In 2014, USAID awarded FHI 360 the Linkages across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) project, a global cooperative agreement funded by PEPFAR and dedicated to addressing the HIV epidemic among key populations — men who have sex with men, sex workers, transgender people, and people who inject drugs. Over the past seven years, LINKAGES transformed how the needs of key populations are addressed in global and local responses to the HIV epidemic. The key-populations-focused programming launched in many countries through LINKAGES now continues under the Meeting Targets and Maintaining Epidemic Control (EpiC) project. As LINKAGES officially comes to an end, we are taking stock of what the project has meant for people, policies, partners, and programming.
This blog is the second in a three-part series dedicated to recognizing and celebrating the achievements of the LINKAGES project around the world. Here we share highlights — with links to technical resources and reports providing more detail — of the work in Asia.
In Cambodia, LINKAGES was not a direct service delivery project but rather provided above-site technical assistance. Working closely with the National Center for HIV/AIDS, Dermatology and Sexually Transmitted Infections (NCHADS), LINKAGES Cambodia contributed to the development of national policies, strengthened national data systems, and supported local partners to introduce innovations designed to improve HIV outcomes among key populations. The project wrote national standard operating procedures for same-day antiretroviral therapy (ART), multi-month dispensing of antiretroviral (ARV) drugs, and partner notification tracing and testing. The project’s pilot of HIV self-testing led to its inclusion in Cambodia’s HIV prevention policy. The project also pioneered an online reservation and case management app that was adopted by NCHADS, and supported rollout of pre-exposure prophylaxis (PrEP).
LINKAGES India not only introduced and scaled new and impactful ways of reaching previously unreached key population individuals and engaging them in HIV services, but also transferred the approaches to the Government of India and integrated them into national HIV guidelines. One of the LINKAGES India team’s notable achievements was its introduction of Yes4Me, a cutting-edge online platform through which virtual outreach workers successfully engaged high-risk individuals and connected them to HIV testing services, producing a case-finding rate of 5.5 percent.
LINKAGES was a critical partner to national and provincial government stakeholders, facilitating the adoption of evidence-based policies; rolling out differentiated strategies to optimize HIV testing and treatment, and viral load testing; and strengthening health information systems. Among the project’s contributions was strengthening of Aplikasi Rekap Kohort (ARK), the country’s system to track individual clients by confidential unique identification codes (UICs) across HIV services and service delivery sites, which has been adopted by 582 primary health care facilities. The project also developed Jak-Trak — a suite of online applications for appointment scheduling, referrals, and client tracking— and transferred it to the Jakarta Provincial Health Office. When COVID-19 hit, LINKAGES Indonesia introduced Jak-Anter, a home-based delivery system that enabled uninterrupted access to treatment during the pandemic.
LINKAGES in Lao People’s Democratic Republic (PDR) enabled unprecedented access to HIV services for men who have sex with men and transgender women. The project successfully implemented case-finding innovations such as the enhanced peer outreach approach, HIV self-testing, and index testing; and pioneered efforts to decentralize ART distribution at the community level, including through home delivery, and led the government of Lao PDR to include it the national HIV strategy.
LINKAGES Nepal worked with and strengthened the capacity of 21 implementing partners to deliver HIV services for key populations and people living with HIV across 19 districts. The project was an early adopter of online approaches, including the web application MeroSathi, which later helped sustain services during the COVID-19 pandemic. The project implemented a mix of differentiated testing and treatment modalities, and conducted HIV self-testing and PrEP demonstration studies to inform rollout in the country. LINKAGES helped update national HIV plans and guidelines and make them more inclusive of key populations, and worked with the National Center for AIDS and STD Control and the National Public Health Laboratory to strengthen logistics, strategic information, and laboratory services related to HIV.
LINKAGES Sri Lanka was successful in improving the access and quality of community and clinic-based HIV services for key populations by engaging private providers; using the enhanced peer outreach approach and going online to enhance case finding; and developing social and behavior change communication materials that focused on the whole person rather than only sexual behavior. The project also introduced client feedback systems, and established a National Key Population Program Monitoring Dashboard.
A cornerstone of LINKAGES Thailand was the successful rollout of the key-population-led health services (KPLHS) model. The project also pioneered several technical strategies to improve service uptake including the enhanced peer outreach approach, use of online platforms, same-day treatment initiation, community-based PrEP delivery, and differentiated services for transgender women. The LINKAGES Thailand team used its data to advocate for and achieve policy changes, including co-financing by the Thai government for KPLHS; authorization by Ministry of Public Health to permit lay health providers to conduct HIV testing; approval of assisted HIV self-testing using OraQuick; and inclusion of PrEP in the national health insurance scheme.
Photo Credit: Johanan Ottensooer