Enhanced peer outreach approach increases HIV case finding among female sex workers and men who have sex with men in Dar Es Salaam, Tanzania


BACKGROUND: In Tanzania, key populations (KPs) are disproportionately affected by HIV with prevalence among female sex workers (FSWs) and men who have sex with men (MSM) estimated at 26% and 25% respectively. Despite community outreach for HIV testing services, higher-risk KP individuals remain hidden due to stigmatization, discrimination, and criminalization. The USAID- and PEPFAR-funded EpiC project implemented the enhanced peer outreach approach (EPOA) to improve HIV case identification among FSWs and MSM in Dar Es Salaam, Tanzania.
DESCRIPTION: Peer-led coupon network mobilization was implemented in an urban region of Dar Es Salaam. Twenty Peer Educators (PEs) were trained to identify hard-to-reach KP members and invite them to access HIV testing services (HTS) using a coupon promotion. Ten Health Care Providers (HCPs) were trained to screen clients accessing HTS and select those with higher-risk peer networks to become peer mobilizers (PMs). PMs were given coupons to distribute to their risk networks and invite them to receive comprehensive HIV services. Each PE and PM was given five coupons and provided with monetary incentives for each one returned. Weekly network analysis was done to identify PEs and PMs with productive networks for continued coupon distribution. We compare case identification rates from EPOA and traditional mobile testing, used Chi-squared test to determine if the difference is statistically significant.
LESSONS LEARNED: EpiC distributed 1,893 coupons (1,325 FSWs and 568 MSM) between July 2020 and September 2021; 1,590 (84%) individuals returned with coupons. Of those, 100% were offered and accepted HIV testing. HIV case finding rate was 14.3% (169/1,179) among FSW tested through EPOA and 6.5% (1,257/19,411) through traditional mobile testing. Among MSM, case finding rate was 16.1% (66/411) through EPOA and 10.4% (534/5,126) through traditional mobile testing. The odds of testing positive were 2.4 times higher among FSW in EPOA compared to traditional mobile testing (2.42 Odds ratio, 2.03-2.89 95%CI), and 1.6 times higher among MSM tested through EPOA (1.65 Odds ratio, 1.23-2.18 95%CI).
CONCLUSIONS: EPOA is effective in identifying high-risk FSWs and MSM, especially those who are difficult to reach through traditional methods. EPOA provides a viable option in settings where case finding has proven to be a challenge.