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MOAD0404

The Sawa Sawa Intervention: A quazi -experimental trial to reduce community level stigma and improve HIV testing service uptake among men in Sofala Province, Mozambique. Andrea L. Wirtz, Elizabeth C. Mallalieu, Jose Chidassicua , Dirce Pinho , Patrick Devos , Lynn Van Lith

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MOAD0404

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  1. The Sawa SawaIntervention: A quazi-experimental trial to reduce community level stigma and improve HIV testing service uptake among men in Sofala Province, Mozambique Andrea L. Wirtz, Elizabeth C. Mallalieu, Jose Chidassicua, DircePinho, Patrick Devos, Lynn Van Lith 10th IAS Conference on International HIV Science, 22 July 2019 MOAD0404

  2. Disclosures: Andrea Wirtz receives other funding support from Gilead Sciences and ViiV Healthcare

  3. Background • Focus on the HIV care continuum has led to scrutiny of gender disparities in uptake of HIV services and outcomes • Observational studies consistently highlight low uptake of HIV testing, ART use, and higher mortality among men living with HIV • HIV “blind spot” a priority to global and country targets • Search for effective combination interventions to engage men in HIV services and ultimately change epidemic trajectories

  4. Intervention Goal & Objectives Sofala Province • Goal:Reduce community level stigma to improve engagement in HIV care continuumamong men in Sofala Province, Mozambique • Primary outcome objectives: • Reduce community stigma • Increase number of men tested for HIV • Other outcomes of interest: • Increase number of men initiating ART Map 1 HIV Prevalence In Mozambique

  5. Intervention Activities

  6. Methods • Quazi experimental design • Longitudinal population-based pre- and post-intervention surveys in intervention (Dondo) and control (Nhamatanda) districts • Validated stigma scale (Genberg 2008;=0.79) and self-reported HIV testing (last 12mo) • Supported by qualitatlive research and process indicators

  7. Results: Intervention Reach • Implemented from March – December 2017 • Community Dialogues • 8,873 people reached; 51% men • Positive Prevention • 821 people reached; 71% men LHIV • HIV testing campaign • 3,107 people reached within one month; 78% men • 4.5% of men tested were newly diagnosed, referred for care and treatment

  8. Endline findings: Coverage of *Significantly different by gender, p<0.05; Denominator for Positive Prevention groups are PLHIV

  9. Intervention impact: • Stigma among all participants • Estimated using residualized change models* • Total stigma score decreased with the overall intervention (β: -2.38; 95%CI: -3.07,-1.69; p <0.001) • Reductions more pronounced among men (p<0.001) • HIV testing among men • Estimated using multi-level model with random effects • Increased odds of HIV testing among men associated with the intervention(aOR: 1.32; 95%CI: 1.01-1.74; p=0.049) • Increased odds of HIV testing in the community (aOR: 1.23; 95%CI: 0.98, 1.53, p=0.073) * Residualized models account for different starting points on stigma scales among participants

  10. Intervention impact: HIV testing among men associated with Sawa Sawa

  11. Conclusions:

  12. Thank you to the village of participants, facilitators, focal points, data collectors, data entry staff, community leaders in Dondo and Nhamatandawho contributed substantial effort to this project. CCP-HC3: Lynn Van Lith, Beth Mallalieu, Patrick Devos, Dida Pinho, Jose “Braz” Chidassicua, Matilde Cunhaque JHU: Andrea Wirtz, Jackie Tran, Shirley Yan, Bee-Ah Khan USAID: Kim Ahanda USAID Maputo: Lopa Basu, Shadit Murargy, Julio Machava, Ferreira Ferreira Our hearts and prayers go to all of the wonderful people of Beira, Sofala Province Acknowledgements

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