A Community-Based Peer-Support Intervention to Improve Men’s Linkage to and Early Retention in HIV Treatment
The loneliest day in a man’s life might be the day he finds out he has HIV. Coach Mpilo offers men an empathetic, resourceful peer—another man living openly and confidently with HIV—to help him overcome his barriers.
Description/Activities: Coach Mpilo reframes the HIV counsellor or case manager as a coach and mentor who provides ongoing guidance and support, borne out of personal experience living with HIV, from the point of diagnosis to the point of viral suppression and treatment stability.
Some men are referred to Coaches by clinics and community HIV testing sites. Others proactively contact a coach in response to posters in the community. Coaches relieve pressure on clinic staff, who can refer challenging cases to someone who is better positioned to provide personalized support.
Both Coaches and Super Coaches are trained on a customized curriculum that focuses on interpersonal communication, mentorship, establishing and maintaining trust, building coping skills, and supporting problem-solving. The curriculum draws on accredited HIV counseling and testing content, the BEST relationships model, and the GROW problem-solving model.
What Makes the Intervention Unique/Different:
Coach Mpilo is a high-impact, cost-effective, rapid-response model for male-friendly services—coaches can be recruited in any community, trained in one week, paid a modest salary, and quickly deployed. Coaches have been very effective in linking or returning men to care and helps them to become stable on treatment.
Coaches are living proof that a man with HIV can thrive on treatment, which provides reassurance to the men they are coaching but also serves to reduce stigma at family and community level.
Coaches help men to understand the importance of staying on treatment and also support them with disclosure to family and friends.
Guidance on adherence focuses on the power of “Undetectable = Untransmitable” (“U=U”), that once a man suppresses HIV in his body, it can’t be detected and it can’t be passed onto anyone else. As long as he takes his pill every day, he hardly has to think about HIV at all. HIV treatment is his tool for beating HIV, feeling good about himself again, and getting back to his normal life.
Support for disclosure follows several principles:
- The coach primarily focuses on the benefits of disclosure to the man, rather than pressure or obligation to disclose.
- The coach acknowledges that disclosure can be scary, rather than shaming or disregarding a man’s fears.
- The coach helps him feel that his privacy will be respected, and he will remain in control of how disclosure will happen.
- The coach draws on his own experience with disclosure, showing the man by example that it can free him from the weight of carrying a secret.
- The coach illustrates in his own life that while it may be difficult to face one’s partner, most relationships do survive disclosure and can even become stronger, and that even in cases where they do not, the man is able to make a new start and have the life he wants.
- The coach offers multiple options for disclosure support. He can help the man make a plan for how to tell his partner, even role-playing the conversation. He can help the man bring his partner for couples testing. He can accompany the man while he tells his partner.
- When accompanying the man, a Coach’s mere presence as a living picture of good health, helps the partner and family to understand that HIV can be managed and there is nothing to fear.
Impact Data: This intervention is in pilot stage, being implemented and evaluated in three districts with 120 coaches and 2400 men. Preliminary data indicate that more than 90% of men are linked or returned to care within the first month of support and remain on treatment thereafter. Final pilot data will be available in late 2020.