WHAT WAS THE PROBLEM?
Data from UNAIDS and PEPFAR programs around the world shows that we are not adequately reaching at-risk men, particularly those ages 24-35 years, with HIV treatment services. This is endangering men’s own health and helping fuel the spread of HIV among adolescent girls and young women. Among people living with HIV aged 15 years and older globally, knowledge of HIV status, treatment coverage and viral suppression in 2018 was considerably lower for men than women. Epidemic control will not be achieved without addressing this gap and reaching men with HIV services.
WHAT IS THE SOLUTION?
The MenStar Coalition, launched in 2018 at the International AIDS Society Conference in Amsterdam, is a global public-private partnership that includes PEPFAR, the Elton John AIDS Foundation, Unitaid, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Children’s Investment Fund Foundation, Johnson & Johnson, and Gilead Sciences.
The partnership is divided into demand creation versus supply. The private sector is helping create demand for HIV services among young men, whereas PEPFAR (alongside other partners) is supporting the supply side with resources from COP funds dedicated towards testing, treatment, and retention.
The partnership brings together the HIV service delivery capacities of the public sector with the consumer-oriented marketing acumen of the private sector to optimize efforts to reach men with HIV testing and treatment services. It’s an innovative way of doing business to reach men where they are, with the services they need. It utilizes a new client-centric approach of leveraging human centered design (HCD) to listen to clients (identify insights and underlying barriers) and adapt HIV treatment services to meet their needs. Powered by these insights, the partnership has developed and refined innovative demand creation and supply side strategies to engage men and differentiate treatment services for them.
To illustrate, in South Africa, the MINA brand was developed to help motivate and encourage men living with HIV (MLHIV) to get back onto or stay on treatment by reconstructing their relationship with healthcare and destigmatizing HIV. This targeted, insights-based, and researched brand speaks directly to men via social media channels and program support tools. Similarly, in South Africa, Daplabmeds was developed as a rebrand of the government’s Centralized Chronic Medicines Dispensing and Distribution (CCMDD) program to create awareness and improve usage of the quick and convenient alternative pickup points available to collect medications outside of healthcare facilities. In Mozambique, to address low ART coverage of MLHIV, the MenStar approach is being leveraged to implement a campaign to increase adherence of men at high risk for disengagement from care, and to reduce HIV stigma by rebranding ART for men as a solution to maintaining a normal life rather than a barrier to it.
HOW DOES IT WORK
MenStar is focused on reaching men where they are through a client-centered approach. It begins by understanding the emotional and health system needs of men, and then calls for an adaptation of HIV service delivery to meet those needs. Men have different needs at different points of the HIV cascade (e.g., undiagnosed, newly on treatment, disengaged from care, etc.) The partnership is re-envisioning men’s relationship with healthcare by developing insight-driven, innovative programs to improve healthcare for men at each stage of the HIV cascade.
These innovative programs are guided by a global MenStar Strategy and Core Package of services, designed to ensure that all our programming addresses the insights gleaned from speaking to thousands of men. Specifically, the partnership is developing a rebranding campaign to communicate with men in a way that demonstrates an understanding of their needs. Country programs are using the insights to adapt and design their programs in a client-centric way that directly address barriers for men to access HIV services.
The partnership is divided into demand creation versus supply. The private sector is helping create demand for services among young men by utilizing data analytics to prioritize areas of greatest need and employing a consumer marketing approach to demand creation, including insights collection, segmented messages, and a communication campaign strategy. PEPFAR is supporting the supply side with resources from COP funds dedicated towards testing, treatment, and retention. Specifically, PEPFAR is working to optimize testing to reach men where they are, implementing facility-based changes to make service delivery more male friendly, helping to decongest facilities by offering convenient pick-up points for drugs for stable patients, and accelerating use of best-in-class new drug regimens to increase adherence.
Client-Centered Cascade / Patient Journey
How do we reach men? Core Package of Services
WHAT WAS THE IMPACT?
