:Peer Group; D010865:Pilot Projects; D011322:Primary Prevention; D055502:Secondary Prevention; D013240:Stereotyping; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents