Promoting HIV testing for high-risk groups in Kenya and beyond
Despite significant progress in increasing HIV treatment and reducing deaths since 2010, progress in reducing new infections has been slower. Reducing new infections requires reaching groups who may be left out by existing HIV prevention efforts. High mobility and erratic schedules put truck drivers among the groups at high risk of HIV who may be missed by traditional HIV testing and counselling services. Since HIV testing is a critical first step to treatment and prevention, governments and other agencies need innovative ways to reach such vulnerable groups.
In Kenya, North Star Alliance, an organization that runs mobile wellness clinics alongside transport corridors, worked with researchers and 3ie to conduct an impact evaluation of HIV self-testing approaches. Part of the evaluation explored the effectiveness of advertising the availability of oral HIV self-testing kits via text message in increasing testing rates among truckers and female sex workers.
A sample of 2,262 male truckers and 2,196 female sex workers registered in the North Star Alliance electronic medical record system and identified as irregular HIV testers were randomly assigned to one of three groups: 1) a group which got three text messages announcing the availability of HIV self-tests at North Star clinics; 2) a group which got three text message reminders about HIV testing but who were only offered standard in-clinic tests; and 3) a group which got one text message reminder about HIV testing and who were only offered in-clinic testing upon arrival.
The study found that announcing the availability of HIV self-tests at roadside wellness clinics via text messages increased rates of HIV test completion among recipients. However, testing rates remained low, suggesting that text message reminders alone may prove insufficient to significantly increase testing rates.
The content of the text message — explicitly announcing the availability of self-tests — was found to be more important than the number of messages. No difference was noted in testing rates when sending a message about HIV testing in general one time versus three times.
Type of impact: Inform global guidelines and policy discussions
When findings from an evaluation or review can be traced to discussions or actions. Examples include governments or multilateral or bilateral donors’ mentioning the findings to inform policy or programming. To date, we have only one case of an individual impact evaluation informing global health guidelines. WHO guidelines require that the guidance is based on randomised evaluation evidence.
This is one of 3ie’s seven types of evidence use. Impact types are based on what we find in the monitoring data for an evaluation or review. Due to the nature of evidence-informed decision-making and action, 3ie looks for verifiable contributions that our evidence makes, not attribution.
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The 3ie-supported study is referenced in WHO’s consolidated guidelines on HIV testing services (2019) prioritizing evidence-based demand mobilization strategies to increase access to and uptake of HIV testing among high ongoing risk and key populations. The guidelines highlight the importance of HIV-specific communication which is tailored to the context and to the needs of vulnerable groups. The guidelines, citing evidence from various sources including the 3ie study, recommend concise communication prior to HIV testing that is informative, encouraging and motivating, and advertises specific attributes of testing services. The messaging is recommended as an effective way to create demand for HIV testing among people who do not know their status and to engage those at high ongoing risk without increasing stigma and discrimination. The guidelines also cite seven other 3ie evaluations; more details are here.
International Initiative for Impact Evaluation (3ie), 2021. Informing ways to increase HIV testing for high-risk groups in Kenya and beyond (online summary), Evidence Impact Summaries. New Delhi: 3ie.
Evidence impact summaries aim to demonstrate and encourage the use of evidence to inform programming and policymaking. These reflect the information available to 3ie at the time of posting. Since several factors influence policymaking, the summaries highlight contributions of evidence rather than endorsing a policy or decision or claiming that it can be attributed solely to evidence. If you have any suggestions or updates to improve this summary, please write to email@example.com