Choice is Crucial to Key Population Enrollment in HIV Care

July 26th, 2018 | Viewpoint


In honor of the recent 15th anniversary of the PEPFAR program, the JSI-implemented USAID Strengthening the Care Continuum Project is running a blog series reflecting on the success Ghana is having in preventing and treating HIV among the LGBTQ community.

This second blog looks at using small-scale technology to empower decision-making, strengthen linkage rates, and improve service delivery.


Technology’s growing role as an exponential enabler is breaking down barriers and improving systems and outcomes. The newest, hottest device, platform, or digital strategy can become the next best practice or impactful program requirement in a short amount of time. But in a sea of options, what actually works?

Under the Care Continuum, using human-centered design principles, and focusing on eliminating interpersonal barriers to service, has helped to make a relatively low-tech intervention an attractive source of information about HIV and STIs.

In Ghana, female sex workers (FSWs) and men who have sex with men (MSM) are disproportionately affected by the HIV epidemic (7 percent FSW and 18.1 percent MSM) compared to the general population (1.6 percent3). In addition to a higher risk for HIV, key populations (KPs) face extreme stigma and discrimination, are less likely to seek HIV services, and can be difficult to find with outreach programs.

To respond to these challenges and provide real-time HIV and STI-related information and services, the Care Continuum developed a cloud-based messaging system known as the Healthy Living Platform (HLP). The HLP is an interactive, two-way system developed to transmit text and interactive voice response messages in English and four local languages (Akan, Ewe, Ga, and Hausa) which are widely used among the LGBTQ community.

If someone chooses to subscribe to the platform, they first select their chosen message campaign (depending on their unique needs), the time they would like to receive messages, and the language they prefer. The information shared through the platform ranges from daily reminders on ART adherence to weekly or monthly healthy living messages. All the messages have been crafted in collaboration with representatives from KP communities to ensure that the information given meets KPs’ communication and HIV and STI education needs, answers their real questions, and empowers them to adopt healthy behaviors.

When subscribers receive messages, they have the option to respond to the message and directly connect with an HIV counselor who speaks their chosen language, listen to a prerecorded audio message, and/or subscribe to a daily or weekly message campaign. The HIV counselors answer health questions, provide emotional support and encouragement, and link the subscriber to their requested service or provider.

The creation of this new version of the HLP was guided by the fundamental idea that choice should be in the hands of the subscriber/client. Previous iterations of this platform only offered one-way communication and lacked language options, interactivity, and ways of linking KPs needing care to services or providers. Subscribers were also not given the choice to opt out.

Existing results already show that focusing on choice works. While the Care Continuum uses differentiated interventions to reach KPs and engage them in HIV services, the use of Help Line Counselors (HLCs) has a positive impact.

Between April and September 2017, a total of 19,430 KPs were tested using four HIV testing modalities. Out of this total, HLCs referrals for HIV testing yielded 40 percent of the total HIV positivity for the period compared to 5 percent, 6 percent and 17 percent for testing at drop-in centers, through mobile outreach, and at health facilities, respectively. The opportunity to use helpline counseling offered through the HLP has resulted in a higher proportion of KPs who know their status and are enrolled into care.

Going forward, the HLP will be a critical tool for the Project to contribute to Ghana’s pursuit of the 909090 targets. HIV-positive KPs who can choose what information or services they want to receive, how and when they want to receive it, and are self-empowered to seek counseling and treatment, can achieve sustained viral load suppression and have a better, healthier future.

Read the first blog: Pride in Our Progress: Reaching the UNAIDS 90–90–90 Goals 

Written by Deborah Kwablah

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