In Uganda’s fishing communities, where mobility is high and access to healthcare is limited, HIV prevalence remains a persistent challenge. But one researcher is charting a new course by empowering the very communities that are most affected.
Dr Joseph Matovu a public health researcher and Africa Oxford Initiative (AfOx) Fellow, is leading a pioneering study to increase HIV self-testing uptake among male fisherfolk. His approach is simple yet powerful: train peer-leaders within these communities to distribute HIV self-test kits and encourage their use. The results have been striking.
Meeting People Where They Are
When I first began working in Uganda’s fishing communities, I was struck by the resilience of the people—and the scale of the health challenges they face. These communities are often remote, highly mobile, and underserved by traditional healthcare systems. HIV prevalence remains among the highest in the country, yet stigma and logistical barriers continue to discourage testing. This is what inspired me to rethink how we approach HIV prevention—not as something imposed from the outside, but as a process rooted in the community itself.
A Peer-Led Model That Builds Trust
My research focuses on increasing HIV self-testing and improving linkage to care or pre-exposure prophylaxis (PrEP) among male fisherfolk. These men are frequently on the move, often working long hours in high-risk environments. They may not have the time or means to access clinics, but they do rely heavily on their social networks.
That’s what led me to design a peer-led intervention—PEST4MEN—which stands for Peer-led HIV Self-Testing for Men. Through this model, we train respected community members to distribute self-test kits and support their peers through the HIV self-testing process.
The results have been promising. In 2022 alone, 99% of the 355 men who received kits from peer-leaders reported using them. Nearly one in three men who tested HIV-positive through this process were first-time HIV-positive testers; 70% of whom were linked to HIV care. This level of engagement shows how much potential this model has to transform HIV prevention and care in these settings.
Learning from Past Success
The idea behind PEST4MEN didn’t emerge in isolation. I was first exposed to network-based interventions while working on the Game Changers for HIV Prevention Project, led by Dr Laura Bogart at the RAND Corporation. That project trained people living with HIV to become prevention advocates within their own circles.
I coordinated the study in Uganda and saw firsthand how peer influence could shift attitudes and behaviours in ways that traditional outreach often could not. I wanted to build on that insight—not to target those already diagnosed, but to reach those at greatest risk who often remain untested.
AfOx Support for Global-Scale Collaboration
The Africa Oxford Initiative (AfOx) has been instrumental in advancing this work. As an AfOx Fellow, I collaborated with Dr Adrian Smith, Associate Professor in the Nuffield Department of Population Health. Since May 2025, we’ve held several in-person meetings to explore how this model could be scaled up and evaluated more rigorously. In September 2025, Dr Smith visited me in Uganda and we, together, went to one of the fishing communities in Kalangala district, to meet with some of the peer-leaders. We had a great meeting and the peer-leaders shared very useful insights that helped to inform our proposed intervention.
The proposed intervention will be conducted in three phases: a) formative research to gather additional insights into how to maximize efforts to reach highly mobile men with HIV self-testing services; b) co-creation of an intervention that fits the mobile nature of the male fisherfolk, and c) piloting the co-designed intervention to generate data necessary to inform the design of a future hybrid type-1 implementation-effectiveness trial to assess how peer-led self-testing—alone or combined with Uganda’s village health teams—can improve both testing rates and linkage to care. It’s a critical next step that could shape how similar strategies are applied in other resource-limited settings.
AfOx has also expanded my academic network. Through Oxford’s college system and my affiliation with Christ Church, I’ve connected with researchers from different departments, four of whom are now potential collaborators on this project. I’ve had opportunities to present at college seminars and at the Health Systems Collaborative Links webinar hosted by the Nuffield Department of Medicine. Dr Claire Keene, from the Nuffield Department of Medicine, is one of such collaborators. These platforms have helped refine my thinking and raise the profile of my research.
A Scalable, Sustainable Model
The beauty of peer-led interventions is that they work with existing community structures. They’re low-cost, scalable, and rooted in trust. If we can demonstrate their effectiveness in Uganda’s fishing communities, there’s no reason this model couldn’t work in other high-risk populations. This is about more than just HIV testing. It’s about empowering communities, building trust, and creating health solutions that people can own.
The work aligns closely with AfOx’s thematic priorities—Healthy People and Innovations for Prosperity. We’re not just improving access to care; we’re creating models that could shift how health systems engage with hard-to-reach groups.
Looking Ahead
I’m currently co-authoring a paper with Dr Smith and developing a joint manuscript with another AfOx Visiting Fellow. These collaborations are helping to turn a locally rooted idea into a globally relevant model. As I look to the future, I’m encouraged by what’s possible. When communities are trusted with tools and responsibility, they rise to the challenge. That’s the kind of health system I want to help build—one where interventions are not just delivered to people but built with them.