UNAIDS AND WHO 2022

POLICY BRIEF

POLICY BRIEF
Virtual interventions in response
to HIV, sexually transmitted
infections and viral hepatitis
Innovate—Implement—Integrate
 This policy brief is a result of ongoing collaboration between the Joint United Nations
Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) on
innovations in HIV testing services and virtual interventions.

The development of this document was led by the UNAIDS Regional Support
Team, Asia and Pacific and the WHO global HIV, hepatitis and STI programmes.
Taoufik Bakkali and Salil Panakadan from UNAIDS and Rachel Baggaley, Muhammad
Shahid Jamil and Cheryl Johnson under the leadership of Meg Doherty from WHO
coordinated the development of this policy brief. Purvi Shah, Regional Consultant,
UNAIDS and WHO, contributed to the development of this policy brief and wrote the
draft. This brief was developed in collaboration with Benjamin Eveslage from FHI 360
and adapts content from FHI 360’s Going Online framework and set of approaches.

Members of the WHO differentiated HIV testing services technical working group
provided guidance and supported external review.

The Global Fund to Fight AIDS, Tuberculosis and Malaria through the Sustainability
of HIV Services for Key Populations in Asia programme grant by the Australian
Federation of AIDS Organisations contributed to the funding of this brief.

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Background

Virtual and online channels have become increasingly common over the past
decade, changing the way people connect with each other and access health-related
information and services. In 2021, about 60% of people worldwide were connected
online, and 54% of these used social media.1 Many people, including those from
key populations, use social media platforms and dating apps to find partners online
because they find them private and convenient.
Over the past two years, the COVID-19 pandemic has presented new barriers to
in-person and facility-based health services, highlighting the importance of virtual
channels to support access to health services.
Many HIV programmes have introduced online and phone-based interventions to
connect people to appropriate services. Interventions include simple client self-
assessment, appointment-booking systems, phone-based information and counselling
services, ordering of HIV self-test kits, and virtual consultations with providers.
During the COVID-19 pandemic, there has been greater use of HIV self-test kits and
online distribution models. Routine adherence support for pre-exposure prophylaxis
(PrEP) and antiretroviral therapy has expanded to include online and phone-based
support, supplemented with home delivery and multimonth dispensing.
Programmes are looking for innovative ways to support service continuity and reach
people who do not access traditional services. Virtual interventions are an important way
to support such efforts. Programmes can design flexible self-care pathways for clients to
access services for HIV, sexually transmitted infections, tuberculosis (TB), viral hepatitis
and other diseases, with the ability to offer virtual support. This helps to conserve health
system resources and decreases the need for client travel and in-person contacts.
Virtual interventions should complement and enhance existing health system functions
through mechanisms such as accelerated exchange of information, reach and improved
access to services, but they do not replace the fundamental components needed by
health systems such as the health workforce, financing, leadership and governance,
and access to essential medicines.
An understanding of which health system challenges can realistically be addressed
by digital technologies and an assessment of the ecosystem’s ability to absorb such
digital interventions are needed to inform investments in digital health. Adoption of
the recommendations in this brief should not exclude or replace the provision of good-
quality non-digital services in places where there is no access to digital technologies,
or the technologies are not acceptable or affordable for people from the priority
populations.2

1 Special report: digital 2021—your ultimate guide to the evolving digital world. London: We Are Social; 2020
(https://wearesocial.com/digital-2021).
2 WHO guideline: recommendations on digital health interventions for health systems strengthening. Geneva: World Health Organization; 2019
(https://apps.who.int/iris/bitstream/handle/10665/311941/9789241550505-eng.pdf?ua=1).

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 This brief provides guidance for countries developing and implementing
comprehensive virtual intervention services. It is complementary to a more detailed
guide on planning and budgeting.3
This brief aims to:

► Support programmes and governments to identify relevant virtual interventions

to accelerate progress towards meeting global HIV goals, including the 95–95–95
targets by 2025, and sexually transmitted infection and viral hepatitis goals from the
global health sector strategies.4,5

► Provide directions to programmes and governments in planning, adapting and

implementing safe and effective virtual service delivery during COVID-19 restrictions
and learn from these for future implementation.

► Provide guiding principles and an adaptable framework for virtual interventions to

enable stakeholders to prioritize approaches and activities based on the country
context and needs.

