Findings from the Tushirikiane mobile health (mHealth) HIV self‐testing pragmatic trial with refugee adolescents and youth living in informal settlements in Kampala, Uganda
Abstract Introduction Urban refugee youth remain underserved by current HIV prevention strategies, including HIV self‐testing (HIVST). Examining HIVST feasibility with refugees can inform tailored HIV testing strategies. We examined if HIVST and mobile health (mHealth) delivery approaches could incr...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-10-01
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| Series: | Journal of the International AIDS Society |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jia2.26185 |
| _version_ | 1797646926398619648 |
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| author | Carmen H. Logie Moses Okumu Isha Berry Robert Hakiza Stefan D. Baral Daniel Kibuuka Musoke Aidah Nakitende Simon Mwima Peter Kyambadde Miranda Loutet Shamilah Batte Richard Lester Stella Neema Katie Newby Lawrence Mbuagbaw |
| author_facet | Carmen H. Logie Moses Okumu Isha Berry Robert Hakiza Stefan D. Baral Daniel Kibuuka Musoke Aidah Nakitende Simon Mwima Peter Kyambadde Miranda Loutet Shamilah Batte Richard Lester Stella Neema Katie Newby Lawrence Mbuagbaw |
| author_sort | Carmen H. Logie |
| collection | DOAJ |
| description | Abstract Introduction Urban refugee youth remain underserved by current HIV prevention strategies, including HIV self‐testing (HIVST). Examining HIVST feasibility with refugees can inform tailored HIV testing strategies. We examined if HIVST and mobile health (mHealth) delivery approaches could increase HIV testing uptake and HIV status knowledge among refugee youth in Kampala, Uganda. Methods We conducted a three‐arm pragmatic controlled trial across five informal settlements grouped into three sites in Kampala from 2020 to 2021 with peer‐recruited refugee youth aged 16–24 years. The intervention was HIVST and HIVST + mHealth (HIVST with bidirectional SMS), compared with standard of care (SOC). Primary outcomes were self‐reported HIV testing uptake and correct status knowledge verified by point‐of‐care testing. Some secondary outcomes included: depression, HIV‐related stigma, and adolescent sexual and reproductive health (SRH) stigma at three time points (baseline [T0], 8 months [T1] and 12 months [T2]). We used generalized estimating equation regression models to estimate crude and adjusted odds ratios comparing arms over time, adjusting for age, gender and baseline imbalances. We assessed study pragmatism across PRECIS‐2 dimensions. Results We enrolled 450 participants (50.7% cisgender men, 48.7% cisgender women, 0.7% transgender women; mean age: 20.0, standard deviation: 2.4) across three sites. Self‐reported HIV testing uptake increased significantly from T0 to T1 in intervention arms: HIVST arm: (27.6% [n = 43] at T0 vs. 91.2% [n = 135] at T1; HIVST + mHealth: 30.9% [n = 47] at T0 vs. 94.2% [n = 113] at T1]) compared with SOC (35.5% [n = 50] at T0 vs. 24.8% [ = 27] at T1) and remained significantly higher than SOC at T2 (p<0.001). HIV status knowledge in intervention arms (HIVST arm: 100% [n = 121], HIVST + mHealth arm: 97.9% [n = 95]) was significantly higher than SOC (61.5% [n = 59]) at T2. There were modest changes in secondary outcomes in intervention arms, including decreased depression alongside increased HIV‐related stigma and adolescent SRH stigma. The trial employed both pragmatic (eligibility criteria, setting, organization, outcome, analysis) and explanatory approaches (recruitment path, flexibility of delivery flexibility, adherence flexibility, follow‐up). Conclusions Offering HIVST is a promising approach to increase HIV testing uptake among urban refugee youth in Kampala. We share lessons learned to inform future youth‐focused HIVST trials in urban humanitarian settings. |
| first_indexed | 2024-03-11T15:08:55Z |
| format | Article |
| id | doaj.art-86852770f5fd48fabb3020637684eadb |
| institution | Directory Open Access Journal |
| issn | 1758-2652 |
| language | English |
| last_indexed | 2024-03-11T15:08:55Z |
| publishDate | 2023-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the International AIDS Society |
| spelling | doaj.art-86852770f5fd48fabb3020637684eadb2023-10-30T01:48:29ZengWileyJournal of the International AIDS Society1758-26522023-10-012610n/an/a10.1002/jia2.26185Findings from the Tushirikiane mobile health (mHealth) HIV self‐testing pragmatic trial with refugee adolescents and youth living in informal settlements in Kampala, UgandaCarmen H. Logie0Moses Okumu1Isha Berry2Robert Hakiza3Stefan D. Baral4Daniel Kibuuka Musoke5Aidah Nakitende6Simon Mwima7Peter Kyambadde8Miranda Loutet9Shamilah Batte10Richard Lester11Stella Neema12Katie Newby13Lawrence Mbuagbaw14Factor‐Inwentash Faculty of Social Work University of Toronto Toronto Ontario CanadaSchool of Social Work University of Illinois Urbana‐Champaign Urbana Illinois USADalla Lana School of Public Health University of Toronto Toronto Ontario CanadaYoung African Refugees for Integral Development (YARID) Kampala UgandaJohns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USAInternational Research Consortium (IRC) Kampala