2021, September 13 | Journal of Biosocial Science
HIV testing and ethnicity among adolescent girls and young women aged 15–24 years in Ghana: what really matters?
Ucheoma Nwaozuru, Thembekile Shato, Chisom Obiezu-Umeh, Florida Uzoaru, Stacey Mason, Joyce Gyamfi and Juliet Iwelunmor
Despite the high prevalence of HIV among adolescent girls and young women (AGYW) aged 15–24 years in Ghana, HIV testing remains low among this population. The objective of this study was to examine the relationship between ethnicity and HIV testing among AGYW in Ghana. The 2014 Ghana Demographic and Health Survey data were used and analyses were restricted to 3325 female participants aged 15–24 years. Chi-squared tests and a logistic regression model were used to assess the association between ethnicity and HIV testing. Furthermore, the PEN-3 cultural model informed the conceptual framework that explained the relationship between ethnicity and HIV testing behaviour. Results from the bivariate analysis showed an association between ethnicity and HIV testing among AGYW (p<0.05). However, when controlling for other behavioural and socioeconomic determinants of HIV testing in the logistic regression, there was no association between ethnicity and HIV testing. The significant predictors of HIV testing were marital status, having multiple sexual partners, and condom use. The AGYW who were married (adjusted odds ratio [aOR] = 4.56, CI: 3.46–6.08) or previously married (aOR = 4.30, CI: 2.00–9.23) were more likely to test for HIV compared with those who were never married. Having multiple sexual partners (aOR = 0.41, CI: 0.20–0.85) and condom use (aOR = 0.56, CI: 0.38–0.84) were associated with lower odds of HIV testing. The results provide evidence that ethnicity is not associated with HIV testing among AGYW in Ghana, as the bivariate association was attenuated when other behavioural and socioeconomic determinants of HIV testing were accounted for. These findings highlight the importance of considering individual-level factors, community-level factors, and other socio-cultural factors as they really matter in the development of HIV prevention programmes for adolescent girls and young women in Ghana.
2021, August 11 | AIDS
Accelerating adolescent HIV research in LMICs: The NICHD HIV prevention and treatment through a comprehensive care continuum (PATC3H) consortium
Tucker, Joseph D.; Iwelunmor, Juliet; Abrams, Elaine; Donenberg, Geri; Wilson, Erin C.; Blachman-Demner, Dara; Laimon, Lauren; Taiwo, Babafemi O.; Kuhns, Lisa M.; John-Stewart, Grace C.; Kohler, Pamela; Subramanian, Sujha; Ayieko, James; Gbaja-Biamila, Titilola; Oladele, David; Obiezu-Umeh, Chisom; Chima, Kelechi P.; Jalil, Emilia M.; Falcao, Joana; Ezechi, Oliver C.; Kapogiannis, Bill G.
Many adolescents and young adults (AYA) have unmet HIV prevention needs. We describe the Prevention and Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings (PATC3H) consortium organization, transition milestones, and youth engagement strategies. The PATC3H consortium focuses on reducing HIV incidence and related health disparities among AYA.
Design and Methods
Organizational data were obtained from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and supplemented with a brief survey completed by study principal investigators. Transition from the initial phase (years 1–2) to the subsequent phase (years 3–5) was contingent on meeting pre-specified milestones. We reviewed the structure and function of the research consortium, identified shared elements of transition milestones, and examined common youth engagement strategies.
The PATC3H consortium supports eight research studies through a milestone transition mechanism. The consortium includes AYA HIV research studies in seven countries – Brazil, Kenya, Mozambique, Nigeria, South Africa, Uganda, and Zambia. The NIH request for applications required transition milestones that included early consultation with stakeholders. The transition milestones required by NIH for the eight studies included early consultation with health and policy stakeholders, pilot intervention data and commitment from national government stakeholders. All studies provided multiple pathways for AYA engagement, including AYA advisory boards and youth-led research studies.
Data suggest that requiring milestones to transition to the final phase may have facilitated health and policy stakeholder engagement and enhanced formative assessment of regulatory protocols. These data have implications for designing engaged research studies in low and middle-income countries.
