Mens Division

March 2022 – February 2023

The Men’s Health Division is dedicated to enhancing men’s access to healthcare and improving their health outcomes through tailored services. This focus stems from the recognition of men’s unique health needs, which are often overlooked. Men face routine barriers that limit their access to care, leading to unfavorable health results. Additionally, concerning TB, men are disproportionately affected by the disease, yet they are less likely to seek testing or treatment. Men are also less likely to access sexual healthcare, resulting in lower uptake of prevention, testing, and treatment services. Consequently, they experience poorer treatment outcomes, such as death or disengagement from care. The division’s mission is to amplify men’s perspectives in the development of interventions and research to improve health outcomes. Operating in two key locations, namely Cape Town, Western Cape, and East London, Eastern Cape, the division is co-led by Drs. Andrew Medina-Marino and Philip Smith.

Emerging Global Leader Award

Program Purpose

The purpose of the Fogarty Emerging Global Leader Award is to provide research support and protected time to a research scientist from a low- or middle-income country (LMIC) with a junior faculty position at an LMIC academic or research institution leading to an independently funded research career.

The Fogarty International Center at the U.S. National Institutes of Health awarded the Emerging Global Leader K43 grant to Dr. Smith. The project, conducted in South Africa from 2022 to 2027, focuses on HIV prevention for men in high disease-burden communities. The research objectives include assessing factors associated with Pre-exposure Prophylaxis (PrEP) uptake and sustained use and utilizing behavioral economics to design an HIV prevention intervention for South African males aged 15-49. This research is embedded within ongoing FastPrEP implementation research.

U=U for Men’s Health

Drs. Andrew Medina-Marino and Alison Buttenheim (UPenn) serve as the principal investigators for a research grant aimed at addressing the significant disparities in HIV testing, treatment initiation, and viral suppression among cis-gender heterosexual men living with HIV in South Africa. The study focuses on evaluating the impact of Undetectable Equals Untransmittable (U=U) messages, developed using behavioural economics insights and human-centered design, on men’s engagement in community-based HIV testing, ART initiation, and retention in care. The research comprises two sequential hybrid type 1 effectiveness-implementation trials, including a cluster randomized trial for HIV testing and an individual-level randomized control trial for ART initiation. If successful, these interventions have the potential to influence global HIV testing, treatment, and adherence counseling guidelines and practices.

The TB and Men’s Health studies seeks to 1) identify men’s preferences for a male-centered TB care intervention, and 2) measure real-time influences of mental and tangible resources on men’s tb treatment lapses and adherence behaviours. Globally, men bear the burden and brunt of incident TB disease and poor TB outcomes. Men are also more likely to not seek or delay care, be lost from care, and die while engaged in TB treatment. In South Africa more than 62% of diagnosed TB cases are among men, and TB is the largest contributor to the differential life expectancy between men and women. However, to date, no interventions have targeted men or taken men’s needs and wants into consideration. These two innovative studies use mixed methods to engage both men and women to inform gender-responsive interventions to improve engagement and retention in care, ensure adherence to treatment and ultimately address the gendered inequities in the burden of TB.

The MISSED TB Outcomes Study (Multi-level and Intersectional Stigma and other Social Determinant Effects on TB Case Detection, Care, and Treatment Outcomes

It is well known that HIV-related stigma can have a major impact on the uptake of HIV testing, initiating and adhering to anti-retroviral therapy, and attaining and sustaining a suppressed viral load. However, significantly less is known about how stigma impacts the TB cascade. The MISSED TB Outcomes Study is the first multi-level, prospective study to look at how individual and intersecting stigmas at the community-, clinic-, household- and individual-levels influence progression along the entire TB cascade. Findings from this study will inform the development of stigma reduction interventions.

TB and Mental Health (The Effectiveness and Cost-Effectiveness of Implementing Evidence-Based Depression Treatment within the TB Care Platform in South Africa: A Hybrid Effectiveness-Implementation Trial

This study uses an implementation science approach to integrate mental health services into TB care in primary health clinics. Individuals with TB have more than a 3 times greater risk for major depressive disorder compared to those that do not have TB. Furthermore, those with co-morbid TB and major depressive disorder have nearly a 3 times greater risk of death and a nearly 9 times greater risk for being loss-to-follow-up compared to those that do not have co-morbid depression. This study is important because it is the first cluster randomized control trial to assess the effectiveness, implementation, and cost-effectiveness of integrating a brief evidence-based counselling intervention for major depressive disorder into South Africa’s TB care platform. Our goal is to improve individual- and health system-level outcomes.

TB Omni study

TB OMNI study, funded by the Foundation for Innovative New Diagnostics (FIND) aims to evaluate the predictive value of pooled individual oral swab specimens as a household-level triage test for TB during community-based household contact investigations using a portable GeneXpert device. As part of this study, we are collecting oral swabs from all household members, pooling them into a single house-hold test, and comparing the pooled result against individual sputum specimens. This study is important because it aims to evaluate a non-sputum specimen to improve the implementation, approach and cost-effectiveness of household contact investigations. Ultimately, we aim to improve active case finding approaches to help reduce the number of missed cases globally.

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