Written by Purvi Shah, Program Manager, LINKAGES India
Online and virtual platforms hold promise for HIV programs to gain access to previously unreached and more diverse populations. They also offer new ways for these populations to engage with HIV services, including self-guided HIV risk screening and referrals. Virtual communication allows HIV programs to circumvent traditional barriers to healthcare access, including time and distance, and to increase the levels of precision in targeting ads and other information toward high-risk key population members.
To capitalize on these benefits, LINKAGES India launched Yes4Me.net in May 2018. On this simple website, clients are offered a revolutionary way of accessing HIV testing services, including the following benefits:
- Convenience: 56 locations for receiving HIV testing across Mumbai, Thane, and Pune with online booking and email results
- Inclusive and confidential: All clients treated with respect and clients are not asked questions about risk behaviors or identity when visiting the lab for testing.
- Quality: Labs use a 4th generation ELISA HIV test with short 15-day window period for less waiting and re-testing to know your status.
- Discount: 90% off the market rate for the same HIV and Syphilis test package
Clients are contacted and encouraged to check out Yes4Me in three ways:
Online Client Support Team
The Online Client Support Team at Yes4Me includes outreach workers and counselors. Outreach workers use social media platforms and dating apps to connect with young, at-risk men and women, post educational messages and information about HIV services, and navigate them to Yes4Me. Counselors follow up with all people who have received HIV testing to provide them additional follow up prevention, care, and treatment services and offer options to offer HIV testing to the client’s peers and partners.
Social influencers are people with a large audience on social media and can persuade others by virtue of their authenticity and reach. Some examples of influencers are health experts, lifestyle experts, make-up artists, and activists. Social influencers are engaged by Yes4Me to connect with their followers on the topic of HIV and promote Yes4Me as a platform for accessing services.
Advertisements on social media platforms like Facebook, Instagram, and dating apps like Grindr are another way to connect with targeted populations online who might benefit from information or services related to HIV and direct them to Yes4Me or a chat with a member of the online client support team.
When landing on Yes4Me, clients can complete a short risk assessment to understand their risk for HIV and other STIs and then continue to book an appointment for an HIV test by choosing a convenient day, time, and lab location.
Once the client books an appointment through Yes4Me, an SMS is sent to the client with the appointment details and link to a pretest counseling video. A reminder SMS is sent three hours prior to the appointment. When the client arrives at the testing site, the lab receptionist marks the client as arrived on the Yes4Me admin system. Lab staff follow their routine process for informing clients of their test results (via email or in-person) and confidentially share results with LINKAGES through a secured portal that is only used for reporting and does not present client results visually to lab staff or to the outreach teams.
A counselor makes follow-up calls to all clients who arrived for an HIV test, to help connect them to any other services they may need. Clients choose whether to disclose their HIV test result to the counselor during this call. The counselor can then provide additional information and appropriate referrals based on their needs. All clients living with HIV are given information on and referrals to public and private antiretroviral therapy (ART) centers. Clients with non-reactive HIV tests are offered the option to receive reminders to rebook HIV testing quarterly, education on safe sex, and referrals for pre-exposure prophylaxis (PrEP), condoms, and lubricant.
Yes4Me successes to date
During the six months since the Yes4Me platform launched, around 8,800 unique users landed on the site. Of these, around 3,490 completed the risk assessment, with 86 percent categorized as high/medium risk and 5 percent as known positive. A virtual support group was formed with seven known positives for messages on positive prevention, ART services, adherence, and viral load testing. Of those who completed the risk assessment, 3,428 were men who have sex with men, 28 were transgender people, 16 were people who inject drugs, and 18 were people who report engaging in sex work. Approximately 22 percent had never been tested for HIV and another 16 percent had their last HIV test more than six months ago. Respondents also reported high frequency in risk behaviors experienced in the prior six months including 52 percent having sex without a condom, 42 percent having multiple sex partners, 15 percent consuming alcohol before sex, and 7 percent participating in group sex and high fun (use of hard drugs during sex).
Yes4Me’s conversion rate, from the number of users who landed on the website (8,800) to the number who booked an appointment (286), is 3.25%, which is comparable with market standards. For example, in 2016 1.5% online shoppers in the United States using a smartphone convert to purchasing a product (source: Statistica). Of the 286 who booked an HIV test on Yes4Me, 120 arrived at a lab and received HIV testing through Yes4Me. The HIV case finding from this approach is at 4.8 percent, and all six individuals who tested positive were linked to treatment. The standard physical HIV outreach and testing approach in the same geographies has an HIV case finding rate of 0.3%. Yes4Me is showing promise for offering a targeted strategy for reaching populations who are at high risk for HIV and not reached by existing models.
The website is being reviewed and client feedback is being collected to support revisions that will improve user experience and increase conversion rates. Additionally, LINKAGES has engaged creative partner M&C Saatchi to develop a communication campaign to bring higher volumes of people to the website and better package the brand identity of the website. Given the initial success of this model and the broader need to update outreach approaches in India to the digital generation, Yes4Me is currently planning its expansion to eight additional cities throughout India to reach previously unreached populations at risk for HIV. The early data are promising, and LINKAGES India is excited to keep refining Yes4Me to maximize its potential and outcomes.