Yaba Guy Che (For the men): Implementation and evaluation of a co-developed multi-disease intervention for men to overcome health systems barriers

RESEARCH: Can a community-based digitally supported care pathway, integrated into the existing primary health system in Zambia, improve the coverage of HIV, sexually transmitted infections (STIs) and non-communicable disease (NCD) services among men. BACKGROUND: Men are less likely than women to attend primary health services in much of Africa. This has led to men falling behind women on coverage of HIV testing and treatment services and in achieving HIV viral load suppression. This inequity in access presents a threat not only to men’s health but also to the continued success of HIV programmes due to ongoing HIV transmission. Furthermore, NCDs and STIs are increasing in countries like Zambia yet there are few screening and prevention services offered and opportunities to access them are particularly limited for men. AIMS AND OBJECTIVES: AIM: To demonstrate delivery of an integrated and co-designed system of providing equitable HIV/STI/TB and NCD preventative and care services for men using a model of strengthened community and primary health systems in a high HIV burden urban community through an international collaboration between researchers, policymakers, and the community. OBJECTIVES: 1. Co-develop an integrated, digitally supported care pathway (“Yaba Guy Che”) with men, community members, healthcare workers and policy-makers. 2. Deliver the Yaba Guy Che intervention and assess adoption, reach, fidelity, sustainability and scalability. 3. Create a men’s peer monitoring group to strengthen community health system accountability and document how men experience the Yaba Guy Che intervention. 4. Estimate the plausible impact of the Yaba Guy Che intervention on coverage of HIV and NCD services. 5. Measure the effect of the intervention across the six building blocks of the health system and assess the cost and economies of scope of implementing Yaba Guy Che to inform scalability and sustainability. METHODS: This project will start by combining learning from two previous formative research grants to co-develop the integrated and digitally supported pathway for men’s health care. The co-designed intervention will then be implemented and we will use the updated Consolidated Framework for Implementation Research to evaluate this innovation based on its reach and fidelity, using quantitative and qualitative data collection. We will assess the interaction between the intervention and the existing health system to understand where the intervention strengthens the whole system but also the ways in which the system affects implementation fidelity and men’s interaction with the services. We will incorporate community-led monitoring and research into the evaluation. Using a before-after design, we will estimate the impact of the intervention using time-location sampling surveys to measure population-level coverage. Costs and an analysis of economies of scope will be measured. TIMELINES FOR DELIVERY: The project will be delivered over 5 years. In the first 24 months, we will co-develop the intervention and conduct baseline evaluations. The intervention will be implemented for 24 months, followed by an endline survey. ANTICIPATED IMPACT AND DISSEMINATION: While results will be disseminated through traditional research channels, we anticipate a potential policy-changing impact due to engagement of community, national and international stakeholders. The digitally supported pathway has the potential for wide adoption across the region.