► Help programmes identify technical assistance needs for approaches they would like
to plan and implement.

3 Virtual HIV interventions: a budgeting and programming aid. Washington, DC and Geneva: FHI 360, Global HIV Prevention Coalition and
Joint United Nations Programme on HIV/AIDS; 2022 (https://hivpreventioncoalition.unaids.org/resource/3332/).
4 Global health sector strategy on sexually transmitted infections 2016–2021. Geneva: World Health Organization; 2016 (http://apps.who.int/
iris/bitstream/handle/10665/246296/WHO-RHR-16.09-eng.pdf?sequence=1).
5 Global health sector strategy on viral hepatitis 2016–2021. Geneva: World Health Organization; 2016 (https://apps.who.int/iris/bitstream/
handle/10665/246177/WHO-HIV-2016.06-eng.pdf?sequence=1&isAllowed=y).

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What are virtual interventions?

Virtual interventions for programmes use virtual channels to create demand for services,
and to reach and engage clients in services. Virtual interventions include simple phone-
based options such as voice calls and messaging, which can be used in settings where
internet access is low but mobile phone use is high. Internet-based options such as
messenger apps, social media apps, online marketing and advertising platforms,
smartphone apps and websites are more applicable in settings with good internet access
and coverage, and where focus populations have access to smartphones.
Virtual interventions enable clients to access services virtually, and anonymously if
preferred, without the need to visit a facility or provider. Virtual interventions can improve
efficiencies within health systems and facilities by freeing up provider time and allowing
them to focus on people who need greater attention, such as those with symptoms.
For clients, this can address long waiting times at facilities, improve convenience and
confidentiality, and reduce opportunity costs associated with visiting facilities.
Virtual case management (also known as targeted client communication) is a virtual
intervention used to manage people living with HIV or other conditions.6 This typically
involves the use of virtual tools to support clients in their journeys and engagement
with the health system after diagnosis. Virtual case management can support
differentiated service delivery models such as community- or home-based services,
including antiretroviral therapy and PrEP initiation and refills, virtual consultations and
support, automated or provider-led client reminders, and chatbots.
The field of virtual interventions is rapidly emerging and evolving. Available evidence
and experiences highlight the potential of virtual interventions to support services
for HIV and sexually transmitted infections. A systematic review of interactive virtual
interventions showed a positive effect on HIV knowledge and prevention behaviours
compared with minimal interventions (e.g. waiting lists, leaflets), and interactive virtual
or digital interventions were at least as effective as fact-to-face interventions.7 Another
systematic review showed that eHealth interventions increased HIV testing and retest-
ing among men who have sex with men.8 Further systematic reviews show mHealth
HIV testing interventions increase testing uptake among men who have sex with men
and other higher-risk populations,9 and mHealth interventions improved antiretroviral
therapy adherence among people with HIV in Asia.10 Additionally, virtual interventions
may reach people who do not otherwise access services and can help implement other
interventions such as distribution of HIV self-tests and self-sampling (see Case study 1).
Implementation research and documentation of experiences are needed to understand
optimal implementation approaches and platforms and community preferences.

6 Classification of digital health interventions v1.0. Geneva: World Health Organization; 2018 (http://apps.who.int/iris/bitstream/
handle/10665/260480/WHO-RHR-18.06-eng.pdf;jsessionid=0156412EB9F07193D4C4B389C73ACEBB?sequence=1).
7 Bailey JV, Waayal S, Aicken CRH, et al. Interactive digital interventions for prevention of sexually transmitted HIV. AIDS. 2021;35(4):643–653.
8 Long HN, Bach XT, Luis ECR, et al. A systematic review of eHealth interventions addressing HIV/STI prevention among men who have sex with
men. AIDS Behav. 2019;23(9):2253–2272.
9 Horvath KJ, Walker T, Mireles L, et al. A systematic review of technology-assisted HIV testing interventions. Curr HIV/AIDS Rep.
2020;17:269–280.
10 Adil M, Ghosh P, Sharma M, et al. Effect of mobile health interventions on adherence of anti-retroviral therapy in HIV infected Asian patients: a
systematic review and meta-analysis. Int J Infect Dis. 2020;101(Suppl. 1):205.

