A Spotlight on Strengthening HIV Self-Testing in the Private Sector (SHIPS)
Photos for this piece were provided by Harrizon Ayallo of PS Kenya and published in an original piece here.
Tell us about the SHIPS project and why it is relevant to self-care.
The project is a 2.5-year project led by Population Services International (PSI), and implemented by Population Services Kenya, PSI in Uganda and Society for Family Health in Nigeria. The project aims to grow the private sector market for HIV self-testing (HIVST) by bundling HIVST kits alongside other sexual and reproductive (SRH) products, thereby repositioning the use of HIVST for linkage to SRH and to HIV prevention, in addition to supporting with HIV case finding. We believe this will go a long way in reducing HIV- related stigma and normalizing routine use of HIVST. We are piloting an overall insight driven campaign through various media including digital, community and pharmacy activations to drive demand for HIVST in the private sector. The target population includes sexually active women and men 18 to 34 years old and men 35 years or older.
The specific pilot geographies in the three countries are: Nairobi and Kisumu counties in Kenya, Abuja and Lagos states in Nigeria and in Uganda’s capital of Kampala. Ultimately, the findings of the pilot will inform the development of a business/investment case and a road map for scale up of integrated HIV-SRH self-care in the private sector.
Since the project’s launch in November 2020, in what ways has SHIPS brough HIV self-care interventions closer to health consumers?
To date, SHIPS has taken several steps to begin growing the private sector HIVST market. The team conducted market research to determine the facilitators and barriers for HIVST within the private sector and designed solutions to increase consumer uptake. The findings from the market research were used in co-design sessions to develop the pilot elements that consist of – the overarching self-care campaign, the identification of private sector channels for selling HIVST kits, the product bundling mix, the tools for linking clients to information on where to purchase the kits, how to use them and referrals into appropriate prevention, care and treatment. On the ground implementation of these elements commenced in April 2022.
So far, early implementation of these solutions demonstrates that HIVST purchase through the private sector is steadily increasing in the pilot geographies due to the community mobilization and pharmacy activation events that have commenced. Private pharmacists and drug shop owners have reported increased inquiries of HIVST kits as well as increased sale of SRH products such as condoms, lubricants, pregnancy testing kits and contraceptives. The toll-free hotlines in Nigeria and Uganda have reported increased calls related to HIVST in the private sector – pointing to increasing confidence among consumers to gain information.
What has been the experience in building self-care interventions into the national HIV response? What were the main successes and challenges, and why?
Building self-care interventions into the national HIV response continues to be a work in progress. We are trying to take a total market, mixed health systems approach. In all the SHIPS implementation countries, we are playing a convening role that supports the ministries of health coordinate private sector players as well as regulatory agencies to ensure we build strong evidence and partnerships that will enable scale up of HIVST as well as development of supportive guidelines/frameworks. We are involved in reviewing HIVST and PrEP guidelines to include considerations for implementing through the private sector, refinement of communication strategies as well as leveraging on national HIVST campaigns. In addition, in Nigeria, SHIPS is providing technical support to the National Agency for the Control of AIDS to roll out a Global Fund-supported HIVST private sector engagement initiative. This will include pharmacy mapping, utilize already developed HIVST demand creation materials and continue to promote select pharmacies and referral sites in a WhatsApp chatbot. Looking ahead in all the three countries, the SHIPSs project will be instrumental in providing data to the government for successful future HIVST campaigns in the private sector.
The key deliverables for SHIPS include developing an investment case and road map for scale up through the private sector. We continue to work with the Ministries of Health to answer key questions such as who will pay for a sustainable scale up of HIVST in the private sector. Time and resources must be invested to convene key stakeholders, conduct further research on the market at large and identify potentials in ensuring holistic and sustainable service delivery. Further, there are emerging opportunities to expand to private health facilities/providers as well as de-medicalize HIVST thus expand through supermarkets; hence we have potential to open further channels of access which need to be explored.
How has SHIPS leveraged public-private partnerships to advance HIV self-care?
We are in the beginning stages of further solidifying multistakeholder partnerships that will inform and influence how the HIVST product supply chain is managed and how the retail price of HIV self-testing may be reduced. As the SHIPS pilot data becomes available, our team will strengthen these partnerships to activate financing for the scale-up of those pilot activities deemed successful. We have established multistakeholder advisory boards to provide oversight, which has helped shape interventions to country contexts and provide confidence to private sector providers interested in buying-in.
One way we have already begun to leverage public-private partnerships to advance HIV self-care is by partnering with private pharmacies and drug shops alongside public and not-for-profit sites that provide HIV products such as antiretroviral therapy (ART), post-exposure prophylaxis (PEP), and pre-exposure prophylaxis (PrEP). These partnerships will allow consumers who use HIVST to access requisite care following their test’s result.
For more information you may contact Serah Malaa, PSI’s Project Director of HIV Self Testing: [email protected]