Acceptability of a tablet-based application to support early HIV testing among men in rural KwaZulu-Natal, South Africa: a mixed method study

Oluwafemi Adeagbo,Hae-Young Kim,Frank Tanser,Sibongiseni Xulu,Nondumiso Dlamini,Velaphi Gumede,Thulile Mathenjwa,Till Bärnighausen,Nuala Mcgrath,Ann Blandford,Janet Seeley,Maryam Shahmanesh

doi:10.1080/09540121.2020.1742867

Abstract

ABSTRACT Uptake of HIV testing remains low among men in South Africa. As part of a trial, we assessed the acceptability of a theoretically derived and adapted tablet-based-application (EPIC-HIV1) in rural South Africa. We conducted 20 in-depth interviews with men aged ≥18 years and offered a tablet-based survey to all men aged ≥15 years who received EPIC-HIV1 (Sep-Dec 2018). We conducted a descriptive analysis of the survey and used Self-Determination Theory (SDT) to guide our thematic analysis. A total of 232/307 (75%) completed the survey, 55% of whom were aged 15–24 years. 96%[ CI: 92.8–98.2%; n = 223] found EPIC-HIV1 acceptable and 77% [95% CI: 71.8–82.6%; n = 179] found it user-friendly. 222 [96%] reported that EPIC-HIV1 motivated them to test; 83% (192/232) tested for HIV, of which 33% (64/192) were first time testers. Those who did not consent (n = 40) were more likely to have had an HIV-positive test result. Participants reported that the app boosted their confidence to test. However, they were unsure that the app would help them overcome barriers to test in local clinics. Given reach and usability, an adapted SDT male-tailored app was found to be acceptable and could encourage positive health-seeking behavioural change among men.

Highlights

In rural KwaZulu-Natal (KZN) South Africa, men are less likely to test for HIV and are more likely to die of AIDS-related illnesses than women (Iwuji et al, 2016; Iwuji et al, 2018; Tanser et al, 2013)
The HITS trial was designed to assess the effectiveness of financial micro-incentives (R50[$3] food vouchers) and/ or a Self-Determination Theory (SDT) informed decision support application (EPICHIV1) delivered on tablet to increase the uptake of home-based HIV testing in men
Eight-seven percent (202/232) of participants evaluated that the quality of the EPIC-HIV1 app as good or

Summary

Introduction

In rural KwaZulu-Natal (KZN) South Africa, men are less likely to test for HIV and are more likely to die of AIDS-related illnesses than women (Iwuji et al, 2016; Iwuji et al, 2018; Tanser et al, 2013). HIV self-testing has shown promise for men (Choko et al, 2015; Harichund et al, 2019; Krause et al, 2013); HIV testing needs to be coupled with promoting benefits of HIV treatment for those who test positive and ways to stay negative for the others Digital interventions such as mobile communication technologies (mHealth) have the potential to fill this health promotion gap and support men’s engagement with HIV care (Adeagbo et al, 2019). The World Health Organization has recommended the use of mHealth for HIV and other chronic disease management (Daher et al, 2017; WHO, 2011; Zhao et al, 2018)

Methods

Results

Discussion

Conclusion