2021, August 04 | Frontiers in Reproductive Health
Implementation Strategies to Enhance Youth-Friendly Sexual and Reproductive
Health Services in Sub-Saharan Africa: A Systematic Review
Chisom Obiezu-Umeh, Ucheoma Nwaozuru, Stacey Mason, Titilola Gbaja-Biamila, David Oladele, Oliver Ezechi, and Juliet Iwelunmor
Youth-friendly health service (YFHS) interventions are a promising, cost-effective approaches to delivering sexual and reproductive services that cater to the developmental needs of young people. Despite a growing evidence-base, implementation of such interventions into practice have proven to be challenging in sub-Saharan Africa (SSA). Thus, the purpose of this review is to synthesize existing evidence on YFHS implementation in SSA and understand which implementation strategies were used, in what context, how they were used, and leading to which implementation outcomes.
A comprehensive literature search in PubMed, Embase, Scopus, and CINAHL, was conducted to identify peer-reviewed research articles published from database inception up until August 2020. Eligible studies were required to include young people (ages 10–24 years) in sub-Saharan Africa. Studies that described implementation strategies, as conceptualized by the Expert Recommendations for Implementing Change (ERIC) project, used to enhance the implementation of YFHS were included. Implementation outcomes were extracted using Proctor and colleagues’ 8 taxonomy of implementation outcomes.
We identified 18 unique interventions (reported in 23 articles) from an initial search of 630 articles, including seven from East Africa, seven from South Africa, and four from West Africa. In most studies (n = 15), youth-friendly health services were delivered within the context of a health facility or clinic setting. The most frequently reported categories of implementation strategies were to train and educate stakeholders (n = 16) followed by infrastructure change (n = 10), to engage consumers (n = 9), the use of evaluative and iterative strategies (n = 8), support clinicians (n = 8), and providing interactive assistance (n = 6). The effectiveness of the strategies to enhance YFHS implementation was commonly measured using adoption (n = 15), fidelity (n = 7), acceptability (n = 5), and penetration (n = 5). Few studies reported on sustainability (n = 2), appropriateness (n = 1), implementation cost (n = 1) and feasibility (n = 0).
Results of the review emphasize the need for further research to evaluate and optimize implementation strategies for promoting the scale-up and sustainability of evidence-based, YFHS interventions in resource-constrained settings. This review also highlights the need to design robust studies to better understand which, in what combination, and in what context, can implementation strategies be used to effectively enhance the implementation of YFHS interventions.
2021, May 31 | BMC Infectious Diseases
A designathon to co-create community-driven HIV self-testing services for Nigerian youth: findings from a participatory event
Kadija M. Tahlil, Chisom Obiezu-Umeh, Titi Gbajabiamila, Ucheoma Nwaozuru, David Oladele, Adesola Z. Musa, Ifeoma Idigbe, Jane Okwuzu, Agatha N. David, Tajudeen A Bamidele, Collins O. Airhihenbuwa, Nora E. Rosenberg, Weiming Tang, Jason J. Ong, Donaldson Conserve, Juliet Iwelunmor, Oliver Ezechi & Joseph D. Tucker
Youth are at high risk for HIV, but are often left out of designing interventions, including those focused on adolescents. We organized a designathon for Nigerian youth to develop HIV self-testing (HIVST) strategies for potential implementation in their local communities. A designathon is a problem-focused event where participants work together over a short period to create and present solutions to a judging panel.
We organized a 72-h designathon for youth (14–24 years old) in Nigeria to design strategies to increase youth HIVST uptake. Proposals included details about HIVST kit service delivery, method of distribution, promotional strategy, and youth audience. Teams pitched their proposals to a diverse seven-member judging panel who scored proposals based on desirability, feasibility, potential impact and teamwork. We examined participants’ socio-demographic characteristics and summarized themes from their HIVST proposals.
Forty-two youth on 13 teams participated in the designathon. The median team size was 3 participants (IQR: 2–4). The median age was 22.5 years (IQR: 21–24), 66.7% were male, 47.4% completed tertiary education, and 50% lived in Lagos State. Themes from proposals included HIVST integration with other health services, digital marketing and distribution approaches, and engaging students. Judges identified seven teams with exceptional HIVST proposals and five teams were supported for further training.
The designathon provided a structured method for incorporating youth ideas into HIV service delivery. This approach could differentiate HIV services to be more youth-friendly in Nigeria and other settings.
