This is a collection of real life examples of how organizations have used the Accelerator to help create demand for PrEP.
Building a media campaign to increase demand for PrEP
Despite PrEP having been rolled out nationally in Kenya in 2017, in early 2019, uptake among adolescent girls and young women (AGYW) remained low in Kiambu County, the second largest county in Kenya. AGYW are particularly vulnerable to HIV because of trans-generational relationships and a persistent inability to negotiate condom use across multiple partners. At the time, the average AGYW in the county hadn’t heard of PrEP at all and those that had were lacking the complete information necessary to consider PrEP as a viable option. Determined to reach this at-risk group, LVCT Health set out to increase demand for PrEP among AGYW.
The LVCT Health team, using their experiences of PrEP provision to AGYW in DREAMS sites and findings from the PrEP demonstration project they carried out prior to rollout in the country, knew that AGYW had key influencers who determined and directed their decision making, particularly their parents and sexual partners. The key influencers were seen as an important element in increasing awareness and, ultimately, uptake and continued use of PrEP by AGYW. However, due to more focus of HIV prevention towards most at risk populations in Kenya, the key influencers are likely to know even less about PrEP than AGYW themselves.
Therefore, the team chose to launch a media campaign to increase awareness of PrEP across Kiambu County, targeting AGYW and key influencers. To start, the team used information from the AGYW audience profile on the PrEP Communications Accelerator and took insights gleaned from it into the field to see whether or not the information resonated with their particular audience in Kenya. Largely, the profile was a match to AGYW in Kiambu County. Further, community dialogues were held with AGYW from DREAMS sites, AGYW peer leaders, male sexual partners of AGYW, parents of AGYW, and representatives from organizations providing services to young people in Kiambu. The dialogues provided additional context specific information in terms of experiences, knowledge and attitude towards PrEP use by AGYW.
In parallel to this testing, the LVCT Health team worked to engage a creative agency to support the media campaign. Using the Creative Partner Request for Proposal (RFP) Template provided by the PrEP Communications Accelerator, LVCT Health reached out to a number of agencies and selected the one that could best meet the needs of the campaign in a cost efficient way. The team used the Strategy and Creative Brief Template to brief the agency and kick off work.
The creative agency that the LVCT Health team partnered with came up with two approaches. One was campaign influenced by a tele-novella style that followed a fictional AGYW character across various situations including romantic relationships and friendships. The other was a social-media focused campaign designed to highlight conversations between AGYW and their parents. Based on feedback from community dialogues with AGYW, LVCT Health ultimately combined the two approaches. A character called Nimo was created but also incorporated the conversational and social media elements of the second approach.
The Media Planning section of the PrEP Communications Accelerator helped the LVCT Health team to plan which media channels they would use to speak to each audience. Initial responses to early campaign materials have been positive—audiences appreciate that Nimo looks like a typical Kiambu girl.
The LVCT Health team is continuing to measure the impact of the campaign with weekly and monthly metrics from December 2019 when the first videos were put up on the institutional social media platforms. Apart from these platforms, the campaign metrics will also be put up on the LVCT Health One2One platforms that serve young people and shared on WhatsApp platforms of young people and their peers. Metrics being measured include the number of times a post has been liked or shared and how many calls One2One help lines are receiving from young people in Kiambu about PrEP.
Using a creative agency to craft a meaningful campaign
In early 2019, Pangaea Zimbabwe AIDS Trust (PZAT) set out to create a demand creation campaign for PrEP targeted at adolescent girls and young women (AGYW) in Chitungwiza, Zimbabwe. The idea to do a demand creation campaign came at a time when uptake was low among sites delivering PrEP in Zimbabwe, with limited reach within at-risk groups. The team focused on AGYW specifically because this target group accounts for 74% of all new HIV infections among adolescents in sub Saharan Africa.
The campaign’s main objective was twofold: increase both foot traffic to the SHAZ! Hub—a youth drop-in center in Chitungwiza where PZAT operated and AGYW could access PrEP—and the number of AGYW taking up PrEP at the Hub. For the PZAT team, developing a campaign was a new endeavor, something they didn’t have the internal know-how to execute. So, they turned to the PrEP Communications Accelerator to guide them through the process.
PZAT used the Demand Creation 101 feature of the Accelerator and community dialogues with the local AGYW community to help formulate the campaign’s problem statement and to define the communications objectives. The PrEP Communications Accelerator helped the PZAT team follow a defined, step-by-step process, allowing them to track which stage of the campaign creation they were in at any point while clearly identifying what would come next. The Accelerator also helped the team define a timeline for their activities. “The Accelerator ensured that our campaign was done in a very systematic way. We had a structure that we followed immediately,” said Definate Nhamo of PZAT.
