Interventions to improve men’s engagement in HIV and other key services in sub-Saharan Africa: a scoping review

Background Men in sub-Saharan Africa (SSA) continue to have worse health outcomes across HIV, STI, and TB-HIV co-infections as compared to women. Improving service coverage is critical for population health and HIV epidemic control. In HIV, for example, recent models show that improving men’s HIV testing and treatment coverage could reduce HIV incidence among women in the region by half. There is potential to combine and optimize services across HIV, STI and TB-HIV co-infections, yet little is known about effective interventions to improve men’s outcomes across health services. Methods We conducted a scoping review of interventions to understand what interventions work for men, and any synergies in interventions that work across health services. We specifically focused on interventions aimed to improve service utilization in the following service domains: condom use; pre-exposure prophylaxis (PrEP); STI testing and treatment; HIV testing, initiation, and retention; and TB testing and treatment among those living with HIV (co-infected). Articles and abstracts had to include sex-disaggregated data or solely focus on men’s health service outcomes. We searched PubMed, Medline, Cochrane Central Register of Controlled Trials, the CABI Global Health databases, and major international conference abstracts. We included studies from SSA, published between January 1, 2009 to Dec 31, 2022, quantitative data on at least one of the selected service domains, disaggregated data for the general male population (not solely key populations), an intervention study (report outcomes for at least one non-standard service delivery strategy) with a comparison group, and available in English. We describe the type of interventions evaluated and synthesize overarching themes of “what works” for reaching men. Findings We identified 15,595 intervention articles and included 71 in the scoping review, representing 111 unique interventions. Over a quarter of interventions targeted male partners and only 7 exclusively targeted men. Nearly half of the interventions had HIV testing as their primary outcome. Only a handful of interventions included outcomes related to condom use, STI, or TB co-infection services. No interventions examined the effect of PrEP use among general male populations. Community services was the most common intervention type (n=40, 36%), followed by community outreach (n=19; 17%), incentives (n=16; 14%) and facility services (n=16, 14%). Counseling and peer support had the least number of interventions evaluated (n=8, 7%). We were unable to identify cross-cutting strategies to reach men across HIV and related health services in sub-Saharan Africa, largely because there is little evidence outside HIV testing interventions. The limited evidence available points to the fact that men need convenient, active outreach, and improved experiences with health services. The same principles may apply to all services intended to reach men, including sexual health and TB co-infection services, although the evidence is limited. Conclusion This review highlights the need for additional research on cross-cutting strategies to improve men’s engagement in HIV and related health services. The limited evidence available suggests that convenient services, actively engaging men, and providing positive experiences with health services largely improve service utilization. Additional evidence is needed for PrEP use and non-HIV services (such as STI and TB co-infection). ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This scoping review presents and summarizes publicly available data. No new human data was collected for this scoping review. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data presented in this scoping review are publicly available from their original sources.