Transforming Social and Behaviour Communication (SBC) using digital platforms: the case of USSD HIV self-assessment and PrEP adherence support tools

BACKGROUND: In 2018 in Zambia, the USAID DISCOVER-Health Project, implemented by JSI, was one of the first partners to roll out PrEP. In Zambia, PrEP is only provided to individuals at substantial risk of HIV, using a paper-based national eligibility screening tool, administered by healthcare workers (HCWs) during service delivery. This is sometimes challenging to do in busy clinics, from both time-constraints and privacy perspectives.
DESCRIPTION: To help address this, the Project developed an Unstructured Supplementary Service Data (USSD) information management system, available to the public, to support self-risk assessment and improve linkage to services. Using mobile phones, clients access the HIV self-risk assessment platform to ascertain their risk level using the USSD. If an individual is at substantial risk, the USSD links them geographically to their nearest PrEP service provider (SP). TheSP reaches out to the client and makes an in-person appointment to initiate them on PrEP. Once the client is initiated, the USSD, in combination with Short Message Service (SMS), provides PrEP adherence support, through periodic reminders.
LESSONS LEARNED: The Project analysed PrEP USSD/SMS access log to determine the volume of access for this service. 123,388 clients accessed this service between October 2018 and June 2019. Out of the 123,388 clients that accessed the USSD platform and used the HIV self-risk assessment, 16,430 were found to be at risk and requested the system to link them to the next step of in-person PrEP services. In addition, 916 clients also requested to be linked to PrEP clinics, before full completion of the HIV risk assessment.Through the USSD, 17,346 people were linked to PrEP clinics from January to December 2021. Duringthe same period, 33,776 clients accessed PrEP Adherence support using the USSD.
CONCLUSIONS: The Project has demonstrated that simple digital solutions, such as USSD platforms, can facilitate health service linkage and adherence support for clients. The USSD platform provides privacy through self-risk assessment and reduces the initial screening burden on busy HCWs, while significantly opening up access to essential HIV prevention services to a wider beneficiary universe.

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