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 Case study 1
Virtual platforms to promote self-care approaches and distribution
of HIV self-tests to priority populations
The use of social media platforms and dating apps to reach people with health services
is becoming increasingly common. Many countries and programmes now use online
and digital platforms to promote self-care approaches and HIV self-testing distribution.
During the COVID-19 pandemic, virtual service delivery, distribution of self-tests and
PrEP and antiretroviral therapy refills, online consultations and virtual case management
have facilitated continuity of essential services for people from priority populations.
Some programmes co-package HIV self-testing with other self-care options, such as
condoms and COVID-19 prevention packages (e.g. masks, sanitizers). An example is
the LoveYourself SelfCare initiative in the Philippines.
SelfCare was officially launched in October 2020 as the first unassisted self-testing
service in the Philippines. SelfCare is designed for people who would like to know
their HIV status quickly, safely and securely in their own homes, thus addressing issues
of privacy and convenience. Clients can visit the SelfCare Facebook page and follow
the online prompts to order self-tests. Instructions on use, pricing and shipping are
provided.
Results from implementation between January 2021 and April 2022 focusing on men
who have sex with men and transgender people show that 11 139 people expressed
interest in getting a HIV self-testing kit. A total of 5279 kits were delivered, 1804 clients
reported their results, and 146 (8.09%) clients tested positive for HIV.
LoveYourself has also implemented other innovative virtual approaches, including a
virtual chatbot (Enzo), hybrid PrEP initiation (PrEPPY), telemedicine through online
consultations (iCON), a mobile laboratory (acXess), express delivery of commodities
such as condoms, lubricants and antiretroviral medicines (Xpress), and community-
based mental health services (Flourish). These virtual platforms provide services without
clients having to visit facilities.

Figure 1.
SelfCare initiative from LoveYourself

Source: LoveYourself, Philippines.

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Why should programmes go virtual?
Virtual interventions can help programmes accelerate progress towards achieving
national goals by:

► Expanding outreach efforts and services for populations that otherwise remain
unreached through traditional in-person services.

► Connecting with the growing number of people who use the internet and prefer to
access services using virtual channels.

► Focusing promotion and demand-creation efforts on people who may benefit from
them (e.g. with adverts on social media or dating apps) or are already seeking
services online (e.g. with search engine adverts).

► Providing new options that better meet the preferences of people for fast,
convenient and affordable virtual services and support without stigma and
discrimination.

► Improving efficiency of service delivery and conserving clinic capacity by reducing

unnecessary clinic visits for people who can receive check-ups and consultations
virtually.

► Mitigating COVID-19 service disruptions and other potential health emergencies

that may limit the ability of programmes to offer uninterrupted in-person outreach
and service delivery.

Who can benefit from virtual interventions?

Virtual interventions can be offered to people from a range of populations, including
people at risk for HIV, sexually transmitted infections and viral hepatitis (Figure 2).
Virtual interventions may also be attractive to people who prefer more privacy,
anonymity or convenience, and for people already using virtual channels to socialize,
find health information, or connect and meet people for dating, sex, sex work or drug
use. Depending on the country context, epidemiology and gaps, priority populations
for virtual interventions may include:

► People who have undiagnosed HIV, are worried about getting HIV, or are at risk of
HIV or other conditions such as viral hepatitis, sexually transmitted infections or TB.

► Key populations (including young people from key populations and their partners),
such as men who have sex with men, sex workers, transgender people, and people
who inject drugs.

► People living with HIV, PrEP clients, partners of people living with HIV, and other
context-specific priority populations such as adolescent girls and young women,
migrants and truckers.

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Figure 2.
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Source: Virtual HIV interventions: a budgeting and programming aid. Washington, DC and Geneva: FHI 360, Global HIV Prevention Coalition and Joint United Nations Programme on HIV/AIDS;
2022 (https://hivpreventioncoalition.unaids.org/resource/3332/).

