Faith- and Community-Led Community Posts in Zambia Close Gaps in Men by Expanding HIV Case Finding, Treatment and Viral Suppression Over 4 Years (2018-2022), in the Context of COVID-19

IntroductionHIV testing and treatment coverage among men in Zambia remains suboptimal, partly due to lower healthcare-seeking behavior compared to women. To address this gap, Circle of Hope (CoH), a local faith-based organization funded by the Presidents Emergency Plan for AIDS Relief (PEPFAR), developed the community post (CP) model. CPs are staffed by multi-disciplinary teams that provide HIV-testing, anti-retroviral therapy (ART), and viral load (VL) testing. This analysis assesses the impact of these CPs on HIV case finding, ART initiation, and VL suppression among men. MethodsRoutine program data reported to PEPFAR by CoH Zambia were analyzed for two periods: pre-COVID 19 (April 2018-March 2020) and during the pandemic (April 2020-March 2022). Indicators included the number of HIV tests conducted and positive results received (overall and for index testing specifically), ART initiation among men living with HIV (MLHIV), 12-month retention on ART, and the proportion of clients with VL suppression (<1000 copies/mL). ResultsBetween April 2018 and March 2022, the number of CPs expanded from 9 to 38 across Zambia. Despite the challenges posed by the COVID-19 pandemic, men continued to represent a substantial share of clients: 49.5% to 41.4% of those tested, 38.5% to 42.0% of those diagnosed (p<0.001), and 38.9% to 43.3% of those initiated on ART (p<0.001). The number of men on ART rose from 3,320 (38%) to 13,580 (43%, p<0.000001). Retention and VL suppression among men also remained high, increasing slightly from 94% to 97% and 95% to 96%, respectively. Over 6,000 men were diagnosed through index testing services, with percent positivity consistently high, ranging from 54.4% to 61.1% (p<0.001). ConclusionsThe CoH model was successful at identifying and linking MLHIV to HIV treatment services and assisting them to achieve and maintain viral suppression even during the COVID-19 pandemic. Expanding this community-based model may help close HIV testing and treatment gaps among men and advance HIV epidemic control in Zambia and beyond.