Mbili Pamoja Dissemination Report held on 22^nd July 2025

Facilitator-Felix Ochieng

Note taker-Patriciah Wambua

Venue-Anza Mapema

Date-22^nd July 2025

Description of attendees

We reached out to a total of 200 participants, and 171 were able to attend the dissemination meeting. Mobilization was carried out through peer educators who played a key role in spreading the word. Additionally, participants were informed about the upcoming dissemination during routine weekly activities at AM, including Movie Mondays, Coffee Wednesdays, Group Therapy Thursdays, and the Sunday church service. A message was also drafted and shared with participants, which read:

Dear Sir,

This is to inform you that the Mbili Pamoja Study dissemination meeting is scheduled for Tuesday, 22nd July 2025. The meeting will be held at Anza Mapema from 2:00 PM to 4:00 PM. Your attendance at this important activity will be highly appreciated.

Thank you for your time. We look forward to seeing you.

Sincerely,
Felix
Study Coordinator, Mbili Pamoja – AM

The message above was sent to all study participants since we had their phone contacts. Of the 171 individuals who attended the dissemination meeting, 151 were study participants of which some are peer educators. The remaining 20 were program participants who were informed through weekly activities and decided to attend.

Dissemination Report

The dissemination session began with a warm welcome and a brief round of introductions from the team representing AM. Afterward, a prayer was led to open the meeting. The facilitator (study coordinator) then introduced the study title and the principal investigators, and took time to remind participants about the Mbili Pamoja Project. He explained the nature and aims of the study, emphasizing that it was a prospective cohort study that followed 500-(250 in Kisumu and 250 in Nairobi) men who have sex with men (MSM) over a period of 12 months. The aim was to examine how bacteria in the penis and rectum relate to common sexually transmitted infections (STIs) like chlamydia and gonorrhoea, and to study how these infections impact the immune system over time.

The objectives of the study were outlined, including characterizing the penile and rectal microbiome at three key points: at the time of detection of STIs, during treatment, and after treatment. The study also aimed to identify dominant mucosal immune profiles and assess how they change in relation to the microbiome and infection. Again, it sought to uncover adaptive immune mechanisms that connect the microbiome, STI infection, and host immunity.

The facilitator clarified to participants why not everyone had been enrolled in the study. He simplified the inclusion and exclusion criteria to enhance understanding. Emphasis was placed on the importance of dissemination, not just as a procedural requirement, but as a vital part of accountability and transparency to the community. Participants were reminded that this step allowed for sharing of results, encouraged knowledge transfer, and helped build trust with the people who made the research possible. It was also noted that findings from such research contribute to shaping health policies and guide future studies. One example shared was the anticipated rollout of injectable PrEP, which is informed by ongoing research evidence. Dissemination was further described as a way for participants to share what they learn with peers, families, and broader networks.

The concept of good and harmful bacteria was introduced, with an explanation of why some STIs can remain undetected due to lack of symptoms. The facilitator asked participants to mention STI symptoms they were familiar with. The group responded with signs such as anal or penile itching, painful urination, blisters, swollen testicles, and different types of discharge. The importance of responding promptly to clinic calls for treatment was highlighted even in the absence of symptoms because asymptomatic infections can still be spread. The need to bring sexual partners for treatment was stressed, to help break the chain of infection.

An overview was also given on why surveys about food and social networks were included in the study. The goal was to assess whether participants were eating foods that strengthen the immune system and to understand the structure and influence of their social networks, particularly in relation to health-seeking behaviour and daily decisions.

Next, the discussion moved to presentation of findings where the comparison between ACASI (Audio Computer-Assisted Self-Interview) and CAPI (Computer-Assisted Personal Interview) methods. The purpose of this comparison was to examine how data collection methods influenced responses, particularly around sensitive topics like sexual behaviour and mental health. It was noted that in Kisumu, participants were 48% less likely to report recent antibiotic use in the past 30 days through CAPI than through ACASI. In Nairobi, responses about food insecurity and recent antibiotic use were less commonly reported in CAPI. On the other hand, reports of vaginal or anal sex with female partners were more frequently disclosed in CAPI than in ACASI in both locations. The implication was that ACASI was more effective at eliciting sensitive information, although both methods were deemed useful for data collection among MSM.

