Viral Suppression among Men Who Have Sex with Men Living with HIV Who Were on Risk Reduction Interventions and Control Group in Mvita Sub-County, Mombasa County, Kenya

Abstract

Globally, men who have sex with men (MSM) are more vulnerable to HIV as compared to men in the general population. However, if commenced promptly on ART and adherence to treatment is observed their viral load can be suppressed hence unable to transmit the virus to their partner. The aim of this study was to determine the effectiveness of the risk reduction interventions on viral load suppression levels among men who have sex with men (MSM) living with HIV versus those in the control group in Mvita sub-County, Mombasa County, Kenya between December 2020 and June 2021. A quasi-experimental study design using quantitative methods was adopted and the study population was the MSM residing in Mvita sub-County in Mombasa County. Inclusion criteria were, being biological male-sex assigned at birth, 18 years and above, had anal sex with at least one male partner in the past 3 months, a resident of Mvita sub-County, and willingness to give informed consent in writing. Exclusion criteria were those who declined to give consent or were intoxicated with alcohol or drugs. The respondent-driven sampling (RDS), a semi-probabilistic method, in the absence of a sampling frame was used to obtain the sample of respondents. A total of 114 HIV positive MSM participated in the study. Half (57) of MSM living with HIV were actively followed and risk reduction interventions (adherence to ARVs, general counseling and nutritional care), and HIV prevention measures (prompt treatment of STI/OI and condom use) were offered after every 2 months for six months. The control group (57) received no risk reduction interventions. Semi-structured questionnaire and laboratory investigations were employed to collect data. Log-binomial univariate and the multivariate regression analysis model were used to identify the variables which were associated with undetectable viral load. Undetectable viral load was defined as having an HIV viral load of less than 50 copies/ml. Data collected was cleaned, coded and analysed using STATA software, Version 17. Level of significance was fixed at 5%. Ethical approval was received from the relevant bodies. Majority of MSM were between ages 19 to 29 (54%), were single (77%), were Christian (61%), never married to a female (39%) and had an income of <5,000 ksh (65%). MSM in the control group, who reported ever use of PEP/PrEP (44%), were likely to have detectable viral load while MSM who received interventions, who reported condom break more than once during anal sex (61%), who had more than one regular anal sex partners (61% both groups), and who drunk more than 2 bottles of beer (33% both groups) were likely to have undetectable viral load. MSM in the control group who reported being always high on alcohol during anal sex (19%), were likely to have detectable viral load. MSM who received interventions and reported feeling uneasy while seeking health services (75%) had detectable viral load while those in the control group who attended private clinics (42%), had undetectable viral load. Overall, after six months, the proportion of MSM achieving viral load suppression was significantly higher in the intervention group as compared to control group by 60% (95% CI= 49‒70, p < 0.001). In conclusion, MSM in the control group had low knowledge of HIV prevention hence detectable viral load. However, high risk behaviours such as condom break were associated with undetectable viral load in the group that received risk reduction interventions. MSM in the control group who were attended in private clinics received better HIV care, thus had undetectable viral load. MSM who received risk reduction intervention had better treatment outcome with many MSM achieving undetectable viral load. From the study it is recommended that peer-led HIV services to be integrated in all HIV programmes targeting MSM, effective substance use intervention program be re-designed to rehabilitate the MSM on alcohol and drugs, improvement on HIV care in public health facilities and risk reduction interventions to be offered to all MSM.