Improving peer outreach through the engagement of people living with HIV in Nepal

BACKGROUND: With funding from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and the United States Agency for International Development (USAID), the Meeting Targets and Maintaining Epidemic Control (EpiC) project supports community partners in Nepal to close HIV service access gaps through an enhanced peer outreach approach (EPOA) involving incentivized peer referrals. However, partners in Nepal have historically experienced lower than expected rates of new HIV case detection through EPOA'possibly because some of the key population peer mobilizers and network members engaged through this approach had already adopted preventive behaviors against HIV.
DESCRIPTION: By helping partners engage people living with HIV (PLHIV) in EPOA, the EpiC Nepal team saw an opportunity to complement index testing with expanded options for PLHIV to make safe and voluntary peer referrals, improving the focus of outreach in networks with higher risk of HIV infection. At the beginning of FY20, the team ramped up efforts to identify PLHIV who were willing to serve as peer mobilizers such that in supported districts, most newly engaged peer mobilizers were PLHIV.
LESSONS LEARNED: With the expanded strategic engagement of PLHIV as peer mobilizers, participating partners experienced a tenfold increase in HIV case-finding rates through EPOA, from a baseline average of 2% of individuals tested, to a post-implementation average of 25% of individuals tested. From October 1, 2020 through September 30, 2021, 1,642 individuals were successfully referred to HIV testing services through EPOA, 457 (28%) of whom received a confirmed HIV diagnosis. Among those diagnosed, 427 (93%) had already initiated HIV treatment services by mid-October 2021. Similarly, out of those screened negative, 650 individuals were referred for HIV pre-exposure prophylaxis (PrEP) services, and 370 (57%) of those referred initiated PrEP services through EpiC Nepal partners.
CONCLUSIONS: The EpiC team has helped establish EPOA as a feature of Nepal's National HIV Strategic Plan (NHSP) 2021'26 and is now working with community organizations and a broader set of partners and stakeholders'including those receiving Global Fund support'to expand voluntary engagement of PLHIV as allies to help close gaps in service access.

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