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Framework for adopting and
implementing virtual interventions

World Health Organization (WHO) guidance on digital interventions for health

systems strengthening provides overarching recommendations for evidence-based
interventions to improve health systems and address challenges along the pathway to
universal health care.11
The example framework presented in this brief addresses several health system
implementation layers including coverage, demand, accessibility and accountability
(Figure 3). The framework guides adoption and implementation of virtual interventions
by programmes. The framework represents client engagement steps across the
cascade of service delivery, with potential virtual intervention approaches that can
support each of the cascade steps. Virtual intervention approaches for each step
must be adapted according to the local context, epidemiology, technology, policy
environment and community preferences. It uses an implementation cycle that consists
of planning, reaching and engaging, and monitoring and improving.
Further information on these approaches, including security and privacy considerations
and budgeting guidance, is available.12

Plan
To plan effective virtual interventions, programmes should take steps to identify
potential priority populations that can be reached virtually and will benefit from virtual
interventions. Virtual intervention approaches and strategies can then be designed
based on the needs and preferences of these populations. The following approaches
can be used to inform the planning process:

► Rapid online surveys such as short programmatic (non-research) surveys can

help programmes, policy-makers and implementers better understand population
segments that use online platforms and can benefit from virtual services for HIV,
sexually transmitted infections and viral hepatitis. They also increase understanding
of risk behaviour-related service needs, technology use, social media interests,
service access history, and preferences for accessing services.

► Social media mapping enables programmes to conduct online searches, find and
list online spaces where people meet virtually (e.g. social media groups, pages,
group chats), and identify potential social media influencers (popular people on
social media) who can reach users to promote services and generate demand.

11 WHO guideline: recommendations on digital health interventions for health systems strengthening. Geneva: World Health Organization; 2019
(https://apps.who.int/iris/bitstream/handle/10665/311941/9789241550505-eng.pdf?ua=1).
12 Virtual HIV interventions: a budgeting and programming aid. Washington, DC and Geneva: FHI 360, Global HIV Prevention Coalition and
Joint United Nations Programme on HIV/AIDS; 2022 (https://hivpreventioncoalition.unaids.org/resource/3332/).

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 ► Density mapping of dating app users within a certain geography enables
geo-mapping and identification of the most frequented locations (virtual hotspots).
This can help outreach workers reach populations when they are most active.

► Estimating the size of the potential online audience based on the number of active
users on online platforms is important for planning the scale of online outreach,
resources needed and promotion efforts.

► Audience segmentation refers to subdividing populations based on typology, risk

behaviours, health-seeking behaviours and current health status. Segmenting online
populations can help programmes match tailored communication campaigns or
service delivery pathways to meet users’ needs and preferences.

► Community advisory groups represent the community and help programmes

engage and learn from new population segments that they aim to reach and
engage. Many countries and programmes have existing community advisory groups
that can be leveraged for virtual interventions.

Reach
Based on findings from the planning phase and identification of priority populations
that may benefit from virtual interventions and potential platforms, programmes can
start to create demand and raise awareness about services and support engagement
in these services. This is often done through social media and other online and virtual
channels used by people from the priority populations.
It is important that any virtual demand-creation approaches and content address
the preferences and interests of people from priority populations; provide culturally
appropriate, accurate and evidence-based information; and dispel myths.
The most promising approaches that can be adapted and implemented to reach target
audiences include the following:

► Social network outreach: train existing or new outreach staff to conduct virtual
outreach to people from priority populations with services such as one-to-one chats
on online or virtual platforms about prevention, testing, treatment and retention.
Trained staff can contact peers or online networks and link them to services.
Untrained community members can also be mobilized to encourage social contacts
to access services.

► Social influencer outreach: engage influential, credible, well-connected individuals,

community leaders or celebrities as partners in virtual outreach and extend
programme reach into new online networks. Influencers include macro-influencers
such as celebrities and nano-influencers with smaller reach. Influencers may be
engaged by the programme in different ways, depending on the objectives and
available resources.

► Social profile outreach: use online advertising across social media, dating apps,
websites and search engines with increasing precision of reaching the right
populations based on demographics, interests and content of online activity.

