Development, Implementation, and Scale Up of the National Furaha Yangu Campaign to Promote HIV Test and Treat Services Uptake Among Men in Tanzania

"The ongoing campaign's messages and SBC [social and behaviour change] efforts include pictures and videos of men diagnosed with HIV as joyful and in control of their lives because they were healthy, employed, and socializing with their family members and peers as a result of ART [antiretroviral therapy] initiation and adherence."

Furaha Yangu! (My Happiness!) was a national campaign whose purpose was, in part, to increase awareness and uptake of Test and Treat services (immediate HIV treatment initiation upon a positive HIV test) at the national level in Tanazia. To inform the development and implementation of the campaign, researchers conducted formative audience insights-gathering (AIG) sessions to assess emotional facilitators and barriers to access and uptake of HIV Test and Treat services. This article reports the findings from the AIG sessions and explains how they were used to inform the creative development of concepts, messages, materials, and media that fed into the national campaign's social and behaviour change (SBC) efforts to reach different groups, with a focus on heterosexual men.

The Furaha Yangu! (My Happiness!) Test and Treat campaign was developed and implemented as part of the USAID Tulonge Afya (Let's Chat about Health) project, which was a nationwide programme that is described at Related Summaries, below. Furaha Yangu! was developed by the Government of Tanzania (GoT), along with other partners, including the Prime Minister and Tanzania Commission of AIDS (TACAIDS), in collaboration with local and international stakeholders, namely, Family Health International (FHI) 360. The design and implementation of the campaign were informed by FHI 360's Audience-driven Demand, Design, and Delivery (ADDED) theoretical framework, which uses an audience-centred approach to ensure strategies meet the diverse and complex needs of individuals, communities, and the SBC systems that support them.

Data for the AIG consultations were collected through in-depth interviews and focus group discussions FGDs that occurred between October and November 2017 and that involved 54 people who were unaware or aware of their HIV status and currently or not currently on treatment, as well as health workers. One questioning technique used was projective techniques, which depersonalise the question, thereby desensitising the respondent to the answer they give and deactivating their conscious defenses about the answer (e.g., "If behaviour change were a car, what kind would it be?")

Insights generated across all audience groups from the consultations suggested that there were four key emotional triggers that serve as facilitators and/or barriers of HIV services uptake, including: (i) a fear of testing positive for HIV; (ii) a deep desire and need to belong, which could be negatively affected by testing positive for HIV; (iii) the desire to maintain control and/or fear of losing control of their narratives (both a barrier and a facilitator of antiretroviral therapy (ART) initiation); and (iv) the concept of reinventing themselves to achieve their dreams and live a happy life by as a result of ART.

Guided by FHI 360's ADDED approach and the audience consultations, the creative concepts and SBC strategies developed for the campaign aimed to motivate men and the general public to seek HIV services (i.e., testing, early ART initiation, and adherence) by portraying that life after an HIV diagnosis was not bleak. Specifically, the campaign played off a My Happiness! creative concept to position ART as a solution to fears, especially for men, around what life would be like after a positive diagnosis and aligning immediate and sustained use of ART as a way for individuals and families to take control of their lives and future, allowing them to belong, reinvent themselves, and achieve their hopes and dreams. The campaign's messages were advertised and broadcast through several media, governmental, and community platforms where men socialise, including, but not limited to:

• Videos portraying different men working, playing soccer, and spending time with their families and friends in their communities while describing the importance of belonging, having control, and reinventing themselves by living an active life, made possible because of antiretrovirals (ARVs);
• Strategic outdoor billboards that emphasised key Test and Treat service calls to action messages with men in the pictures;
• Radio spots on high-male-listenership radio programmes that aired more than 8,500 times across national and regional radio stations;
• Social media content across Facebook, Instagram, and Twitter that was designed to further engage men in interactive reflection and dialogue around HIV risk perceptions, going to test for HIV if at high risk, and HIV-related stigma and discrimination;
• More than 110 Furaha Yangu interpersonal communication (IPC) sessions and 500 small group discussion sessions conducted with at-risk individuals, with a focus on men;
• Community-level toolkits, facilitated by community volunteers, that engaged men in fun activities and relevant dialog and that were employed tactically to profile and identify at-risk men; and
• Theatre events.

These SBC activities were often combined with community-based HIV testing services and referral services for voluntary male circumcision offered by implementing partners that provide health services, including HIV prevention counseling for those who tested HIV negative. There was a 16% increase in HIV testing uptake among men in the 6 months period during the campaign compared with 6 months prior. In addition, there was a 5% increase in new men living with HIV identified during the first 6 months compared with 6 months prior to the campaign: from 40,928 identified in January to June 2018 period to 43,052 men identified in July to December 2018.

Per the researchers: "The project's success in targeting men was rooted in its targeted implementation strategy. This includes implementation of mass media programming during time slots with high male listenership and community-based interventions using interactive and small group dialogs that targeted men who were at risk of HIV and also employed at hot spots (areas such as plantation areas, fisheries, highway parking stations, and mines). These factors contributed to high male uptake of testing services. The use of emotionally appealing messages developed from the audience insights helped further motivate men and the campaign's audiences."

Launched by the Prime Minister in Dodoma, Tanzania, on June 19 2018, the campaign was initially implemented in 12 regions. The support and strong buy-in from various stakeholders led to the scale-up and sustainability of the campaign to 26 regions.

In conclusion: "Given the success of the campaign based on the messages, activities, and creative concepts, as well as the support from multiple stakeholders, similar SBC strategies can be developed to reach men in other East African countries where men face similar HIV testing barriers."