Mobile Health–Supported HIV Self-Testing Strategy Among Urban Refugee and Displaced Youth in Kampala, Uganda: Protocol for a Cluster Randomized Trial (Tushirikiane, Supporting Each Other)

Carmen Logie,Stella Neema,Daniel Kibuuka Musoke,Katie Newby,Stefan D Baral,Miranda Loutet,Joshua Musinguzi,Uwase Mimy Kiera,Isha Berry,Moses Okumu,Clara Mcnamee,Richard Lester,Peter Kyambadde,Robert Hakiza,Simon Mwima,Lawrence Mbuagbaw

doi:10.2196/26192

Abstract

BackgroundHIV is the leading cause of mortality among youth in sub-Saharan Africa. Uganda hosts over 1.43 million refugees, and more than 83,000 live in Kampala, largely in informal settlements. There is limited information about HIV testing uptake and preferences among urban refugee and displaced youth. HIV self-testing is a promising method for increasing testing uptake. Further, mobile health (mHealth) interventions have been effective in increasing HIV testing uptake and could be particularly useful among youth.ObjectiveThis study aims to evaluate the feasibility and effectiveness of two HIV self-testing implementation strategies (HIV self-testing intervention alone and HIV self-testing combined with an mHealth intervention) in comparison with the HIV testing standard of care in terms of HIV testing outcomes among refugee/displaced youth aged 16 to 24 years in Kampala, Uganda.MethodsA three-arm cluster randomized controlled trial will be implemented across five informal settlements grouped into three sites, based on proximity, and randomization will be performed with a 1:1:1 method. Approximately 450 adolescents (150 per cluster) will be enrolled and followed for 12 months. Data will be collected at the following three time points: baseline enrollment, 8 months after enrollment, and 12 months after enrollment. Primary outcomes (HIV testing frequency, HIV status knowledge, linkage to confirmatory testing, and linkage to HIV care) and secondary outcomes (depression, condom use efficacy, consistent condom use, sexual relationship power, HIV stigma, and adolescent sexual and reproductive health stigma) will be evaluated.ResultsThe study has been conducted in accordance with CONSORT (Consolidated Standards of Reporting Trials) guidelines. The study has received ethical approval from the University of Toronto (June 14, 2019), Mildmay Uganda (November 11, 2019), and the Uganda National Council for Science and Technology (August 3, 2020). The Tushirikiane trial launched in February 2020, recruiting a total of 452 participants. Data collection was paused for 8 months due to COVID-19. Data collection for wave 2 resumed in November 2020, and as of December 10, 2020, a total of 295 participants have been followed-up. The third, and final, wave of data collection will be conducted between February and March 2021.ConclusionsThis study will contribute to the knowledge of differentiated HIV testing implementation strategies for urban refugee and displaced youth living in informal settlements. We will share the findings in peer-reviewed manuscripts and conference presentations.Trial RegistrationClinicalTrials.gov NCT04504097; https://clinicaltrials.gov/ct2/show/NCT04504097.International Registered Report Identifier (IRRID)DERR1-10.2196/26192

Highlights

HIV is the leading cause of death among young people globally and the main cause of death among adolescents and young people in sub-Saharan Africa [1]
A three-arm cluster randomized controlled trial will be implemented across five informal settlements grouped into three sites, based on proximity, and randomization will be performed with a 1:1:1 method
This study will contribute to the knowledge of differentiated HIV testing implementation strategies for urban refugee and displaced youth living in informal settlements

Summary

Introduction

HIV is the leading cause of death among young people globally and the main cause of death among adolescents and young people in sub-Saharan Africa [1]. In sub-Saharan Africa, half of newly infected adolescents and young people are girls [2,3]. HIV vulnerabilities among displaced/refugee adolescents are shaped by a complex interplay of factors, including poverty, violence, host community HIV prevalence, urbanization, HIV testing and care access, and living conditions [10,11,12]. Uganda hosts more than 1.4 million refugees [13], with 62% aged below 18 years [14]. Uganda hosts over 1.43 million refugees, and more than 83,000 live in Kampala, largely in informal settlements. There is limited information about HIV testing uptake and preferences among urban refugee and displaced youth. Mobile health (mHealth) interventions have been effective in increasing HIV testing uptake and could be useful among youth

Methods

Results

Conclusion