Engage
Once reached, interested clients can be supported virtually using tailored, client-
centred approaches to help them access services. Services may be fully virtual (e.g.
distribution of self-testing kits, online ordering and delivery, virtual support), or they

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may allow virtual referral and navigation to facilities (e.g. for confirmatory testing after
HIV self-testing or initiation of PrEP or antiretroviral therapy). These approaches can
be particularly useful to link people to services, such as post-exposure prophylaxis
(PEP), needle–syringe services, opioid substitution therapy, HIV testing, identification
and referral of people with symptoms of sexually transmitted infections or HIV,
contraception, mental health services, and support for people experiencing violence,
and to support the client’s journey from initiation of antiretroviral therapy to achieving
viral suppression.
Approaches that can be adapted and implemented to engage people in services
include the following:

► Virtual case management is an individual relationship between a case manager and

a client. The case manager helps the client achieve goals along the service cascade.
Case managers focus on supporting their clients to initiate and sustain antiretroviral
therapy or PrEP, including refills, and assist and track clients as they access services
across a range of providers, including doctor consultations, telehealth and viral load
suppression.

► Home-based services can reduce client visits to facilities and the need for face-
to-face interaction with health-care providers. This can include prevention services
(e.g. PrEP refills), testing services (e.g. HIV self-testing with home delivery or pick-up
from collection points, pharmacies or vending machines), and treatment services
(e.g. antiretroviral therapy refills). Combination services can also be considered for
greater efficiency, such as offering prevention packages with condoms, lubricants,
self-tests and self-collection kits.

► Chatbots (bots) are computer programs that simulate natural human conversation.
Users communicate with a chatbot via the chat interface or by voice as if talking to
a real person. Programmes can use chatbots to support engagement with services,
including information and awareness, demand creation and referral to services.

Improve
It is important to review the success of virtual interventions in reaching people
from priority populations, engaging with them and improving access to services.
Programmes can adapt approaches to improve and reach their objectives. The
following approaches can be implemented to enable programmes to track, monitor
and manage virtual outreach and virtual case management services:

► Web and phone apps can be developed so that clients can easily make reservations
for health services using a smartphone, tablet or laptop. These tools may also
provide clinic and programme staff with functions for monitoring, tracking and
reporting the current status of the client.

► Existing programme tools can be adapted to distinguish when support or

service delivery results from virtual outreach or is delivered via virtual channels.
For example, client intake forms at facilities can be adapted to include an option
for virtual referrals, or existing data systems can be adapted to track clients on
antiretroviral therapy or PrEP.

► Programmes can establish electronic client feedback systems to collect

suggestions for improvement and feedback directly from clients who have been
reached or engaged by the programme virtually.

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Figure 3.
Framework for virtual intervention approaches across the HIV cascade
Community Engagement and Capacity Development Enabling Environment

Human rights | Gender equality | Stigma, discrimination and violence

TAILORED COMBINATION PREVENTION

Condoms, lubricant, PrEP, behaviour change,
community empowerment, sexual and reproductive
health and rights services including sexually
transmitted infections and harm reduction

Reach PrEP as part of combination prevention

Re-engagement
Initiate
combination Retain in Remain HIV
HIV - prevention prevention negative

HIV +

Treatment as prevention
Identify Reach HIV Test
Participation of people Initiate ART Sustain ART Suppress VL
living with HIV in broader
prevention programming

Approaches

Quick online Broad marketing Service locations

Self-reach Virtual case management and cohort tracking
surveys
Quick profile
Social online Government
surveys
outreach facility
Social media HIV
Virtual Decentralized Viral load referrals
mapping self-testing Medicine Distribution
Social counselling & home delivery and tracking
Social media Private
influencer
mapping
outreach provider
Density Network referrals
mapping
Online partner Auto-calculated Automated
Outreach
Quick online Community/
mobile/ notification refill status client reminders
Social network staff
surveys
Community drop-in centre
outreach
advisory groups
Socialnetwork
Social media Tools supporting various stages
Home delivery
mapping
referrals of the HIV services cascade
Audience size
estimation
ORA DHIS2
Index
Audience
segmentation Client feedback Chatbots

1. Plan 2. Reach 3. Engage

4. Improve

ART antiretroviral therapy DHIS2 District Health Information Software 2 ORA Online Reservation and Case Management App

Source: Virtual HIV interventions: a budgeting and programming aid. Washington, DC and Geneva: FHI 360, Global HIV Prevention Coalition, and Joint United Nations Programme on HIV/AIDS;
2022 (https://hivpreventioncoalition.unaids.org/resource/3332/).

