Comparing online and traditional service use models among key populations in Liberia

Theoretical Background and research questions/hypothesis:

In Liberia, key and vulnerable populations account for most HIV cases, with the prevalence of HIV among men who have sex with men at 37.9%, transgender people at 27.6%, female sex workers at 16.7%, and people who inject drugs (PWID) at 14.4%. Traditional (offline) services are the main modality of HIV service provision, but stigma and discrimination toward key and vulnerable populations deter these groups from accessing services. The FHI 360 Meeting Targets and Maintaining Epidemic Control (EpiC) Liberia project, through PEPFAR and USAID funding, piloted the use of QuickRes, a (KP)-friendly and safe online application that allows clients to determine service needs and book appointments online.

Methods: We reviewed HIV testing data from July 2021 through September 2022 and used a two-service model z test to compare population type and case finding between those who booked HIV testing online and those who were linked to HIV testing offline

Results: Among the beneficiaries who were referred and booked HIV testing services online (n=1,062), 78% were KP and 22% were general population. For those who received HIV testing services offline (n=136,130), 70% were general population and 30% were KP. Case finding among those who booked via online platform was 20.8% compared to 5.3% offline (95% CI: 10.2-20.9).

Conclusions:

• Online platforms are an alternative to linking individuals to HIV testing, including KP who may prefer online to offline due to stigma.
• Working with peer outreach networks will help programs tailor interventions that target specific at-risk groups based on their preferred service platform and promote the use of those platforms.
• Online screening and booking for testing services represent a fraction of overall HIV testing but show the potential to reach those at higher risk for HIV infection, making it a valuable strategy to reach last mile clients.

Implications for research and/or practice:

Among the beneficiaries who were referred and booked HIV testing services online (n=1,062), 78% were KP and 22% were general population. For those who received HIV testing services offline (n=136,130), 70% were general population and 30% were KP. Case finding among those who booked via online platform was 20.8% compared to 5.3% offline (95% CI: 10.2-20.9).