Factors associated with clinic escorts in peer-led HIV prevention interventions for men who have sex with men (MSM) in Sri Lanka

BACKGROUND Sri Lanka has recently completed an HIV prevention project for most-at-risk populations (MARP) under the Global Fund. The intervention includes delivery of a HIV prevention package (HPP) to men who have sex with men (MSM) that includes provision of: (1) knowledge about sexually transmitted infections (STI); (2) HIV knowledge; (3) MSM-tailored leaflets; (4) condom/dildo demonstration; (5) provision of condoms; and (6) clinic escorts. MSM who received services 1-5 in the HPP are defined as 'reached'. The final step is to escort the reached MSM to an STI clinic, and they are then defined as 'escorted'. This HPP was delivered to MSM through peer educators (PE) scattered in four highly populated districts in the country. Each PE has contact with another 15 peers forming a peer group (PG). However, in this model, a significant number of MSM do not take up the escorting step of the HPP. Therefore, the purpose of this paper is to analyse the factors associated with clinic escorts among MSM peers in the HIV prevention project. METHODS All the MSM peers (699 MSM) registered and retained during the project period had been reached in 2013, 2014 and 2015 and were chosen from the web-based Monitoring and Evaluation information management system (MEIMS) for analysis. The sample was divided in to two groups based on escort status (escorted peers vs non-escorted peers). Variables were compared between the two groups for the hypothesis of difference to identify significant factors associated with clinic escorts. RESULTS The study sample (699 MSM) represented four districts: Galle (37%), Colombo (35%), Gampaha (14%) and Kalutara (14%). Escort status depended on the district (P<0.001), age group of MSM (P=0.008), level of education (P=0.007) and urban/rural status (P<0.001), duration of MSM behaviour (P=0.018), experience of an HIV test during previous 12 months (P=0.050), and recent receptive anal sex (P=0.050). CONCLUSIONS Older MSM (>25 years), MSM living in urban and semi-urban areas, Nachchi MSM (effeminate males), MSM with receptive behaviours as well as less-educated MSM were less likely to be escorted and needed some extra effort to improve escort rate among MSM. In addition, performance of PEs, field supervisors and coordinators was observed to be a major factor in improving escort rate.