Reaching Hidden Populations on Social Media for HIV Self-testing in India

Summary:

India, with an estimated 2.1 million people living with HIV, has a concentrated epidemic with a high-burden among key populations (KPs) including men who have sex with men, female sex workers, people who inject drugs and transgender individuals. Challenges remain to achieve UNAIDS' 95-95-95 targets (95% diagnosed, 95% linked to care, 95% virally suppressed) in India, but HIV self-testing (HIVST) presents a new technology in the toolbox to accelerate progress. Recommended by the WHO, HIVST allows individuals to collect their own specimen and interpret the HIV test result in a private setting. KPs may especially benefit from HIVST given the stigma and discrimination they often experience when going to healthcare facilities. ACCELERATE, a USAID initiative led by Johns Hopkins University, is designing an online demand generation communication campaign targeting KPs in India to increase uptake of HIVST. ACCELERATE is capitalizing on the penetration of low-cost smartphones in Indian markets to promote HIVST to KPs. Through targeted advertising on online social media and dating sites, tailored videos are displayed based on the anticipated risk behaviors of the viewer. Videos driven by character narratives influence viewers' HIV risk perception, develop self-efficacy for accurate HIVST procedures, and encourage linkage to care. Campaign effectiveness analyzed through web analytics and surveys can inform novel designs for online behavior change communication strategies, demonstrate new insights for HIVST messaging, and explore challenges such as quantifying impact and achieving equitable reach tied to HIVST costing structure and smartphone access.

Background/Objectives:

Marginalized key populations (KPs) are underserved in HIV testing and prevention efforts. HIV self-testing (HIVST) is an innovative approach to reduce inequitable service access, especially for KPs who face barriers to in-person care. Due to the expected supply-side surge and autonomous nature of HIVST, communication campaigns are needed to effectively persuade populations at risk for HIV to accept, access, and accurately use HIVST kits. Leveraging the increasingly widespread use of mobile technology by advertising on social media sites popular among KPs in India, ACCELERATE aims to promote self-efficacy for increased HIVST uptake and linkage to care.

Description of Intervention and/or Methods/Design:

ACCELERATE is creating a communication campaign promoting HIVST and linkage to care to select KP groups in India who use online networking and social media sites and are at high risk to acquire or transmit HIV (i.e., men who have sex with men, female sex workers, and transgender individuals). ACCELERATE is creating three versions of video advertisements featuring distinct characters who demonstrate high-risk behaviors tailored to our target groups. Based on the Extended Parallel Process Model, our videos influence viewers' perceived susceptibility of contracting HIV and HIV disease severity through character narratives and introduce HIVST as an effective tool to know one's HIV status. Each video incorporates a demonstration showing how to use a HIVST kit and connect to care, promoting the constructs of response efficacy and self-efficacy. Advertisements include links to a website with resources to acquire HIVST kits and access to further HIV education and support.

Results/Lessons Learned:

As one of the first HIVST communication projects worldwide, monitoring and evaluating ACCELERATE's online campaign can shape global HIVST roll-out. Informed by previous targeted campaigns on Indian social media and dating sites, ACCELERATE will use audience segmentation techniques, including algorithm-based artificial intelligence, to match the viewer to relatable content. ACCELERATE will monitor web analytics to track indicators including viewer impressions, clicks, referrals to our website, bounce rate, usability, pages accessed and self-reported outcomes related to HIVST from online surveys. Surveys will measure behavioral constructs which our messaging aims to influence (i.e., perceived HIV susceptibility and severity, response efficacy and self-efficacy). Findings will demonstrate the effectiveness of ACCELERATE's campaign to encourage viewer engagement with additional online content, promote self-efficacy for HIVST, and assess user behaviors to seek confirmatory testing after a positive HIVST result.

Discussion/Implications for the Field:

HIVST has potential to reduce barriers of engagement for HIV testing and care such as stigma and inconvenience associated with in-person services. Promoting HIVST to KPs through online targeted advertising supports high-risk populations overcome these barriers. ACCELERATE's approach explores challenges inherent to online communication strategies such as measuring impact on specific behaviors as well as ethical considerations of restrictions due to smartphone access, cost of HIVST kits, and mental health risks of autonomous HIV testing. Findings from ACCELERATE's HIVST campaign can inform future HIV prevention, testing, and care messaging directed at KPs and online advertising leveraging social media.

Abstract submitted by:

Rose Pollard - ACCELERATE Program, Johns Hopkins Medicine
Samit Tandon - ACCELERATE Program, Blue Lotus Advisory
Jalpa Hasmukh - ACCELERATE Program, Johns Hopkins Medicine