2021, July 05 | Implementation Science Communications
Costs of implementing community-based intervention for HIV testing in sub-Saharan Africa: a systematic review
Florida Uzoaru, Ucheoma Nwaozuru, Jason J. Ong, Felix Obi, Chisom Obiezu-Umeh, Joseph D. Tucker, Thembekile Shato, Stacey L. Mason, Victoria Carter, Sunita Manu, Rhonda BeLue, Oliver Ezechi & Juliet Iwelunmor
Community-based interventions (CBIs) are interventions aimed at improving the well-being of people in a community. CBIs for HIV testing seek to increase the availability of testing services to populations that have been identified as at high risk by reaching them in homes, schools, or community centers. However, evidence for a detailed cost analysis of these community-based interventions in sub-Saharan Africa (SSA) is limited. We conducted a systematic review of the cost analysis of HIV testing interventions in SSA.
Keyword search was conducted on SCOPUS, CINAHL, MEDLINE, PsycINFO, Web of Science, and Global Health databases. Three categories of key terms used were cost (implementation cost OR cost-effectiveness OR cost analysis OR cost-benefit OR marginal cost), intervention (HIV testing), and region (sub-Saharan Africa OR sub-Saharan Africa OR SSA). CBI studies were included if they primarily focused on HIV testing, was implemented in SSA, and used micro-costing or ingredients approach.
We identified 1533 citations. After screening, ten studies were included in the review: five from East Africa and five from Southern Africa. Two studies conducted cost-effectiveness analysis, and one study was a cost-utility analysis. The remainder seven studies were cost analyses. Four intervention types were identified: HIV self-testing (HIVST), home-based, mobile, and Provider Initiated Testing and Counseling. Commonly costed resources included personnel (n = 9), materials and equipment (n = 6), and training (n = 5). Cost outcomes reported included total intervention cost (n = 9), cost per HIV test (n = 9), cost per diagnosis (n = 5), and cost per linkage to care (n = 3). Overall, interventions were implemented at a higher cost than controls, with the largest cost difference with HIVST compared to facility-based testing.
To better inform policy, there is an urgent need to evaluate the costs associated with implementing CBIs in SSA. It is important for cost reports to be detailed, uniform, and informed by economic evaluation guidelines. This approach minimizes biases that may lead decision-makers to underestimate the resources required to scale up, sustain, or reproduce successful interventions in other settings. In an evolving field of implementation research, this review contributes to current resources on implementation cost studies.
2021, May 04 | The Patient - Patient-Centered Outcomes Research
Designing HIV Testing and Self-Testing Services for Young People in Nigeria: A Discrete Choice Experiment
Jason J. Ong, Ucheoma Nwaozuru, Chisom Obiezu-Umeh, Collins Airhihenbuwa, Hong Xian, Fern Terris-Prestholt, Titilola Gbajabiamila, Adesola Z. Musa, David Oladele, Ifeoma Idigbe, Agatha David, Jane Okwuzu, Tajudeen Bamidele, Juliet Iwelunmor, Joseph D. Tucker & Oliver Ezechi
Background and Objective
A third of new human immunodeficiency virus (HIV) infections occur among young people and the majority of young people living with HIV are in sub-Saharan Africa. We examined the strength of Nigerian youth preferences related to HIV testing and HIV self-testing (HIVST).
Discrete choice experiments were conducted among Nigerian youth (age 14–24 years). Participants completed one of two discrete choice experiments: (1) preferred qualities of HIV testing (cost, location of test, type of test, person who conducts the test, and availability of HIV medicine at the testing site) and (2) preferred qualities of HIVST kits (cost, test quality, type of test, extra items, and support if tested positive). A random parameter logit model measured the strength of preferences.
A total of 504 youth participated: mean age 21 years (standard deviation 2 years), 38% male, and 35% had a higher than secondary school education. There was a strong preference overall to test given the scenarios presented, although male individuals were less likely to test for HIV or use HIVST kits. Youth preferred HIV testing services (with attributes in order of importance) that are free, blood-based testing, available in private/public hospitals or home, for HIV medications to be available in the same location as testing, and a doctor conducts the test. Participants preferred HIVST kits (with attributes in order of importance) that are available from community health centers, free, approved by the World Health Organization, include other sexually transmitted infection testing, have the option of an online chat, and oral-based HIVST.
The HIV home testing was equally preferred to testing in a hospital, suggesting a viable market for HIVST if kits account for youth preferences. Male youth were less likely to choose to test for HIV or use HIVST kits, underscoring the need for further efforts to encourage HIV testing among young male individuals.
