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Gay, bisexual, and other men who have sex with men (GBMSM) living with HIV in rights-constrained settings need support for antiretroviral therapy (ART) adherence due to barriers including stigma. The Shikamana intervention combined modified Next Step Counseling by providers with support from trained peers to improve adherence among GBMSM living with HIV in Kenya. A randomized controlled trial with 6-month follow-up was used to determine feasibility, acceptability, safety, and initial intervention effects. Generalized estimating equations examined differences in self-reported adherence and virologic suppression. Sixty men enrolled, with 27 randomly assigned to the intervention and 33 to standard care. Retention did not differ by arm, and no adverse events occurred. Feedback on feasibility and acceptability was positive based on exit interviews. After adjustment for baseline viral suppression and confounding, the intervention group had a sixfold increased odds of viral suppression during follow-up. A larger trial of a scaled-up intervention is needed.

Original publication





AIDS and behavior

Publication Date





2206 - 2219


Departments of Medicine, Global Health, and Epidemiology, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA.


Humans, HIV Infections, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, Feasibility Studies, Homosexuality, Male, Peer Group, Adolescent, Adult, Middle Aged, Patient Acceptance of Health Care, Kenya, Female, Male, Medication Adherence, Young Adult, Sexual and Gender Minorities, Outcome Assessment, Health Care