The USAID-funded Linkages Across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) project, implemented in 30 countries, aims to increase the availability of and demand for HIV services for key populations and strengthen national government and civil society capacity to deliver these services. The objectives of the mid-term evaluation were to: assess project effectiveness, planning, management, service delivery, and sustainability; identify constraints to implementation; and propose recommendations for improvements. Methods included review of project documents and data, key informant interviews, and country visits.
All project countries have increased key population numbers being reached, being tested for HIV, and initiating treatment. This is a considerable achievement in a relatively short time and in contexts with significant policy, systems, and structural challenges. LINKAGES is making an important contribution to national responses for key populations by raising government awareness, supporting the provision of essential HIV services, and building the capacity of local implementing partners. LINKAGES is also introducing innovative approaches and identifying promising practices with the potential to engage “harder to reach” groups, increase HIV testing uptake and yield, and improve treatment uptake and retention. However, achieving some targets has been a challenge, and losses to follow-up occur at multiple points in the HIV cascade. Key lessons include the importance of demonstrating “proof of concept” to justify national scale-up, ensuring planning is informed by sound situation analysis and data, adapting approaches to local and hyperlocal contexts, strong collaboration with public sector providers of clinical services, sustaining capacity development for organizations providing services to key populations, and strengthening structural interventions.