Jean Raoul Nsanganira, Digital Communication Assistant, FHI 360
The digital era has brought innovative ways for people to stay connected and reach out to one another. While social media use is low in Mali compared to other countries (10 percent nationally), the USAID- and PEPFAR-supported Meeting Targets and Maintaining Epidemic Control (EpiC) project in Mali implemented an approach to reach this online segment of their target audience, who may be missed by the traditional face-to-face peer outreach model. They specifically focused their online efforts to reach key population members at higher risk of HIV such as men who have sex with men (MSM) and transgender people.
The Going Online approach, developed by the EpiC and LINKAGES projects, lays out a framework for HIV programs to leverage online and virtual approaches to support their outreach, demand generation, service delivery, client retention, and quality improvement efforts. Social network outreach is a particularly well-known method within the Going Online framework that leverages individual virtual client support to reach and links clients from online platforms to local HIV services. This strategy helps the project reach out to and engage with vulnerable groups virtually while respecting their privacy and safety given the stigma and persecution they often face. Here, we describe how the EpiC project implemented a social network outreach approach in Mali.
Learning and adapting during implementation
First, the Mali team hired a social and behavior change specialist to train community-based peer educators (PEs) to use online (web-based) and virtual platforms (WhatsApp messenger, telephone calls) to find and reach members of their target audience and link them to HIV services. The training helped PEs create online profiles for several apps and provided them with strategies on online networking and communication that protected their privacy, as well as that of their clients. The initial training involved all PEs and their supervisors.
Four months into implementation, staff supporting both in-person and virtual HIV outreach found that a sizeable portion of MSM served by the program were already using a range of online platforms to connect and communicate with their peers, so the program hired four dedicated online outreach workers. These workers focused on private/closed social media groups with followers and members among the MSM and transgender communities. Workers sent authorization requests to group administrators, explaining their aim to raise awareness among group members regarding HIV risk and services availability. Clients of FSWs were reluctant to disclose details of their sexual life to PEs via the online risk assessment, so the program moved away from targeting this population online.
In the private social media groups, online outreach workers regularly posted information on HIV prevention services and asked members to message them directly to learn more. Additionally, workers sent direct messaging to members on social media platforms (e.g., Facebook, Snapchat, Instagram) and dating apps (e.g., Grindr, Planet Romeo, Tinder) to introduce themselves and build awareness of the kinds of support and services they could avail from them when needed. New data and tracking tools were developed to complement online service provision. Excel-based tool track online communications by PEs and revised clinic forms help track whether clients reached online attend their appointments.
Additional remote technical assistance supported the implementation process and performance review. At the start of the COVID-19 outbreak in March 2020, the program launched Ibadon.com (a deployment of FHI 360’s Online Reservation and Case Management App, or “ORA” for short). Ibadon simplified the outreach process by allowing PEs to share with their clients a link to book HIV service appointments on their own at local providers, directly on the Ibadon website. Where clients used a simple phone or did not have mobile data connection, PEs could book appointments on their behalf.
This became the program’s service uptake tracker for clients reached online.
Mahamadou Habib Maiga, a peer educator with EpiC partner Coalition Anti Sida, explained how Ibadon improved client tracking. “Ibadon is a very discreet and innovative tool that allows me to push people to make an appointment discreetly and receive the appropriate care either at home or at the different centers. As soon as I was trained to do this, I was very enthusiastic because everything is done online, and most of my target [audiences] connect [online] at least once a day. Thanks to the link-sharing system, I promote Ibadon and easily manage appointments through my account. I see everything and follow the clients individually.”
About 200 PEs were trained to use Ibadon to help walk beneficiaries through an online risk assessment, book online appointments at health facilities or schedule home-delivered services, and schedule ART refill pick-up appointments.
“Ibadon is convenient for me and more professional because it makes my job easier,” said Mamoudou Traore, a peer educator with EpiC partner ARCAD Santé PLUS. “Risk assessments prepare clients before they arrive, and for some clients, they appreciate having multiple centers within reach with different schedules.”
Results of the online approach
Between May 2020 and July 2021, 1,303 people booked online appointments and 735 got HIV tests; 56 percent of these users had never been tested for HIV. Of those who tested, 120 (16 percent) were diagnosed HIV positive. The online outreach approach with ORA had higher case finding than the overall HIV testing program (16 percent vs. 10 percent).
During scale-up of the virtual approaches, much of the impact came from the team of four dedicated online outreach workers, who worked with more than 200 in-person PEs who had rarely used ORA for service referrals because of low literacy. Figure 1 shows the overall cascade for online outreach for HIV services delivery from May 2020 to July 2021.
Based on user feedback and data reviews, the program integrated an audio option into ORA in June 2021 for users with low literacy, placing a button next to the options to have the text read and explained. Additionally, the program plans on using paid targeted ads and promotions through Facebook and Instagram to increase the number of ORA users.