2021, February 26 | BMJ Innovations
Strategies for enhancing uptake of HIV self-testing among Nigerian youths: a descriptive analysis of the 4YouthByYouth crowdsourcing contest
Nora E Rosenberg, Chisom S Obiezu-Umeh, Titilola Gbaja-Biamila, Kadija M Tahlil, Ucheoma Nwaozuru, David Oladele, Adesola Musa, Ifeoma Idigbe, Jane Okwuzu, Tajudeen Bamidele, Weiming Tang, Oliver Ezechi, Joseph D Tucker, Juliet Iwelunmor
What are the new findings?
• Our crowdsourcing contest was an effective approach to youth engagement and participation in HIV research.
• Through the participation of over 800 Nigerian youths, our 4YouthByYouth crowdsourcing contest generated several high-quality ideas for the promotion of HIV self-testing in Nigeria.
• Our findings suggest that the use of multiple modalities (both offline and online platforms) encouraged a diverse and broad participation from a range of youths with access to different types of technology.
How might it impact on healthcare in the future?
• Strategies generated can be cultivated into effective interventions that ultimately improve HIV self-testing uptake among youth.
2021, January 07 | BMC Public Health
Young people’s preferences for HIV self-testing services in Nigeria: a qualitative analysis
Chisom Obiezu-Umeh, Titilola Gbajabiamila, Oliver Ezechi, Ucheoma Nwaozuru, Jason J. Ong, Ifeoma Idigbe, David Oladele, Adesola Z. Musa, Florida Uzoaru, Collins Airhihenbuwa, Joseph D. Tucker & Juliet Iwelunmor
HIV self-testing (HIVST) provides young people with a convenient, discreet, and empowering way to know their HIV status. However, there is limited knowledge of young people’s preferences for HIVST services and potential factors that may influence the uptake of HIVST among this population. The purpose of this research was to use qualitative methods to examine HIVST preferences among Nigerian youth.
Semi-structured in-depth interviews with a purposive sample of young people 14–24 years old were conducted in Lagos, Nigeria. Data were analyzed thematically to identify themes and domains related to preferences and factors influencing the use of HIV self-testing.
A total of 65 youth with mean age of 21 years, were interviewed, and the majority were females (56%). Four themes emerged as the most important characteristics that may influence young people’s preferences for HIV self-testing: 1) Cost (i.e. majority of participants noted that they would pay between NGN500 to NGN1,500 naira (USD1.38–USD4.16) for oral HIV self-testing kits); 2) Testing method (i.e. although blood-based sample kits were more popular than oral-based self-testing kits, most preferred the oral-based option due to its perceived benefits and for some, phobia of needles); 3) Access location (i.e. participants suggested they preferred to obtain the HIVST kits from youth-friendly centers, pharmacies, private health facilities, and online stores); and 4) Continuing care and support (i.e. participants highlighted the importance of linkage to care with trained youth health workers for positive or negative test results or toll-free helpline).
HIV self-testing preferences among Nigerian youth appear to be influenced by several factors including lower cost, less invasive testing method, location of testing, and linkage to care and support post testing. Findings underscore the need to address young people’s HIV self-testing preferences as a foundation for implementing programs and research to increase the uptake of HIVST.
2020, June 23 | PloS One
Psychosocial correlates of safe sex self-efficacy among in-school adolescent girls in Lagos, Nigeria
Ucheoma Nwaozuru, Sarah Blackstone, Chisom Obiezu-Umeh, Donaldson F. Conserve, Stacey Mason, Florida Uzoaru, Titi Gbajabiamila, Oliver Ezechi, Patricia Iwelunmor, John E. Ehiri, Juliet Iwelunmor
Adolescent girls in Nigeria are at heightened risk for HIV and other sexually transmitted infections. However, there are limited studies on psychosocial factors that are associated with safe sex intentions among this population. Self-efficacy has been established as an important correlate of behavioral intentions and the actual behavior. The objective of this research was to examine how key psychosocial factors such as social support, parental monitoring, and future orientation influence perceived safe sex self-efficacy among in-school adolescent girls in Nigeria. Furthermore, we assessed the associations between these psychosocial factors and HIV-related knowledge and safe sex self-efficacy.
