| New themes |
| How treatment contributes to men’s goals |
We work with men to frame their possible future goals based on their health. Prior to this, men argued that ART engagement competed with business and agriculture priorities. We discuss how HIV services contribute to their key goals. We employ motivational interviewing skills to discussing ART as an integral component to achieve goals. |
| Feeling healthy on treatment and low ART knowledge |
We explicitly acknowledge challenges of taking ART when feeling healthy, and ask men to reflect on their own experience. We discuss how taking ART while healthy will prevent disruption of earning prospects and support strong business and better families, using local analogies and graphics that resonate with Malawian men. |
| Navigating health system |
We discuss barriers men have experienced when seeking health services at facilities and discuss how to overcome them, and notably, to report poor services. We address the pre-existing discord between HCWs and men. |
| Self-compassion/patience for lifelong treatment |
We normalize the fact that men may forget a dose, feel guilty and panic. We highlight the importance of returning to care as soon as possible. We discuss alcohol use and fears about long-term treatment adherence. We acknowledge individual concerns about competing responsibilities, fear of disclosure, and treatment fatigue, and stress that such fears are normal. |
| Modified Themes |
| Status disclosure to male friends/family |
Beyond disclosure to their sexual partners, we highlight the importance of disclosing to their male social support system. We discuss who is important to them, how to disclose to other men, and how to get social support for ART disclosure. |
| Treatment as prevention |
In addition to the general treatment as prevention message, we provide a detailed description about how treatment as prevention works, men’s role in preventing vertical transmission, and how these concepts contribute to men’s role as provider and building a stronger future. |
| Understanding ART (Side effects) |
MOH counselling simply describes potential side effects and tells clients to report to clinic if they persist. We focus on the changes in ART regimen including that the new dolutegravir regimen has fewer side effects than the older regimens. |
