From the Case Study Series from the United States Agency for International Development (USAID)'s AIDSTAR-One (AIDS Support and Technical Assistance Resources, Sector 1, Task Order 1), this report explores the process and results of a communication initiative designed to reach most-at-risk populations (MARPs) in India, including sex workers, people who inject drugs, and men who have sex with men. The Mumbai-based Avert Society is working in 5 districts of Maharashtra with partner non-governmental organisations (NGOs) to deliver HIV and sexually transmitted infections (STIs) testing via mobile testing clinics. This project is supported by the United States (US) President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID) and the National AIDS Control Organization (NACO), in coordination with the Maharashtra State AIDS Control Society (MSACS).
The rationale for using mobile clinics, instead of referring clients to existing HIV testing and counselling centres, was based on several assumptions - including that it would be easier for MARPs and bridge populations to access services if a mobile clinic came to select locations near them and during convenient times and that these groups might thereby enjoy greater anonymity, respect, and attention than at venues such as government hospitals. To implement the mobile clinic program, the Avert Society procured 6 large vans, each of which was remodelled and subdivided; training was also provided for counsellors, lab technicians, and doctors.
Organisers note that careful scheduling and advance outreach and promotion among the intended populations are key to the successful implementation of the mobile clinics. At the beginning of each month, the NGO responsible for the mobile clinic in each district convenes a scheduling meeting for all of the NGOs working with the intended populations in that district. For example, in Thane district, the NGO Udaan Trust, which serves the MSM community, proposed scheduling and locations that would best serve that community; namely evening hours near MSM cruising spots. Following completion of the schedule, each NGO's outreach workers and peer educators spread the word and encourage their contacts to visit the mobile clinic for HIV and STI testing on the dates selected. Sometimes, the collaborating NGOs also set up a tent at the location to promote the services of the mobile clinic, register clients with the NGO, and do advance counseling using the NGO’s own counsellors and peer educators.
"Although the mobile clinic program has only been operating for about a year, it has shown promising results. A typical day brings in 35 to 40 clients from high-priority groups, more than are usually seen daily in government HIV testing and counseling centers. The NGOs and their outreach workers and peer educators assert that they are reaching greater numbers of high-risk clients than they did before the program began...
Key to the success of the mobile clinic in each district is a close working relationship among the Avert Society, the NGO responsible for operating the mobile clinic and hiring staff, and the NGOs that work with MARPs in each district and refer clients to the mobile clinic. It was observed that good communication and relations were present among these three entities in each district. The monthly scheduling meetings are especially important to this coordination. The NGOs appreciate the participatory process and report that their suggestions are implemented and that the schedules reflect efforts to ensure that the mobile clinic's visits are timed to maximize convenience for their clientele."
Email from Anna Lisi to The Communication Initiative on November 9 2011; and AIDSTAR-One website, November 28 2011.