BACKGROUND: The war in Ukraine is characterized by ongoing shelling, infrastructure and commodity destruction, injury and death, security concerns, internal displacement, and migration. To sustain case finding among key and priority populations (KP/PP), innovative and adaptive approaches tailored to the context and changing client needs, are crucial.
DESCRIPTION: From October 2022 to December 2023, the PEPFAR funded Community Action for HIV Control project, implemented by Pact, FHI360 and AFEW, supported 22 local NGOs in 15 regions, including frontline areas, to design and implement HIV-case finding initiatives tailored to the specific needs of KP/PP through approximately 60 differentiated service delivery (DSD) models.
Each DSD model is comprised of a detailed description of activities and services, specifying the frequency, hotspots, service providers necessary to identify new HIV cases within specific KP/PP. These models undergo quarterly revisions based on results and experiences gained during implementation, ensuring continuous improvement to better reach KP/PP representatives.
LESSONS LEARNED: From October 2022 to December 2023, 64,993 KP/PP individuals were engaged in HIV testing delivered through the DSD models. Among them, 1,492 were diagnosed with HIV, with 1,393 linked to ARV treatment.
We conducted a qualitative assessment of the DSD model implementation, through 43 independent interviews with lay providers and project coordinators involved in DSD models implementation. Those interviewed identified several advantages of the DSD approach including a systematic and clear algorithm for working with KP/PP, flexibility to incorporate features specific to these groups, comprehensive consideration of their needs, and the provision of enhanced services. Furthermore, the quarterly review and revision process allowed for adjustments and adaptations to factors including contextual factors like war and migration, thereby reducing interruption of services.
CONCLUSIONS: In navigating the challenging wartime environment, the implementation of DSD models has proven to be an effective and adaptable strategy for sustaining HIV case finding. The project recommends dissemination of best practices and lessons learned, scaling up adaptable approaches to other regions, ongoing monitoring and evaluation to further refine and optimize DSD models, and integration of additional services such as humanitarian aid screenings on non-communicable diseases, gender-based violence, and mental health services to enhance the reach and impact of DSD models.