During the question-and-answer session, one participant asked how the study determined who was a top, bottom, or versatile, and also inquired about support for individuals dealing with mental health issues. It was clarified that sexual roles were not used as inclusion or exclusion criteria, and all MSM were eligible regardless of sexual role. It was also explained that information about sexual roles was inferred based on how participants answered questions during ACASI. When concerns were raised about the potential for false responses, it was emphasized that participation in the study was voluntary and relied on honest reporting. On the issue of mental health, the study team acknowledged its significance and confirmed that referrals could be made for those in need of additional support.

Study findings on factors associated with urethral and rectal STIs among MSM in Kisumu and Nairobi were presented. It was reported that the prevalence of urethral and rectal chlamydia/gonorrhoea infections stood at 9.2% and 3.7% in Kisumu, and at 10.4% and 18.7% in Nairobi, respectively. Rectal infections were found to be more common than urethral infections, with chlamydia being the more dominant infection compared to gonorrhoea. Urethral infections were significantly associated with individuals aged 25–29 years. Interestingly, hazardous alcohol use, food insecurity, and recent antibiotic use were found to be inversely related to rectal infections. The overall conclusion was that STI prevalence among MSM remains high in both Nairobi and Kisumu, with a notably higher burden of rectal infections in Nairobi. Several behavioural and structural factors including sexual role, symptoms of mental health issues, and substance use were significantly linked to STI prevalence.

The group then engaged in a discussion comparing Kisumu and Nairobi based on the study findings. I asked the participants to share their views on the results, and this opened up a candid and thought-provoking exchange. One participant felt that PrEP use appeared higher in Kisumu due to a heightened awareness of HIV risks among MSM. Another attributed this to more consistent sensitization efforts on sexual and reproductive health (SRH) issues within the county. A different participant observed that access to PrEP in Kisumu is easier since many health facilities are located close to residential areas or estates. Several participants agreed that STI prevalence seemed higher in Nairobi, possibly because of the underutilization of available health services and the widespread abuse of over-the-counter (OTC) medications.

Some pointed out that economic hardships in Nairobi often force individuals into unprotected sex for quick money, with many unable to negotiate for safer sex due to desperation. It was also mentioned that Nairobi has more “sponsors” wealthy older men who tend to have multiple sexual partners, particularly among younger MSM, which may fuel the spread of STIs. In contrast, Kisumu MSM were described as having stronger health-seeking behaviours, regularly attending appointments and participating in program activities. Others commented on Nairobi’s vibrant party culture and the rising trend of group sex, which they felt contributed to riskier sexual practices. One participant humorously noted that the high levels of education in Nairobi may lead some MSM to experiment more, including engaging in unprotected sex. It was also observed that transactional sex is more common in Nairobi, largely due to the city’s high population.

It was noted that younger MSM tend to be more sexually active some reportedly having sex daily compared to their older counterparts, making them more susceptible to contracting STIs. The engagement throughout the session reflected genuine interest and appreciation for being involved in research that directly affects their lives.

It was also noted that the Community Advisory Board (CAB) had held a separate dissemination session, during which they were presented with findings similar to those shared with participants. The CAB emphasized many of the same points, including the importance of timely treatment for symptomatic and asymptomatic infections, the value of sharing knowledge within networks, and the need for continued community engagement in research. Their feedback reinforced the study team's efforts to ensure transparency, community involvement, and relevance of the research to those most affected.

The dissemination session was successful in meeting its objectives sharing study findings, addressing community concerns, and creating space for knowledge exchange. The candid feedback and observations from the participants enriched the discussion and offered real-world context to the data collected.