Retention and Access to Viral Load Testing Among Key Populations Living Infected with HIV In Community Care Center in Bamako, Mali

Background: In Mali, USAID and PEPFAR support the EpiC project to provide HIV prevention and treatment services to key populations.Retaining men who have sex with men in the continuum of HIV services is a major concern for the programs.The national NGO SOUTOURA, with technical assistance from FHI360, was implementing peer navigation and case management approaches to improve ART adherence and viral load suppression rates among MSM.Method: SOUTOURA provides the continuum of care for MSM through three community clinics.Community clinic staff trained in peer navigation and case management approaches provide support to Key population living with HIV through therapeutic education sessions, adherence assistance and self-support groups with a special focus on unstable clients.Standard operating procedures for monitoring ART adherence, retention, viral load testing, and achieving and maintaining suppression have been implemented.Aggregate retention and viral load data report is generated from KOLOCHI (DHIS2 e-tracker) disaggregated by population type and by age from October 2020 to September 2021.Result: During this period, the community clinics followed 400 MSM on ART, of which 33% (131/400) were young MSM (under 25 years) and 67% (269/400) were older MSM (25 years and older).The retention rate was 90% (360/400) between 10/2020 -09/2021.The retention rate was higher among young MSM at 95% than among MSM over 25 at 87% (p = 0.018).38% (137/400) of MSM were found eligible for viral load testing, of which 84% (115/137) were tested for viral load.77% (89/115) of MSM received their viral load result, of which 76 (85%) had a suppressed viral load result.The suppression rate was slightly higher in older MSM 98% than in younger MSM 75%.Conclusion: Although the implementation of a structured peer navigation and case management approach has improved retention rates, viral load suppression rates remain low among young MSM.MSM programs need to integrate the generational differences between younger and older MSM into their interventions to tailor service delivery to the needs of different groups.