Despite major progress over the last three decades, HIV/AIDS remains a major health problem in Sub-Saharan Africa. According to The Joint United Nations Programme on HIV and AIDS (UNAIDS), of the 35 million people living with HIV in the world, 19 million do not know their HIV status. HIV testing and counseling (HTC) continues to be a vital first step so people who test positive are linked to treatment and care, and those who need antiretroviral therapy (ART) are successfully placed on treatment to achieve viral suppression.
Data from a recent UNAIDS gap report identified Kenya, in addition to Uganda and Mozambique, as having the fourth-largest HIV epidemic in the world in terms of the number of people living with HIV. In response, Kenya, for instance, has adopted a number of strategies around HIV testing and counseling. Still, there are many barriers to HIV testing, engagement in care and adherence to ART which include stigma, privacy issues, distance to the clinic, long wait times and lack of community involvement.
Jeff Korte, Ph.D., an associate professor in the MUSC Department of Public Health Sciences is tackling these issues with a yearlong pilot grant from the Center for Global Health. Korte’s research project builds on the growing body of evidence that demonstrates sports-based HIV prevention programs often have positive effects on HIV-related knowledge, stigma, self-efficacy and risk behaviors. Korte developed a collaborative partnership with one such program in Kenya – Vijana Amani Pamoja (VAP) – a non-profit HIV prevention organization that organizes football (what would be soccer in the U.S.) tournaments in low-income areas around Nairobi and offers free HIV testing and counseling for attendees. The incentive for testing at these “Kick ‘N’ Test” events is players and members of the community can earn extra points for their teams by getting screened for HIV. In the event of a game ending in a tie, these extra points would play a significant role in determining the winning team.
“These tournaments provide a unique opportunity to understand risk behaviors and perceptions of testing in a high-risk population,” said Korte. “We expect that we will be able to collect preliminary data from hundreds of people participating in or attending the football tournaments.”
Korte and his colleagues will administer surveys to players, coaches and spectators, ages 14 years and older, at four different football tournaments, organized by VAP, in low-income neighborhoods around Nairobi. The survey will allow the research team to assess perspectives of the attendees on attitudes and perceptions about HIV testing, risk behaviors and access and linkage to care among people living with HIV.
The study will be instrumental in helping design future studies among key at-risk populations in Kenya and also create effective strategies to improve uptake and quality of HIV testing, as well as linkage to care and retention on ART for those testing positive. One innovation that has the potential for breaking down barriers to testing is the use of HIV self-testing kits, but more research is needed to ascertain the likelihood of acceptance and uptake of self-testing in different populations. This study will specifically explore the feasibility of self-testing, as well as innovative strategies for increasing adherence and retention in HIV care.
MUSC team members contributing to the study include Danielle Stevens and Caroline Vrana, epidemiology graduate students in the Department of Public Health Sciences.