EMPOWERING COMMUNITIES WITH DATA:

LESSONS FROM A GROUNDBREAKING HIV PROGRAM IN ETHIOPIA

By Bekele Belayihun (Dr.), Evidence and learning Director and Fana Abay, Marketing and Communication Director, PSI Ethiopia

In Ethiopia, tackling the HIV epidemic presents a formidable challenge, especially for female sex workers (FSWs) and other key populations, who face a prevalence rate around 20% — significantly higher than the less than 1% rate in the general population. USAID’s MULU program, led by Population Services International (PSI), is making remarkable strides by adopting a data-driven approach that is both innovative and impactful. Since its launch in 2018, this program has transformed the design and implementation of HIV prevention and treatment initiatives, specifically targeting FSWs and other key populations through community drop-in centers (DICs).

The Beginning of a Data-Driven Journey

Imagine a client-friendly drop-in center in Ethiopia where health workers convene weekly to address challenges and analyze data. These centers provide a safe, stigma-free space for FSWs and other key populations to access health and social services, share experiences, and receive support. The collaborative and engaging environment of these centers fosters data-driven decisions that build trust and lead to life-changing outcomes.

From the outset, the USAID MULU program was designed with a clear objective: to combat the HIV epidemic with precision and adaptability. By leveraging data for informed decision-making, the program sets clear targets for each DIC, integrates these into annual plans, and ensures accountability across all levels.

Building a Culture of Accountability and Innovation

One of the standout features of the MULU program is its focus on data ownership. Every team member, from project leaders to field managers, participates in regular performance reviews. These reviews focus on interpreting data to identify areas for improvement rather than assigning blame.

Bi-weekly meetings with USAID are dynamic sessions where real-time data drives the agenda. These meetings lead to actionable insights and a robust tracking system that adapts strategies to the community’s evolving needs. For instance, in October 2023, the program identified low achievements in KP_PREV and PP_PREV metrics. A detailed review revealed a lack of clarity at the site level regarding definitions. After updating these definitions, there was a notable improvement in both KP_PREV and PrEP (Pre-Exposure Prophylaxis — Daily pill preventing HIV in high-risk population) initiation metrics, enhancing access to PrEP for HIV-negative FSW clients.

Driving Innovation Through Peer-Centered Models

Innovation is at the core of the MULU program. By focusing on “peer” centers, the program identifies opportunities for transformative change that address persistent challenges. Peer-centered models, where those most affected by HIV are central to the solution, enhance treatment adherence and improve viral suppression rates. This approach enables providers to better understand and respond to the needs of their clients.

For example, addressing gender-based violence (GBV) among FSWs led to the development of a Social Behavior Change Counseling tool with peer educators. Since its implementation in January 2023, there has been a significant increase in the uptake of post-violence care and improved reporting of sexual violence. Notably, 91.5% of sexual violence cases received HIV testing, identifying one positive case, and 55% received post-exposure prophylaxis (PEP) with a 100% completion rate. This approach underscores the program’s commitment to addressing the complex needs of marginalized populations comprehensively.

Achieving Remarkable Results

The impact of this data-driven, innovative approach is profound. The program’s index and social network testing strategies have resulted in sustained HIV case rates of 11% for index testing and 3.6% for the social network strategy (SNS). These statistics reflect real, positive changes in lives and a secure future.

With 84% of the first target achieved (diagnosing 95% of all HIV-positive people), an average ART adherence rate of 90%, and viral suppression rates exceeding 95%, the program stands out as a model of success. It accounts for nearly a third of new HIV cases in its regions, outperforming other HIV programs that rely on passive client influx.

Lessons for the Future

The USAID MULU program provides valuable lessons for other organizations working with marginalized groups:

1. Data-Driven Innovation: In areas with low HIV prevalence, innovative, data-driven approaches are essential for achieving high caseloads and effective outcomes.
2. Peer-Centered Models: Placing peers at the center of service delivery enhances providers’ understanding of clients’ needs, improving treatment adherence and viral suppression.

By consistently identifying and addressing HIV cases through targeted strategies, the program not only improves service quality but also contributes significantly to the broader goal of tackling the HIV epidemic in Ethiopia. These data-driven decisions lead to early detection and prompt treatment, reducing the overall transmission rates and effectively curbing the spread of HIV. The insights gained offer a strategic blueprint for global initiatives, proving that targeted, community-centered strategies can effectively reverse the course of the HIV epidemic.

Key/Priority Populations in the Ethiopian context include groups such as female sex workers and others who are at increased risk for HIV infection due to specific high-risk behaviors.