Findings from the Tushirikiane mobile health (mHealth) HIV self-testing pragmatic trial with refugee adolescents and youth living in informal settlements in Kampala,

Logie, Carmen H., Okumu, Moses, Berry, Isha, Hakiza, Robert, Baral, Stefan D., Kibuuka Musoke, Daniel, Nakitende, Aidah, Mwima, Simon, Kyambadde, Peter, Loutet, Miranda, Batte, Shamilah, Lester, Richard, Neema, Stella, Newby, Katie and Mbuagbaw, Lawrence, (2023). Findings from the Tushirikiane mobile health (mHealth) HIV self-testing pragmatic trial with refugee adolescents and youth living in informal settlements in Kampala,. International AIDS Society, e26185-n/a

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  • Sub-type Journal article
    Author Logie, Carmen H.
    Okumu, Moses
    Berry, Isha
    Hakiza, Robert
    Baral, Stefan D.
    Kibuuka Musoke, Daniel
    Nakitende, Aidah
    Mwima, Simon
    Kyambadde, Peter
    Loutet, Miranda
    Batte, Shamilah
    Lester, Richard
    Neema, Stella
    Newby, Katie
    Mbuagbaw, Lawrence
    Title Findings from the Tushirikiane mobile health (mHealth) HIV self-testing pragmatic trial with refugee adolescents and youth living in informal settlements in Kampala,
    Appearing in International AIDS Society
    Publication Date 2023-10-18
    Place of Publication Geneva
    Publisher John Wiley & Sons Ltd
    Start page e26185
    End page n/a
    Language eng
    Abstract 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.
    Keyword HIV self-testing
    refugees
    youth
    Uganda
    humanitarian health
    Health
    Copyright Holder author(s)
    Copyright Year 2023
    Copyright type Creative commons
    DOI 10.1002/jia2.26185
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    Created: Sat, 21 Sep 2024, 02:16:33 JST by Haideh Beigi on behalf of UNU INWEH