Iterative Development of In This toGether, the First mHealth HIV Prevention Program for Older Adolescents in Uganda

Ybarra, Michele L.; Agaba, Edgar; Chen, Emilie; Nyemara, Novatus

doi:10.1007/s10461-020-02795-4

Cited by 17 publications

(39 citation statements)

References 20 publications

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“…Researchers employing RDC tools may have to adapt existing measurement scales or instruments; for example, researchers operating in settings where internet is unaffordable may have to condense online-based surveys or offer binary or ordinal response choices over SMS. 57 Measurement tools specifically designed to measure VAWG using RDC tools may need to be further developed and validated. Lastly, in the absence of randomisation and an appropriate control group, use of RDC tools to evaluate programmes could lead to selection biases given that eligibility criteria such as the ownership of a private device systematically exclude women and girls of lower socioeconomic status and could bias evaluation results.…”

Section: Discussionmentioning

confidence: 99%

Remote evaluations of violence against women and girls interventions: a rapid scoping review of tools, ethics and safety

et al. 2021

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Although programmes and policies targeting violence against women and girls (VAWG) have increased in the past decade, there is a paucity of evidence on the effectiveness of these interventions. To expand this evidence base, researchers increasingly employ remote data collection (RDC)—including online surveys, mobile applications and telephone interviews—in their evaluations. Although RDC allows for evaluations without in-person interactions—which are restricted during crises such as the COVID-19 pandemic— information about these methods is necessary to understand their potential usefulness and limitations. This scoping review examines remote evaluations of VAWG interventions to describe the landscape of RDC methods, reflect on safety and ethical considerations, and offer best practices for RDC in VAWG research. Fourteen studies met eligibility criteria, with seven, five, and two studies employing telephone interviews, online surveys, and mobile applications, respectively. Studies commonly stated that participants were asked to use a safe email or device, but the method for verifying such safety was rarely specified. Best practices around safety included creating a ‘quick escape’ button for online data collection to use when another individual was present, explaining to participants how to erase browsing history and application purchases, and asking participants to specify a safe time for researchers to call. Only eight studies established referral pathways for respondents as per best practice. None of the eligible studies took place in low/middle-income countries (LMICs) or humanitarian settings, likely reflecting the additional challenges to using RDC methods in lower resource settings. Findings were used to create a best practice checklist for programme evaluators and Institutional Review Boards using RDC for VAWG interventions. The authors found that opportunities exist for researchers to safely and effectively use RDC methodologies to gather VAWG data, but that further study is needed to gauge the feasibility of these methods in LMICs and humanitarian settings.

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Section: Discussionmentioning

confidence: 99%

Remote evaluations of violence against women and girls interventions: a rapid scoping review of tools, ethics and safety

et al. 2021

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“…18 studies (33%) assessed acceptability concurrently, during the delivery of the intervention, while 14 (25%) assessed acceptability post-intervention, retrospectively. The remaining seven (13%) of the studies assessed interventions prospectively and retrospectively; among these, two studies worked with separate groups of adolescents who had received and not yet received the intervention (52, 63), while the remaining 5 interviewed adolescents at two different stages of the intervention (40, 44, 55, 64, 65). Five studies involved adolescents in the study design (43, 50, 53, 55, 65).…”

Section: Resultsmentioning

confidence: 99%

“…These are presented in Table 1, by type of intervention, for studies with both low and high overall acceptability. The main reasons e-Health interventions were acceptable to adolescents were: knowledge gained from the intervention regarding their sexual health (34, 65), the privacy these interventions provided (23, 48) and knowing how to make use of the intervention (25, 34). Adolescents who instead did not find these interventions acceptable felt that the content was not culturally appropriate (23, 25, 65), highlighted technological glitches (48, 50, 65) or were concerned with inclusiveness where, for example, not all the young adults had access to a necessary device or risked unintended disclosure of private information when sharing devices (65, 73).…”

Section: Resultsmentioning

confidence: 99%

A decade of Acceptability Research with Adolescents in Africa: Systematic review and evidence map