UgandaInternational Research Consortium (IRC) Kampala UgandaSchool of Social Work University of Illinois Urbana‐Champaign Urbana Illinois USANational AIDS and STI Control Programme, Ministry of Health Kampala UgandaDalla Lana School of Public Health University of Toronto Toronto Ontario CanadaOrganization for Gender Empowerment and Rights Advocacy (OGERA Uganda)KampalaUgandaDepartment of Medicine University of British Columbia Vancouver British Columbia CanadaDepartment of Sociology and Anthropology Makerere University Kampala UgandaCentre for Research in Psychology and Sport Sciences School of Life and Medical Sciences University of Hertfordshire Hatfield UKDepartment of Health Research Methods, Evidence and Impact McMaster University Hamilton Ontario CanadaAbstract Introduction Urban refugee youth remain underserved by current HIV prevention strategies, including HIV self‐testing (HIVST). Examining HIVST feasibility with refugees can inform tailored HIV testing strategies. We examined if HIVST and mobile health (mHealth) delivery approaches could increase HIV testing uptake and HIV status knowledge among refugee youth in Kampala, Uganda. Methods We conducted a three‐arm pragmatic controlled trial across five informal settlements grouped into three sites in Kampala from 2020 to 2021 with peer‐recruited refugee youth aged 16–24 years. The intervention was HIVST and HIVST + mHealth (HIVST with bidirectional SMS), compared with standard of care (SOC). Primary outcomes were self‐reported HIV testing uptake and correct status knowledge verified by point‐of‐care testing. Some secondary outcomes included: depression, HIV‐related stigma, and adolescent sexual and reproductive health (SRH) stigma at three time points (baseline [T0], 8 months [T1] and 12 months [T2]). We used generalized estimating equation regression models to estimate crude and adjusted odds ratios comparing arms over time, adjusting for age, gender and baseline imbalances. We assessed study pragmatism across PRECIS‐2 dimensions. Results We enrolled 450 participants (50.7% cisgender men, 48.7% cisgender women, 0.7% transgender women; mean age: 20.0, standard deviation: 2.4) across three sites. Self‐reported HIV testing uptake increased significantly from T0 to T1 in intervention arms: HIVST arm: (27.6% [n = 43] at T0 vs. 91.2% [n = 135] at T1; HIVST + mHealth: 30.9% [n = 47] at T0 vs. 94.2% [n = 113] at T1]) compared with SOC (35.5% [n = 50] at T0 vs. 24.8% [ = 27] at T1) and remained significantly higher than SOC at T2 (p<0.001). HIV status knowledge in intervention arms (HIVST arm: 100% [n = 121], HIVST + mHealth arm: 97.9% [n = 95]) was significantly higher than SOC (61.5% [n = 59]) at T2. There were modest changes in secondary outcomes in intervention arms, including decreased depression alongside increased HIV‐related stigma and adolescent SRH stigma. The trial employed both pragmatic (eligibility criteria, setting, organization, outcome, analysis) and explanatory approaches (recruitment path, flexibility of delivery flexibility, adherence flexibility, follow‐up). Conclusions Offering HIVST is a promising approach to increase HIV testing uptake among urban refugee youth in Kampala. We share lessons learned to inform future youth‐focused HIVST trials in urban humanitarian settings.https://doi.org/10.1002/jia2.26185HIV self‐testingrefugeesyouthUgandahumanitarian healthmHealth |
| spellingShingle | Carmen H. Logie Moses Okumu Isha Berry Robert Hakiza Stefan D. Baral Daniel Kibuuka Musoke Aidah Nakitende Simon Mwima Peter Kyambadde Miranda Loutet Shamilah Batte Richard Lester Stella Neema Katie Newby Lawrence Mbuagbaw Findings from the Tushirikiane mobile health (mHealth) HIV self‐testing pragmatic trial with refugee adolescents and youth living in informal settlements in Kampala, Uganda Journal of the International AIDS Society HIV self‐testing refugees youth Uganda humanitarian health mHealth |
| title | Findings from the Tushirikiane mobile health (mHealth) HIV self‐testing pragmatic trial with refugee adolescents and youth living in informal settlements in Kampala, Uganda |
| title_full | Findings from the Tushirikiane mobile health (mHealth) HIV self‐testing pragmatic trial with refugee adolescents and youth living in informal settlements in Kampala, Uganda |
| title_fullStr | Findings from the Tushirikiane mobile health (mHealth) HIV self‐testing pragmatic trial with refugee adolescents and youth living in informal settlements in Kampala, Uganda |
| title_full_unstemmed | Findings from the Tushirikiane mobile health (mHealth) HIV self‐testing pragmatic trial with refugee adolescents and youth living in informal settlements in Kampala, Uganda |
| title_short | Findings from the Tushirikiane mobile health (mHealth) HIV self‐testing pragmatic trial with refugee adolescents and youth living in informal settlements in Kampala, Uganda |
| title_sort | findings from the tushirikiane mobile health mhealth hiv self testing pragmatic trial with refugee adolescents and youth living in informal settlements in kampala uganda |
| topic | HIV self‐testing refugees youth Uganda humanitarian health mHealth |
| url | https://doi.org/10.1002/jia2.26185 |
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