Core components of male-specific person-centred HIV care: a qualitative analysis from client and healthcare worker perspectives in Malawi.

Introduction: Person-centred care (PCC) improves clinical outcomes for people living with HIV. Heterosexual men in sub-Saharan Africa are under-represented in HIV care, yet PCC interventions for men are lacking. We identified core components of a PCC intervention for men living with HIV (MLHIV) in Malawi from both client and healthcare worker (HCW) perspectives, as well as strategies for implementation in routine settings. Methods: MLHIV≥15 years and not in care were enrolled in parent randomised trials to test the impact of male-tailored HIV services on 6-month treatment outcomes (n=1303). Clients received a PCC package including male-specific counselling+facility ART distribution or outside-facility ART distribution. 50 male clients were recruited for qualitative in-depth interviews using stratified random sampling to assess perceptions of the PCC packages. Focus group discussions were conducted with HCWs who delivered the intervention to understand implementation strategies and potential considerations for scale-up in routine settings. Interviews were audio recorded, translated into English, transcribed and coded in Atlas.ti V.9 and analysed using thematic analysis. Results: 36 MLHIV and 20 HCWs (10 lay cadre and 10 nurses) were interviewed between February and July 2022. Positive interactions with HCWs-characterised by kindness, reciprocity, privacy and focused conversations-and compelling, relevant counselling were considered the most important components of male PCC. While outside-facility ART dispensing was considered helpful, it was not as critical as these other components. HCWs outlined five steps to implementing male PCC: begin with kindness, apologise for past negative interactions, understand men's holistic story, provide tailored counselling and support development of strategies for adherence. HCWs believed that male PCC enhanced their ability to support male clients but emphasised the need to be integrated into routine services. Discussion: PCC strategies that foster positive HCW relationships and addresses men's unique experiences are highly valued by MLHIV. HCWs identified several strategies for delivering PCC to MLHIV that may help close gaps in HIV care for men. Trial registration numbers: NCT04858243; NCT05137210.