A self-administered questionnaire was distributed to 426 adolescent girls attending public and private school systems in Lagos, Nigeria. Multiple linear regression was used to evaluate the influence of psychosocial and demographic factors on safe sex self-efficacy. Further, stratified analysis was conducted to compare the estimates between participants attending public schools (n = 272) and those attending private schools (n = 154).
Results from the study show that future orientation (β = 0.17; p < 0.05), participants age (β = 0.14; p < 0.05), and HIV knowledge accuracy (β = 0.17; p < 0.05) were associated with safe sex self-efficacy. Future orientation remained statistically significant in the sub-group analysis among participants attending public (β = 0.13; p < 0.05) and private schools (β = 0.24; p < 0.05). Among participants attending public schools, HIV accuracy (β = 0.2; p < 0.05) remained a significant correlate of safe sex self-efficacy while this association dissipated among private school attendees.
These findings point to the importance of including future orientation strategies in interventions developed for in-school adolescent girls in Nigeria. School-based interventions that increase positive future orientation outcomes may be beneficial to improve safe sex intentions among adolescent girls in Nigeria.
2020, June 10 | Implementation Science Communications
Is it time to RE-AIM? A systematic review of economic empowerment as HIV prevention intervention for adolescent girls and young women in sub-Saharan Africa using the RE-AIM framework
Juliet Iwelunmor, Ucheoma Nwaozuru, Chisom Obiezu-Umeh, Florida Uzoaru, John Ehiri, Jami Curley, Oliver Ezechi, Collins Airhihenbuwa, Fred Ssewamala
Economic empowerment (EE) HIV prevention programs for adolescent girls and young women (AGYW) in sub-Saharan Africa are gaining traction as effective strategies to reduce HIV risk and vulnerabilities among this population. While intervention effectiveness is critical, there are numerous factors beyond effectiveness that shape an intervention’s impact. The objective of this systematic review was to assess the reporting of implementation outcomes of EE HIV prevention programs for AGYW in SSA, as conceptualized in the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework.
We searched PubMed, Ovid/MEDLINE, Science Direct, Ebscohost, PsycINFO, Scopus, and Web of Science for EE HIV interventions for AGYW in SSA. Study selection and data extraction were conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Two researchers coded each article using a validated RE-AIM data extraction tool and independently extracted information from each article. The reporting of RE-AIM dimensions were summarized and synthesized across included interventions.
A total of 25 unique interventions (reported in 45 articles) met the predefined eligibility criteria. Efficacy/effectiveness 19(74.4%) was the highest reported RE-AIM dimension, followed by adoption 17(67.2%), reach 16(64.0%), implementation 9(38.0%), and maintenance 7(26.4%). Most interventions reported on RE-AIM components such as sample size 25(100.0%), intervention location 24(96.0%), and measures and results for at least one follow-up 24(96.0%). Few reported on RE-AIM components such as characteristics of non-participants 8(32.0%), implementation costs 3(12.0%), and intervention fidelity 0(0.0%).
Results of the review emphasize the need for future economic empowerment HIV prevention interventions for AGYW in SSA to report multiple implementation strategies and highlight considerations for translating such programs into real-world settings. Researchers should pay close attention to reporting setting-level adoption, implementation cost, and intervention maintenance. These measures are needed for policy decisions related to the full merit and worth of EE HIV interventions and their long-term sustainability for AGYW.
2020, May 29 | PloS one
The 4 youth by youth HIV self-testing crowdsourcing contest: A qualitative evaluation
Juliet Iwelunmor, Oliver Ezechi, Chisom Obiezu-Umeh, Titilola Gbaja-Biamila, Ucheoma Nwaozuru, David Oladele, Adesola Z. Musa, Ifeoma Idigbe, Florida Uzoaru, Collins Airhihenbuwa, Kathryn Muessig, Donaldson F. Conserve, Bill Kapogiannis, Joseph D. Tucker
Crowdsourcing, a participatory approach to solicit ideas from a large group of diverse individuals, provides an opportunity to nurture youth participation in HIV self-testing service design. The objective of this study was to describe the responses to a crowdsourcing contest aimed at soliciting ideas on how to promote HIV self-testing (HIVST) among young people in Nigeria.
