Special Report: ICT is Effective in Supporting Behavior Change Communication, Strengthening Peer Outreach and Facility-Based Services, and Increasing Service Uptake Among MSM and FSW
This report explores the impact of the Text Me! Flash Me! Helpline, which uses cell phone technology to provide most-at-risk populations (MARP) with friendly and accessible HIV and AIDS information, referrals, and counseling services from qualified providers. It is a creation of the Ghana SHARP project (Strengthening HIV/AIDS Response Partnerships), which is managed by AED (Academy for Educational Development), through collaboration with the Ghana National AIDS Control Program, the Ghana Health Services (GHS), and 9 local non-governmental organisation (NGO) Implementing Partners, and with funding by the United States Agency for International Development (USAID). The Helpline was launched in September 2008 through a pilot focusing on men who have sex with men (MSM) exclusively, and then was expanded in February 2009 to include female sex workers (FSW).
An evaluation of the Pilot, conducted in February-March 2009, included the review of 1,169 Helpline Client Session Report Forms completed by the 12 Helpline Counselors, a telephone survey of 135 randomly selected MSM Helpline clients, and focus group discussions (FGDs) with Helpline Counselors and MSM Peer Educators, among a number of other research methodologies. This report presents some of the findings from the Helpline Pilot Evaluation, along with information from AED/SHARP's Implementing Partners' monthly reports and data from MARP-friendly facilities entered into the project's routine performance monitoring database between the months of April 2008 and March 2009.
Preliminary information indicates that the Helpline has had a significant impact on sexually transmitted infection (STI) and counseling and testing (CT) service uptake among MSM and FSW.
Impact on STI services utilisation by MSM:
Seeking information about STIs was the second most frequent reason MSM Text Me! Flash Me! clients had for flashing the Helpline (the most frequent reason for flashing the Helpline was to seek basic information about HIV). 33.5% of the 1,169 Helpline client sessions held during the Pilot phase were in response to clients' requests for information about STIs. Approximately 37% of the 135 respondents who participated in the Helpline evaluation telephone survey spontaneously mentioned seeking information about STI, while 63% of those responding to an open-ended question about what they had learned about STI indicated that they learned about the symptoms. A smaller number of survey respondents reported learning about types of STIs, STI transmission routes, and overcoming STI stigma.
The Helpline Pilot evaluation suggests that the Text Me! Flash Me! services help to support MSM's care-seeking from qualified providers STI care and treatment, and may mitigate or reduce their tendency to rely on self-medication and care-seeking at pharmacies and drug shops.
Impact on STI services utilisation by FSW:
Whereas 82 FSW sought STI treatment in January 2009, after the Helpline expansion for FSW began the next month, that number rose to 182.
Impact on CT services utilisation by MSM:
Despite widespread knowledge of voluntary counseling and testing (VCT) sites, only a quarter (26%) of the 385 MSM respondents in AED/SHARP's 2007 behaviour surveillance survey (BSS) in Accra and Tema reported ever having been tested for HIV. The most common reason cited for not having been tested was that they "never thought about it."
CT remains the most frequent referral made through the Helpline. 1,169 (71.5%) of all client call sessions during the Pilot included a CT referral. Forty percent (466) of client call sessions also included psychosocial support on CT. Counselors reported that the MSM clients were afraid to receive their test results and feared rejection and/or discrimination if the results were positive. For example, in one of the bi-weekly meetings, a Helpline counselor described how an 18 year-old client was afraid to take the test because he was afraid of getting the results. By the end of the Helpline session, the client agreed to take the test but asked the counselor to meet him at the clinic to provide additional support. The counselor agreed, and reported that this additional psychosocial support helped the client to successfully receive CT services.
Of the survey respondents who were referred for services by a Helpline counselor, 47% reported that they followed up and went for these services. Seventy-seven percent said they intended to go for CT services, while 23% said they did not intend to, mainly because they were "already aware of my HIV status" or had "already taken the HIV test". Telephone survey respondents were also asked if after the Helpline call session they intended to go for CT services after the Helpline phone session. Most respondents (77%) reported they intended to go for CT services. Among those who said that they intended to go, 62% of those answering the question were motivated by their interest in knowing their HIV status. Several also indicated that they were motivated to go by what they "had learned about HIV" or because they were "moved by the message."
The Helpline Pilot was launched in September 2008. Whereas in August 2008 9 MSM pursued CT treatment, this number had risen to 303 by March 2009.
Impact on CT services utilisation by FSW:
Helpline services began reaching out to FSW in February 2009. Whereas in January 2009, 156 FSW pursued CT treatment, by March 2009 this number had risen to 388.
"This review clearly shows that the Text Me! Flash Me! services are strengthening the information, referrals and counseling services already provided through other project interventions, particularly peer education and facility-based services, and are resulting in an increased uptake of STI and CT services by FSW and MSM."
According to the report, most of the Text Me! Flash Me! services will be ending by June 30 2009 in preparation for the project's close in September 2009. Two of SHARP's non-governmental organisation (NGO) Implementing Partners, Prolink (which provides HIV services to FSW) and Maritime (which provides HIV services to MSM), have been trained and supported to have the capacity to continue operating the Helpline services in collaboration with the National AIDS Control Program and MARP-friendly Ghana Health Service clinics.
Editor's note: To request an electronic copy of this report, please consult contact details below. In addition, a PowerPoint presentation is available. "Preliminary Findings: Helpline Pilot Evaluation: Review & Dissemination Meeting for Implementing Partners, March 23, 2009" offers further information, including these preliminary conclusions about the Helpline:
- Generates trust among clients and increases their self-disclosure of sexual orientation.
- Appreciated and used by MSM as a source of friendly information, skilled advice, and psycho-social support.
- Texts seem to be effective reminders for key behaviours.
- Increases clients' knowledge and intention to adopt key behaviours.
- Increases effective CT and STI referrals with significant increase in CT/STI services uptake among MSM.
- Serves as an effective complement to peer education and facility-based services.
- The Helpline Counselors are doing a great job - very "MSM-friendly" and knowledgeable.
- Helpline Counselors are challenged by the time commitment and the lack of monetary incentives - this could be a threat to the sustainability of the Helpline.
- The Helpline Counselors' challenge of balancing responsibilities of a facility-based job with the Helpline phone counseling is another threat to sustainability.
Emails from Lydia Clemmons to The Communication Initiative on May 1 2009, May 8 2009, May 9 2009, and July 9 2009.