As young women continue to bear the brunt of new HIV infections, it can’t be business as usual when it comes to HIV prevention.
This is the thinking behind the University of KwaZulu-Natal’s Africa Centre for Population Health research which is seeking to incentivise men for testing and initiation on to antiretroviral treatment (ART).
The intervention study is aimed at reducing high rates of HIV-related deaths among men and in turn, reducing the high levels of new HIV infections in young women.
Heading the cutting-edge study, is founding member Professor Frank Tanser as well as Professor Till Bärnighausen of the Harvard TH Chan School of Public Health.
The study has recently been awarded a prestigious five-year multimillion-rand National Institutes of Health grant.
“The solution to both of these seemingly intractable problems is to encourage more men into HIV care and on to antiretroviral therapy.
“By getting men on to treatment earlier, this will reduce HIV viral loads, thereby reducing HIV transmission, especially to the vulnerable group of young women in these areas,” said Bärnighausen.
He said the study came about because of the low uptake of antiretroviral treatment by men in the rural community of Mtubatuba, in northern KwaZulu-Natal where the Africa Centre is based.
This, despite ART being highly successful and easily accessible through government health facilities.
Tanser said HIV researchers had tried lots of different things to get men into care.
“This is not business as usual, we need to do something different and there is evidence from other fields that small financial incentives work,” said Tanser.
Higher levels of HIV viral suppression among men would prevent HIV transmissions to women.
Over the 16 years since the Africa Centre was established, they had observed that women benefited much more from the scale-up of antiretroviral therapy than men.
“Women often get tested as part of antenatal care and generally health care services are often perceived by men as being female-centred.
“Worldwide, it is difficult to get men to take treatment of any sort,” said Tanser.
As part of the recruitment phase of the research, there would be the provision of potentially two “one-off, small financial incentives”.
The first incentive would be given to participants who took a rapid test at home. Those testing HIV positive would then be given a second financial incentive if they linked successfully to the HIV care programme at one of the local clinics.
Tanser said the amount would be determined in a pilot phase but it was likely to be “quite small, less than R100”.
Over the next five years, the researchers would then compare HIV-related mortality in men and the level of new HIV infection in young women in communities which received and those which didn’t receive the incentives.
“The key message here, is that we sit at a pivotal moment in HIV prevention.
“Mathematical models have shown that if we continue doing what we have been doing, we are not likely to have a major impact on the unacceptably high level of new infections – particularly in young women,” said Tanser.
The study and the grant funding came at a great time, given the news that the South African government would roll out ART to everyone who tested positive for HIV, regardless of their CD4 count.
The professors said this study was an opportunity to intervene in the most vulnerable groups, made possible by the grant which they believed was recognition that the Africa Centre had the potential to find solutions to the most pressing problems in HIV today.