The “4 Youth by Youth” HIV Self-Testing Crowdsourcing contest was an online and off-line contest that asked Nigerian youth (10–24 years old) for ideas in response to the following: How might we promote HIVST among young people in Nigeria? All data were collected and analyzed between October 2018, and June 2019. Ideas and perceptions generated from the crowdsourcing contest were qualitatively analyzed using thematic content analysis. Specifically, four reviewers analyzed whether the ideas generated were desirable (appealing to young people), feasible (easy to implement) and impactful (will significantly influence HIVST uptake among young people).
A total of 903 entries were received in response to the contest prompt. Participants submitted entries in various forms: online form (39.7%), offline Dropbox (44.6%), email (6.1%) and WhatsApp (9.7%). Of the total entries, 85% (n = 769/903) entries were eligible and were scored as having either high, moderate or low level of feasibility, impact and desirability, on a 3-point Likert scale. A significant portion of the entries were given a score of 3 for feasibility (4.9%), desirability (7.1%), impact (3.0%) or a total overall score of 7 or more (8.2%). The three main themes that emerged from the entries include:1) Peer-to-peer distribution and leveraging on existing infrastructures 2) Youth-Oriented Branding of the HIVST Kit 3) Mobile platforms and social media technology.
The “4 Youth by Youth” Self-Testing contest engaged a broad audience of young people to generate ideas and perspectives on how to promote HIVST. This process informed the development of youth innovated implementation strategies to increase uptake of HIVST among adolescents and youth at risk for HIV.
2020, April 21 | AIDS Patient Care and STDs
Verification of HIV Self-Testing Use and Results: A Global Systematic Review
Kadija M. Tahlil, Jason J. Ong, Nora E. Rosenberg, Weiming Tang, Donaldson F. Conserve, Susan Nkengasong, Kathryn E. Muessig, Juliet Iwelunmor, Oliver Ezechi, Titi Gbaja-biamila, Sani H. Aliyu, Chisom Obiezu-Umeh, Bill Kapogiannis, and Joseph D. Tucker
HIV self-testing (HIVST) allows individuals to interpret and report their own test results, thus decentralizing testing. Yet, this decentralization can make it difficult to verify self-testing results, which is important for linkage to care and surveillance. The aim of this systematic review is to summarize methods for verifying HIVST use and results. We followed guidance from the Cochrane Handbook 5.1 on systematic reviews. We searched four journal databases (PubMed, Embase, Scopus, and Cochrane Library), one clinical trials database (ClinicalTrials.gov), two conference abstract databases (International AIDS Society and Conference on Retroviruses and Opportunistic Infections) and one gray literature database (OpenGrey). We included studies that verified opening of kits or test results. Two researchers independently screened articles and extracted data regarding HIVST location, method of verification, who performed verification, proportion of results verified, and primary or secondary kit distribution. The search yielded 3853 unique citations, of which 40 contained information on HIVST verification and were included. Among these 40 studies, 13 were in high-income countries, 16 were in middle-income countries, and 11 were in low-income countries. Seventeen studies included key populations and two focused on youth. Three methods verified results: supervision by a health provider, returning used test kits, and electronic transmission of photographs. One method verified opening of kits using Bluetooth sensors. Although HIVST has increased worldwide, strategies to verify self-testing results remain limited. These findings suggest a need for additional innovative strategies for verifying HIVST use and results and linkage of self-testing results to surveillance and care systems.
2020, April 01 | The Lancet Global Health
An innovation bootcamp model to develop HIV self-testing social enterprise among young people in Nigeria: a youth participatory design approach
Ucheoma Nwaozuru MS, Titilola Gbajabiamila MBBS, Chisom Obiezu-Umeh MPH, Florida Uzoaru MSc, Stacey Mason MPH, Kadija Tahlil MPH, David Oladele MBBS, Adesola Musa PhD, Ifeoma Idigbe MSc, Collins Airhihenbuwa, Oliver Ezechi, Joseph Tucker MD, Juliet Iwelunmor PhD
There is a critical gap in the uptake of HIV testing among young people in sub-Saharan Africa. In Nigeria, only a quarter of young people aged 14–24 years have ever tested for HIV. Recent evidence suggests that HIV self-testing (HIVST) may play a role in addressing gaps in HIV testing coverage and serve as an entry point for HIV prevention services. However, there is limited information on strategies that may increase the uptake of HIV testing among young people. Current strategies rarely include young people in the design stages, which often results to poor adoption of HIV interventions. We aimed to address this gap with the development of an innovation bootcamp for participants aged 14–24 years to generate interventions to promote HIVST among young people in Nigeria.