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Implementation steps

Programmes need to view virtual interventions as an integral part of service delivery

and ensure resources and expertise to support their implementation. Technical
assistance to national programmes, staff and health-care providers can be provided by
WHO, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and other local and
international partners to adapt and operationalize approaches based on the country
context, priority populations and service delivery objectives.
The following steps may guide programmes in implementing virtual interventions:

1. Hold a community and stakeholder consultation to understand the needs and

preferences of the priority population to access services virtually.
2. Conduct situational analysis and plan virtual intervention models to map and
engage populations based on their context and requirement (e.g. internet or
phone-based).
3. Define and segment priority populations to be reached through virtual
interventions and establish mechanisms for their ongoing engagement in the
programme.
4. Design interventions that meet the priority population’s preferences based
on segmentation, including virtual outreach, service delivery models, referral
pathways, follow-up, and reporting mechanisms that may help in smooth transition
of clients across the cascade.
5. Develop a budget for the planned virtual interventions.13
6. Develop and generate demand for services and raise awareness among
populations based on segmentation. This may be outsourced to external partners
in the absence of capacity within programmes.
7. Procure devices such as tablets or smartphones and mobile data for outreach and
case management teams as needed.
8. Develop job aids and standard operating procedures for staff responsible for
implementing virtual interventions.
9. Train implementers on virtual approaches, such as online outreach workers, peers,
virtual case managers and service providers.
10. Implement the planned interventions. Consider a phased approach starting in
selected districts or populations, and then scale up to increase coverage and
service delivery options as experience grows.
11. Provide ongoing supportive supervision to teams implementing virtual
interventions on new approaches, security and safety or technology-related
updates.
12. Monitor and review outcomes regularly to see whether programmes are achieving
their objectives. Document any challenges, adverse events and client feedback.
Routinely share results of virtual interventions with partners, communities and
stakeholders to support programme adaptations, scale-up and national adoption.
Plan course corrections to improve performance by lessons learnt for future
scale-up and implementation.
See the Digital implementation investment guide for more guidance.14

13 Virtual HIV interventions: a budgeting and programming aid. Washington, DC and Geneva: FHI 360, Global HIV Prevention Coalition and
Joint United Nations Programme on HIV/AIDS; 2022 (https://hivpreventioncoalition.unaids.org/resource/3332/).
14 Digital implementation investment guide: integrating digital interventions into health programmes. Geneva: World Health Organization; 2020
(https://apps.who.int/iris/handle/10665/334306).

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 Considerations for successful
implementation of virtual
interventions

Virtual intervention is an emerging and rapidly evolving area. This policy brief provides
overarching principles and a framework for implementation of virtual interventions. It
is expected, however, that new experiences and lessons will readily accumulate over
time. Programmes need to remain flexible and continue to adapt service delivery,
approaches and models based on their own and others’ experiences. The following
considerations can support successful implementation of virtual interventions:

► Virtual interventions are meant to supplement existing services, including facility-

and community-based services. Clients should be able to choose their preferred
service options. Virtual approaches should not be implemented only as a cost-
saving measure but rather as an additional approach for clients to access services.
These interventions need to be integrated and adapted to use any platforms that
already exist to ensure sustainably and avoid duplication.

► As for any service delivery approach, community engagement and participation in

virtual interventions planning and development are essential to ensure suitability of
services for priority populations.

► Virtual implementation can greatly increase coverage of services with relatively

fewer resources, but it may not lead to a similar uptake of services. This is often due
to gaps in targeting and follow-up mechanisms. This is not unusual and should not
deter implementation and offering of virtual service delivery options. With time and
experience, it is expected that services will be focused appropriately, thus increasing
uptake. Offering a choice to clients in service delivery options may also increase
uptake.

► Turnover or attrition of trained staff and service providers is very common and
can often slow down progress. This should be anticipated, and ongoing online
capacity-building of staff should be budgeted for and provided. Care should be
taken to avoid loss of skilled specialists or providers. It is important to appropriately
remunerate staff and providers delivering services virtually.

► Ensuring the safety and security of client data and confidentiality of staff who
also work as peers is important. Adequate guidance and mechanisms should be
provided to ensure this.

► Implementation costs vary between countries and should be budgeted based on

the gaps that need to be filled with virtual interventions—for example, a country
with high internet costs might plan to use phone and SMS interventions instead of
virtual platforms (see Case study 2).