Equipped with core campaign ideas and a defined process and timeline, PZAT set out to identify a creative agency to develop their campaign’s materials. The team used the Strategy and Creative Brief Template to brief the agency and kick off work. The agency developed different creative concepts which PZAT tested with AGYW to see if the campaign materials resonated with them. Concept testing was informed by the Creative Testing Sample Questions provided on the Accelerator. PZAT carrying out this testing, with light support from the creative agency, was one way to keep campaign costs down.
Taking into consideration feedback from the testing process, the creative agency came up with new materials. PZAT defined the campaign assets they needed for the campaign—including billboards, posters, flyers, social media content, and a video—that endeavored to include all of the various realities of AGYW and the preparedness narrative throughout the campaign. The campaign was live in Chitungwiza from September 2019 to December of 2019. PrEP initiations amongst AGYW accessing the Hub increased by 47% in the 9 weeks following campaign launch, when compared to baseline data spanning 14 weeks prior to the launch. PrEP initiations amongst all people accessing the Hub increased by 113% in the same time period. In addition, the number of people coming to the Hub who had heard of PrEP nearly doubled. The team will continue to track metrics over time to evaluate the impact of the campaign.
To view assets, and learn more about this campaign, view the campaign photo story.
Drafting a demand creation strategy
When the Zimbabwe Ministry of Health and Child Care, planned an introduction and rollout of PrEP, with Pangaea Zimbabwe AIDS Trust (PZAT), and other partners, they set ambitious goals: To reach high-risk groups (such as men who have sex with men, transgender and adolescent girls and young women) as well as other people who perceive themselves to be at substantial risk. The team tasked with developing a national HIV prevention, care and treatment communications strategy had the resources to engage 13 population groups directly through key informant interviews, consultations and focus groups. With a wide group of stakeholders involved in the effort, they needed an overall vision and guidance on the best way to approach drafting a new demand creation campaign strategy.
From the earliest stages, the team used the PrEP Communications Accelerator to guide and support its work—even the initial Terms of Reference, used to recruit the consulting team, drew from PrEP Communications Accelerator materials. Throughout the process, resources from the PrEP Communications Accelerator served as useful guides for deeper local research; for example, insights from the Audience Profiles served as the foundation for focus group questioning. And even though the team was engaging a far wider group of audiences than those found in the PrEP Communications Accelerator, they were able to use the research as a guide for creating questions about audience motivations, behaviors, and relationship to high-risk activities. In other words, the PrEP Communications Accelerator was a true jumping-off point.
The team has drafted the official communications strategy, based on primary research and a process that has been buttressed by the PrEP Communications Accelerator from start to finish. More broadly, PrEP Communication Accelerator materials have helped to align diverse stakeholders and develop a shared vision for their work: Outputs from the “Communications Fast Tracker” have been used as a model for team members as well as participants in stakeholder interviews, and the “Demand Creation 101” section was shared with high-level partners and ministry officials, especially those without much professional background in communication. Feedback on the PrEP Communications Accelerator from all partners has been positive, and the national HIV prevention, care and treatment communications strategy was completed in April, 2019.
Linkages Across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES)—a global project funded by USAID and PEPFAR to deliver HIV prevention, care, and treatment services to key populations—began working with Eswatini’s Ministry of Health to launch one of three PrEP demonstration projects. During the implementation of the project, the LINKAGES team found that groups and organizations across the country working to implement PrEP were struggling to create demand and, among those who chose to use PrEP, continuation over time was low. In order to address the demand and PrEP continuation challenges identified, the team sought to carry out informal dialogues with members of key populations to better understand the needs of current and potential PrEP users in the country. As a starting point, LINKAGES used the PrEP Communications Accelerator to better understand these factors across a range of settings, particularly how PrEP fits into the lives of the populations they wanted to reach.
The team used the Community Dialogue Discussion Guide Template to prepare for and inform the community dialogues they were conducting. They also looked closely at the Audience Profiles to gain insight into the specific, PrEP-related needs of key populations that may be relevant in Eswatini. Because the profiles are filled with information that includes suggested communication messages that have resonated with relevant audiences in other countries, LINKAGES was able to fast-track their community dialogues by calibrating and building off of messages that had already been validated elsewhere.
Being able to access deep, quality information in one place allowed the LINKAGES team to more quickly and efficiently prepare for the dialogues they needed to hold as well as craft questions to ensure that they got specific, useful information to inform their future PrEP-related activities. The information from the Audience Profiles was used as a substitute for substantial portions of the literature review process that typically informs the community dialogue preparation process. While the PrEP demand generation activities are still being developed, the PrEP Communications Accelerator has already been useful in laying the groundwork for the project’s PrEP dialogues and message development. “The [PrEP Communications] Accelerator is terrific. It’s clear that so much work has gone into every component of it,” says Rose Wilcher, LINKAGES’ Director of Knowledge Management. “As someone who works everyday on key population-related programming, sometimes it can be really hard to get communications right. The profiles did a good job in capturing the nuances and concerns of key populations related to PrEP use.”