Somefun

Casale

Hauptronnie

et al. 2021

Preprint

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Interventions aimed at improving adolescent developmental outcomes are more likely to be successful if the young people they target find them acceptable. However, no standard definitions or indicators exist to assess acceptability, acceptability research with adolescents in LMICs is still limited, and no known reviews synthesise the evidence from Africa.We conducted a systematic review of peer-reviewed studies assessing intervention acceptability with young adults (aged 10-24) in Africa, published between January 2010 and June 2020. This paper maps and qualitatively synthesizes the scope, characteristics, and findings of these studies, including definitions of acceptability, methods used, the type and objectives of interventions assessed, and overall findings on adolescent acceptability.The review was carried out in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Key word searches generated 4692 unique records and 55 final eligible studies, assessing 60 interventions. Most studies were conducted in Southern Africa, of which 32 jointly in South Africa and Uganda. The majority of interventions assessed for acceptability could be classified as HIV or HPV vaccine interventions (10), E-health (10), HIV testing interventions (8), support group interventions (7) and contraceptive interventions (6). The objectives of most interventions were linked to SDG3, specifically to HIV and sexual and reproductive health. Acceptability was overall high among these published studies. 22 studies provided reasons for acceptability or lack thereof, some specific to particular types of interventions and others common across intervention types.Our review exposes considerable scope for future acceptability research and review work. This should include: extending acceptability research beyond the health (and particularly HIV) sector and to regions in Africa where this type of research is still scarce; including adolescents earlier, and potentially throughout the intervention process; further conceptualising the construct of acceptability among adolescents and beyond, and examining the relationship between acceptability and uptake.Key QuestionsWhat is already known?Addressing the developmental needs of adolescents in African countries is critical if the continent is to achieve its sustainable development goals (SDGs).Many interventions aimed at strengthening adolescent developmental outcomes have not achieved desired impact, and adolescent involvement is often poorly envisaged and implemented.Uptake and effectiveness of interventions is likely to be higher if these interventions are acceptable to adolescent end-users.What are the new findings?Acceptability of interventions assessed in Africa was generally high among adolescents.Understanding of the intervention, ease of use, adequate emotional support, autonomy, confidentiality and protection from stigma were key overarching themes explaining why young people found interventions acceptableWhat do the new findings imply?Intervention developers and implementers across the continent should pay attention to these key aspects of interventions and their delivery.It is important to strengthen adolescents’ understanding of interventions, involve adolescents early on in intervention development, and engage with the broader context within which adolescent acceptability is shaped.There is a need for more acceptability research in important areas for adolescent development beyond (physical) health and, within the health sector, beyond HIV.

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“…Studies with adult women in sex work in Zambia and Uganda [ 46 ] and MSM in South Africa [ 17 ] and the US [ 47 ] have shown that these models are effective at increasing HIV testing completion among priority populations and should be evaluated with AYA. Task-shifting of additional HIVST and prevention services to lay cadres could enhance efficiency of HTS [ 48 – 50 ]. Consistent with studies among adults in sub-Saharan Africa, we found that willingness to pay for HIVST was low, and most AYA wanted HIVST for free [ 5 , 25 , 51 ].…”

Section: Discussionmentioning

confidence: 99%

“…HIVST offered through pharmacies, vending, machines or online will require fair pricing so that these strategies for increasing access by location are not limited by cost. Given widespread use of cell phones and social media among AYA in sub-Saharan Africa [ 48 , 52 ], digital platforms have the potential to increase demand for HIVST among AYA and complement in-person counseling through live chats with trained counselors. Finally, our study reached young people with high unmet needs for additional HIV/STI and sexual and reproductive health (SRH) services.…”

Section: Discussionmentioning

confidence: 99%

High Acceptance and Completion of HIV Self-testing Among Diverse Populations of Young People in Kenya Using a Community-Based Distribution Strategy

et al. 2021

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Oral HIV self-testing (HIVST) may expand access to testing among hard-to-reach reach adolescents and young adults (AYA). We evaluated community-based HIVST services for AYA in an urban settlement in Kenya. Peer-mobilizers recruited AYA ages 15–24 through homes, bars/clubs, and pharmacies. Participants were offered oral HIVST, optional assistance and post-test counseling. Outcomes were HIVST acceptance and completion (self-report and returned kits). Surveys were given at enrollment, post-testing, and 4 months. Log-binomial regression evaluated HIVST preferences by venue. Among 315 reached, 87% enrolled. HIVST acceptance was higher in bars/clubs (94%) than homes (86%) or pharmacies (75%). HIVST completion was 97%, with one confirmed positive result. Participants wanted future HIVST at multiple locations, include PrEP, and cost ≤ $5USD. Participants from bars/clubs and pharmacies were more likely to prefer unassisted testing and peer-distributers compared to participants from homes. This differentiated community-based HIVST strategy could facilitate engagement in HIV testing and prevention among AYA.

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Iterative Development of In This toGether, the First mHealth HIV Prevention Program for Older Adolescents in Uganda

Cited by 17 publications

References 20 publications

Remote evaluations of violence against women and girls interventions: a rapid scoping review of tools, ethics and safety

Remote evaluations of violence against women and girls interventions: a rapid scoping review of tools, ethics and safety

A decade of Acceptability Research with Adolescents in Africa: Systematic review and evidence map

High Acceptance and Completion of HIV Self-testing Among Diverse Populations of Young People in Kenya Using a Community-Based Distribution Strategy

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