Engaging social networks to increase HIV case finding among key populations


BACKGROUND: In Zambia, the USAID Open Doors project (ODP) provides access to comprehensive HIV prevention, care, and treatment services to key populations (KP): female sex workers (FSWs), men who have sex with men (MSM), and transgender people. After observing that the project's initial HIV case-finding rate among KPs was lower than the national general population yield of 12%, the project introduced the social networking strategy (SNS) to increase HIV case finding. We share lessons from eight project sites for implementation October 2017'September 2019.
DESCRIPTION: To implement SNS, ODP identified 33 KP peer leaders who were familiar with the project, maintained a large KP social network, and could mobilize their peers. Peer leaders were trained to identify high-risk clients from their social networks who could act as 'seeds' to distribute coupons for services at ODP wellness centers to additional unreached clients. Each coupon included a unique identifier to track clients and seeds. Peer leaders were asked to identify at least three seeds to distribute coupons each month. Monetary incentives were provided for every coupon returned to the wellness center. A risk assessment tool'evaluating condom use, number of sexual partners, and sexually transmitted infection history'was used to gauge clients' risk level and eligibility to receive a coupon.
LESSONS LEARNED: After implementation of SNS, project case finding increased from 13% in FY17 (FSWs=1,221 [16%]; MSM=117 [5.6%]; transgender people=30 [11%]) to 28% in FY19 (FSWs= 3,574 [32%]; MSM=774 [19%]; transgender people=119 [36%]). There was a significant increase in project yield in FY19 (M = 1105.75, SD = 370.3) compared to FY17 (M = 342, SD = 119.7), t(3) = -3.21, p < .05. By the end of FY19 the total SNS positivity contribution to the project yield was 32%, and 2,115 (76%) coupons were returned from 2,799 distributed to clients across all sites.
CONCLUSIONS: SNS was successful in increasing case finding among KPs. Leveraging trusted and knowledgeable social relationships to extend HIV services to hard-to-reach KP individuals is a strategy that should be scaled up.

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