Project Summary
There is a critical need for heterosexual men in Sub-Saharan Africa (SSA) to receive HIV care, including
antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP), following an HIV self-test (HIVST).
Heterosexual men in SSA are routinely shown to be at a high risk for HIV acquisition, but test at lower rates
than women and experience inadequate linkages to HIV care following a self-test, regardless of the test
result. Tanzania’s Sauti Project was launched in 2015 by the Tanzania Ministry of Health (MoH) and included
the piloting of HIVST and community-based PrEP and ART administration for women, female sex workers,
and men who have sex with men. However, heterosexual men were not included in this study, despite their
high risk. Based on feedback from men that peer-based navigation and community-based linkage to care
services are preferrable to facility-based HIV care, the STEP+cbNIMART intervention was developed. There
are three aims to this study. Aim 1.) Tailor the STEP+cbNIMART intervention for heterosexual male self-
testers. In Aim 1, the intervention will be further tailored to men through a “theater test” and feedback from
key stakeholders and topical experts, and later utilized for training Community Based Health Service
Providers (CBHSPs) who will help deliver the intervention. Aim 2.) Test the effectiveness of the
STEP+cbNIMART intervention on ART or PrEP initiation and retention for male self-testers. We will
conduct a cRCT using a hybrid type I implementation-effectiveness study design to assess the effectiveness
of the intervention. The cRCT will include an intervention and control arm, with intervention participants
receiving nurse-led community-based ART and PrEP initiation, and control arm participants receiving the
standard of care. ART and PrEP adherence will be measured through a baseline survey and subsequent
follow-ups of participants in both arms. Aim 3.) Evaluate the facilitators and barriers of implementing the
intervention to refine the intervention for adoption in other settings. We will use a qualitative approach
to explore facilitators and barriers affecting nurses’ and CBHSPs’ abilities to implement the intervention and
men’s abilities to participate in the intervention and refinements that are needed to make the intervention as
successful as possible.