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 Case study 2
Virtual interventions for HIV programmes can be
implemented in a range of settings as an affordable
and impactful approach
Between 2017 and 2021, FHI 360 implemented an online outreach
and online reservation application (ORA) platform in Mali, Nepal
and Thailand. In each country, a unique set of activities adapted to
the local context, needs and resources was implemented to support
community HIV outreach by online outreach workers, based on popular
social media applications and internet coverage in each country. The
interventions included online demand creation such as periodic paid
advertisements and online influencer promotions through social media.
The interventions were effective in reaching people from priority
populations. More than two-thirds (69%) of clients who booked
appointments through ORA were first-time testers (47% in Mali, 81% in
Nepal; no data for Thailand). HIV positivity was higher compared with
traditional outreach (6.3% versus 4.4% in Thailand, 10.1% versus 3.6%
in Nepal, 15.6% versus 11.2% in Mali).
Online outreach through ORA contributed to the overall prevention,
testing and case-finding goals in all three countries. In Thailand,
between July 2017 and March 2021, online outreach accounted for
10% of all people reached by the programme, 11% of all people tested
for HIV, and 15% of all people who tested positive for HIV.
In Nepal, between October 2018 and March 2021, online outreach
accounted for 9% of all people reached, 4% of all people tested for
HIV, and 11% of all people who tested positive for HIV.
In Mali (which had a smaller online outreach team), between May 2020
and March 2021, online outreach accounted for 1% of all people tested
Figure 4.
and 2% of people who tested positive for HIV.
Outreach worker in Nepal Overall monthly programme costs for online outreach increased
conducting virtual outreach after introduction of ORA, but the cost per client diagnosed with HIV
decreased. ORA streamlined the journey from online outreach to offline
service uptake with automated SMS appointment reminders for clients
and follow-up by outreach staff if appointments were missed.
In Nepal, the cost per person sensitized was halved from US$ 8 to
US$ 4 after ORA implementation, and the cost per HIV diagnosis
dropped from US$ 1864 to US$ 914. In Mali, the cost per HIV diagnosis
decreased from US$ 1060 to US$ 827 after ORA implementation.
In Thailand, the cost was US$ 38 per person reached through ORA,
US$ 41 per test conducted, and US$ 652 per HIV diagnosis.
These experiences from diverse settings demonstrate that demand
creation and HIV service delivery through virtual platforms are feasible,
affordable and potentially impactful. This model can effectively reach
people who do not routinely access traditional services and remain
untested or undiagnosed. These lessons can inform implementation in
Source: EpiC Nepal, FHI 360.
other settings.

15
 Safety and security

To be effective and ethical, virtual interventions must be built on trust. This can be
achieved through strong community engagement, careful attention to protecting
service users and providers, and maintaining confidentiality as clients access
information and services through a variety of virtual channels.
Many people think of online platforms as being more anonymous and confidential
than face-to-face communication. Some people connecting through social media or
messaging apps create new virtual identities for communication with service providers.
Virtual outreach may be better suited for people who are more willing to connect
online or from the privacy of their phone or computer.
Virtual and mobile platforms have become increasingly sophisticated in data collection
and use, but assumptions about their anonymity may not be warranted. Programme
staff and beneficiaries may be unaware of how online platforms can monitor and use
data and how other users can cause harm. Additionally, the scale and centralization
of data collection from online outreach may lead to data security vulnerabilities that
have the potential for harm if there is a breach or if client data are handled improperly.
Programmes should ensure data security, client safety and privacy policies in their
country when considering the use of virtual and mobile platforms for outreach and
service delivery.
Programmes need to consider community-specific risks by engaging community
members and tailoring this vision and framework to the country context and audience.
The safety and privacy of beneficiaries and staff, and maintaining their trust, are
critically important for all programmes. As such, virtual and mobile platforms require
new safeguards and heightened awareness.
Additional safety and security guidance can be found in Secure use of mobile devices
and apps.15
Contact UNAIDS or WHO for support on virtual interventions.

15 Secure use of mobile devices and apps: a guide for HIV programs providing virtual client support. Washington, DC: FHI 360; 2021 (https://
www.fhi360.org/sites/default/files/media/documents/resource-secure-mobile-devices-apps.pdf).

16
UNAIDS
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Programme on HIV/AIDS Department of HIV/AIDS

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+41 22 791 3666 [email protected]

unaids.org who.int/hiv