BACKGROUND: Due to high levels of stigma and discrimination, key populations (KP) -- men who have sex with men, sex workers, people who inject drugs, and transgender persons-- are often hard-to-reach for HIV testing services. Social network strategy (SNS) is a network-based, HIV case-finding approach that encourages people living with HIV or persons at high-risk for HIV infection to refer their sexual, drug-using, or social network members for HIV testing services. In doing so, SNS can efficiently identify undiagnosed HIV-positive KP members.
DESCRIPTION: The U.S. Centers for Disease Control and Prevention (CDC) introduced SNS in 17 PEPFAR countries to improve upon traditional case-finding methods and to diagnose KP who may be missed in other HIV-testing efforts. Kenya, South Africa, Tanzania, and Zambia were selected as examples of countries with SNS programs that operate with fidelity to the SNS model, which includes the core elements of engagement with KP civil society on implementation strategy, proper coupon tracking, well-trained staff, and data monitoring Population- and region-specific considerations were incorporated into the SNS approaches in each country, customizing SNS for their specific needs.
LESSONS LEARNED: HIV testing yield for SNS was reported for each country selected in 2022 and ranged from 4.4% in Kenya to 20.4% in Zambia (Figure 1). The number of HIV tests conducted using SNS varied greatly. Tanzania conducted the most with 43,876 tests and Zambia conducting the fewest with 6,689 tests. Within each country, SNS testing yields were generally higher compared to voluntary counseling and testing (VCT) and outreach testing. SNS testing targeted KP, while outreach and VCT targeted all populations.


CONCLUSIONS: SNS continues to be an effective strategy for HIV case-finding among KP. While each SNS program was customized to the local context, the core elements within the strategy are important to identify undiagnosed KP and achieve high HIV testing yields.

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