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

Autor: Logie CH; Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.; United Nations University Institute for Water, Environment & Health, Hamilton, Ontario, Canada.; Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada., Okumu M; School of Social Work, University of Illinois Urbana-Champaign, Urbana, Illinois, USA.; School of Social Sciences, Uganda Christian University, Mukono, Uganda., Berry I; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada., Hakiza R; Young African Refugees for Integral Development (YARID), Kampala, Uganda., Baral SD; Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA., Musoke DK; International Research Consortium (IRC), Kampala, Uganda., Nakitende A; International Research Consortium (IRC), Kampala, Uganda., Mwima S; School of Social Work, University of Illinois Urbana-Champaign, Urbana, Illinois, USA.; National AIDS and STI Control Programme, Ministry of Health, Kampala, Uganda., Kyambadde P; National AIDS and STI Control Programme, Ministry of Health, Kampala, Uganda.; Most at Risk Population Initiative, Mulago Hospital, Kampala, Uganda., Loutet M; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada., Batte S; Organization for Gender Empowerment and Rights Advocacy (OGERA Uganda), Kampala, Uganda., Lester R; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada., Neema S; Department of Sociology and Anthropology, Makerere University, Kampala, Uganda., Newby K; Centre for Research in Psychology and Sport Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK., Mbuagbaw L; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada.; Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon.; Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
Jazyk: angličtina
Zdroj: Journal of the International AIDS Society [J Int AIDS Soc] 2023 Oct; Vol. 26 (10), pp. e26185.
DOI: 10.1002/jia2.26185
Abstrakt: 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.
(© 2023 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.)
Databáze: MEDLINE
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