The goal of MenStar is to reach an additional one million men with HIV treatment services and achieve 90% viral suppression among men to effectively interrupt HIV transmission.
This is being achieved through multiple approaches: quantitative and qualitative research to better understand and adapt services to men’s needs; targeted demand-creation using consumer marketing approaches; innovations such as HIV self-testing; and improvements to the service delivery experience.
Since baseline of 2018 Q4, we have added 2,194,202 new men 15+ years onto treatment (TX_NEW) in our 21 highest burden countries
We have retained 1,187,386 men on treatment (TX_NET_NEW) between baseline of 2018 Q4 and 2021 Q2 (TX_CURR).
Viral Suppression (TX_PVLS) among males 15+ years increased from 88% in 2018, to 90% in 2019, achieving the stated MenStar goal, and then 93% in 2020 and 94% in 2021 YTD, surpassing the goal.
In South Africa, TX_CURR increased by 3.1% from 2020 Q2 to 2021 Q2 in males 15+ years
*Data is from the following OUs: South Africa, Tanzania, Mozambique, Zambia, Uganda, Nigeria, Kenya, Zimbabwe, Malawi, Cote d'Ivoire, Democratic Republic of the Congo, Ethiopia, Lesotho, Cameroon, Eswatini, Namibia, Botswana, South Sudan, Rwanda, Burundi, and Angola.
MANAGEMENT AND OVERSIGHT
PEPFAR TEAM INVOLVEMENT
All country programs were asked to take a client centered approach by adapting programs to address the insights generated by the MenStar Coalition to increase access to HIV services for men. Specifically, MenStar guidance was created to help PEPFAR country teams with the development, coordination, and implementation of the MenStar approach during the annual Country Operational Planning (COP) process. To successfully develop the partnership, PEPFAR country teams were asked to: help identify countries that could benefit from additional investment/innovation by reviewing quarterly performance (including trend data) at the IP and site level to identify areas where targets for finding and reaching men are not being met, with a focus on where the proportion of men to women age 15+ is particularly low; identify existing successful solutions and implementing partners working on finding and reaching men that could be taken to scale; identify urban clinics where improve service delivery can be improved by offering welcoming, male-friendly services at clinics; understand the potential level of investment country teams can make on finding and reaching men to meet planned targets for COP; and review COP plans to ensure country programming addresses key insights/findings from qualitative and quantitative research developed by MenStar private sector partners.
MONITORING
PEPFAR Monitoring, Evaluation, and Reporting (MER) indicators are used to track progress towards coverage goals, help identify and prioritize geographies, and identify opportunities for course-correction, as needed. The following quarterly and annual program data is collected: HTS_TST, TST_POS, TX_NEW, TX_CURR, TX_PLVS, TX_ML, TX_RTT.
To remain true to MenStar’s goal, using TX_CURR is the most reasonable proxy for measuring success.
Resources & Tools
MenStar Coalition Website (External)
http://www.menstarcoalition.org
MenStar Repository of Resources (Internal to USG)
https://pepfar.sharepoint.com/sites/MenStar
MenStar Strategy
Summarizes the insights, archetypes of men across the clinical cascade, core package of services, and overall strategy for MenStar.
https://menstarcoalition.org/strategy
MenStar Operational Guidance
Provides a step-by-step process to help country teams operationalize this new way of finding and reaching men, while also providing sample resources, toolkits, and country examples.
https://pepfar.sharepoint.com/:b:/s/MenStar/EfMBjtvCf19DrrnazWNQ73YBZYXNwoclMdXpjLb8REhvIg?e=BoiMOb
MenStar Compendium of Program Examples
Showcases innovative solutions being implemented currently by PEPFAR OUs
https://pepfar.sharepoint.com/:p:/s/MenStar/EXJscVYBGo9NppxqrgNjGC8B-2a8LSNnA7X6toQyo96q-Q?e=jO30z0