Differentiated Service Delivery (DSD)
• One stop shop clinics which offer integrated HIV, STI, HBV, TB and mental health services have proven effective service delivery models for key populations in Asia and the Pacific.
• Providing transgender-competent care in community-based organizations is an effective intervention for increasing uptake of PrEP. This includes providing information on PrEP and hormone use, as well as hormone testing and counselling.
• COVID-19 has instigated many innovative adaptations to differentiated service delivery, including decentralized service distribution, home delivery of HIV medications and online peer-based support services which respond to the unique needs of key populations.
Evidence from Vietnam has shown that the Key Population-Led Health Services (KPLHS) model has been very successful at improving uptake of HIV services such as PrEP, especially among transgender women, among whom PrEP uptake increased by more than five times when gender-affirming services were offered by specific clinics.
HIV Prevention Services and PrEP
• The results of formative assessments and pilot studies are key to influencing ministerial commitment and funding for PrEP implementation.
• Evidence from Philippines has shown that rapid same-day initiation to PrEP after receiving a negative HIV test result is vital for increasing uptake.
• Multi-month dispensing of PrEP (up to six months) in response to the COVID-19 pandemic in Malaysia, has led to a form of de-medicalization of PrEP, which offers a potential advantage for uptake and adherence to PrEP
National leadership in a collaborative cross-sectoral response, is essential to rollout U=U, to increase understanding and to counter the stigma and discrimination associated with HIV.
• U=U is being effectively used as a lobbying tool for HIV decriminalization laws in both South Korea and Taiwan.
• Sex positive messaging has been successful for promoting U=U in countries such as Vietnam and South Korea, but this may not be appropriate for other country contexts where messaging should be more culturally-sensitive.
• HIV activism at the community level which is centred around supporting and uplifting the voices of people living with HIV is essential for reducing the stigma around HIV and disseminating the messages about alternatives to condom-led
prevention efforts such as U=U.
• U=U is also having a positive impact on STI testing frequency which is an additional positive outcome.
Community-led mechanisms and community-based monitoring
• Lessons learned from Global Fund investments in community-led monitoring have demonstrated a strengthening of local, data-driven decision-making, leading to subsequent improvements in program quality, equity and impact.
• An essential aspect of community-based monitoring systems strengthening is the incorporation of external monitoring processes, to ensure that data collection at the community level is accurate and reliable.
• Regional networks such as APCOM and APTN provide a vital lifeline for many community-based organizations throughout the region, who provide continuous support for establishing and strengthening community-based monitoring systems .
• Community-based monitoring provides a sense of ownership for communities and ensures that activities are responsive to the needs of the community
Community-led generation demand
• The #MenOfPrEP and #QueensOfPrEP campaign campaigns developed by LoveYourself Philippines are excellent examples of successful demand generation campaigns.
• Digital campaigns have been successfully harnessed to disseminate comprehensive information about HIV and generate demand for testing and treatment services.
Excellent examples of online demand generation activities in the region include:
• The use of gay dating apps to share HIV testing campaigns;
• Information hotlines
• Illustrated social media messages
• Endorsement from celebrities or influencers
• Interactive methods of engaging with key populations have also proven effective at generating demand for HIV services in the region, such as competitions or online movie nights.
• Formative research among the target key population group has proven an important precursor for tailoring the messages of demand generation activities and identifying the most effective modes of outreach.
• Sharing personal stories in outreach campaigns can facilitate a more open dialogue around HIV, which dismantles stigma and is also vital for sharing the lived realities of LGBTQI+ people.