MOBILE MEN

The challenge

In most sub-Saharan African countries, heterosexual men have generally not been considered a high-priority population for HIV prevention. However, there is growing interest in targeting such men, particularly those who migrate for work, such as truck drivers, farm workers and, in countries such as Uganda, fishermen. The prevalence of HIV is typically high in these populations and shows little sign of declining. 

Mobile men could benefit from new HIV prevention options, such as long-acting cabotegravir (CAB-LA), an injectable antiretroviral providing protection for two months; or oral on-demand pre-exposure prophylaxis (PrEP), which means using oral antiretrovirals in advance of a sexual encounter. On-demand PrEP gives people control over medication use but requires men to carry a supply of drugs with them. CAB-LA removes this need but requires that men attend health facilities every two months for a CAB injection. 

Little is known about the preferences of mobile men for these options, or how feasible it would be to deliver CAB-LA or on-demand PrEP services to them.

The project

The MOBILE MEN project is gathering background information on mobile populations, exploring their mobility patterns, knowledge, attitudes and current HIV prevention practices, and the existing national policies for HIV prevention in this group.

The project will also carry out a trial, in which 400 mobile men from South Africa or Uganda will be provided with either CAB-LA or a choice of daily or on-demand PrEP (at the end of the trial, they will be able to choose which intervention they would like to continue with). The study will assess the success of the two approaches at retention in care during a 9-month follow-up, as well as the number of unprotected sexual encounters covered by PrEP. It will also explore the perceptions of participants and barriers to uptake. 

Health system factors affecting access or uptake will also be explored, alongside healthcare worker perceptions and a cost-effectiveness analysis. Materials will be created to support the effective implementation of mobile men-focused HIV prevention services.

Impact

The MOBILE MEN project will provide much-needed evidence on the HIV prevention option preferred by mobile men, and on factors associated with successful implementation and take-up. It will:

• Provide key insights into the preferences and use of different prevention methods, helping to shape national policy and the options made available to mobile men.
• Provide a better understanding of issues affecting implementation and take-up, to inform the planning of service introduction.
• Ensure that HIV prevention programmes reflect mobile men’s needs and preferences, and are compatible with healthcare systems, increasing the likelihood that they are successful. 

Successful implementation of on-demand PrEP or CAB-LA-based HIV prevention programmes for mobile men would help to reduce the burden of HIV in this currently overlooked population and those with whom they interact.