Nadia Sam-Agudu

This session features lessons learned and study results from community-based program implementation and research in different settings in SE Asia and east and southern Africa. Speakers share information on the impact of a variety of community-involved interventions among young men and women, pregnant and breastfeeding women, and key populations.

Justine Tumusiime presents HIV self-testing (HIVST) for adolescent girls and young women (AGYW) in Uganda. HIVST kits are distributed to ~60,000 AGYW (15-24 years old) using community, private sector and public sector models. The community-based model reaches 67% of AGYW, and positivity rate is highest with private sector (5.6%) vs. community model (0.64%). Matthew Kusen discusses a community-led monitoring (CLM) toolkit for community-led HIV service improvements in Mongolia, Bhutan and Sri Lanka. The toolkit focused on MSM, transwomen, sex workers, people living with HIV, and people who use drugs. The toolkit helps identify facilities where stigma and discrimination are prevalent or have low availability of key services. Rashida Ferrand presents the CHIEDZA trial of community-based integrated HIV services for ~37,000 16–24-year-old people in Zimbabwe. Popular services for women are: menstrual hygiene (96.5% uptake), HIV testing (83.7%) and period pain management (59.9%); for men: condoms (93.9%), HIV testing (85.6%) and SRH text messages (67.1%). Gilton Kadziyanhike and team engage community HIV/AIDS service agents (CHASAs) to find, link and retain pregnant/breastfeeding mothers and children living with HIV in Zimbabwe. CHASAs referred 1,612 clients for HIV testing, with 3% tested, and 3% of those lost-to-care successfully returning to care.

These 4 studies demonstrate the successful use of a variety of implementation strategies in community HIV service delivery for different populations in different contexts: 1) Community and private sector approaches for reaching and identifying HIV among AGYW; 2) Community-led monitoring toolkit and strategies for improved HIV care for key populations; 3) integrated HIV services for young people, and 4) Lay community providers to increase HIV testing and retention for pregnant/breastfeeding women and children. There is ample room for more rigorous and explicit application of implementation science methods and outcomes measures in community projects such as those described in this session.