The innovation bootcamp was a 4-week accelerated training programme to build entrepreneurial and research capacities among young people to develop HIV self-testing social enterprise. The training programme consisted of social enterprise and research development modules. At the completion of the bootcamp, we also examined participants’ perspectives of the programme using surveys.
Between May 6 and May 30, 2019, 20 people participated in the innovation bootcamp in Lagos State, Nigeria; 13 (65%) were male and age range was 22–24 years. The innovation bootcamp generated five youth-participatory HIVST social enterprises. Two of the social enterprise focused on repacking HIVST kits to increase their appeal among young people, one idea focused on leveraging community engagement platforms (vocational skills training and youth community events) to promote HIVST, and another social enterprise seeks to use a reward-referral system to promote HIVST in young people. Participants’ survey responses suggest that the innovation bootcamp fostered an environment for young people to connect with their peers to generate ideas and solutions. The bootcamp also provided opportunities for skills development such as logistics management and research (protocol writing, data collection, and needs assessment) skills.
The innovation bootcamp model can leverage the resourcefulness, capabilities, and resilience of youth to generate youth-centred and youth-sensitive interventions to promote HIV testing. The innovation bootcamp led to the development of five youth-centred and participatory interventions to promote uptake of HIV self-testing among young people in Nigeria.
2020, April 01 | The Lancet Global Health
Development of HIV self-testing services through youth engagement: a qualitative evaluation of a health designathon in Nigeria
Chisom Obizu-Umeh MPH, Titilola Gbajabiamila MBBS, Ucheoma Nwaozuru MS, Florida Uzoaru MSc, Stacey Mason MPH, David Oladele MBBS, Ifeoma Idigbe MSc, Adesola Musa PhD, Donaldson Conserve PhD, Suzanne Nkengasong MSc, Collins Airhihenbuwa, Oliver Ezechi MBBS, Joseph Tucker MD, Juliet Iwelunmor PhD
Providing a platform to engage young people as active participants and decision-makers in the design and delivery process of HIV testing efforts is critical to optimise uptake of HIV testing and other preventive services among this population. Designathon, an intensive team-based contest to crowdsource solutions, is a form of participatory approach that may increase the effectiveness of implementation strategies by fully engaging the end users in the design process. In this study, we explore strategies for HIV self-testing (HIVST) delivery developed at a designathon contest in Nigeria.
The 48-h HIVST designathon held from March 29 to March 31, 2019, in Lagos state, Nigeria, occurred in three phases. First, we solicited solutions from Nigerian youth on how to encourage self-testing for HIV and other sexually transmitted infections in a way that is low-cost, accessible, youth-friendly and confidential. Second, submissions were shortlisted by an advisory committee and the top teams were invited to compete at the designathon contest. Third, the top teams presented their strategies using the business model canvas (BMC) to an expert panel. The BMC included: (1) description of the value of the HIVST service; (2) how and where to deliver HIVST; and (3) youth-friendly HIVST service strategies. Thematic analysis was used to explore key elements of the business model canvas.
Of the 127 submissions received, 13 teams (with a total of 42 participants) were selected to participate at the designathon. Participants’ median age was 22·5 years (IQR 21–24 years) and 28 (67%) were male. Teams developed segment-specific approaches such as online (ie, unstructured supplementary service data (USSD) services, gamification) and offline (ie, vending machines, community youth mobilisers) options for distributing and promoting the HIVST kit to reach a wider range of young people in both urban and rural settings. Multi-stakeholder partnerships at the local, state, and federal level were identified as key implementation mechanisms to drive scale-up and sustainability efforts.
Designathons are a feasible method of facilitating meaningful youth engagement to develop deployable strategies to increase the uptake of HIV testing in young people in Nigeria. Additional refinement and rigorous evaluations of the proposed strategies in practice is an important next step to assess the effectiveness and impact of the models.
2020, February 10 | Journal of the International AIDS Society
Youth engagement in HIV prevention intervention research in sub-Saharan Africa: a scoping review
Sarah E Asuquo, Kadija M Tahlil, Kathryn E Muessig, Donaldson F Conserve, Mesoma A Igbokwe, Kelechi P Chima, Ezienyi C Nwanunu, Lana P Elijah, Suzanne Day, Nora E Rosenberg, Jason J Ong, Susan Nkengasong, Weiming Tang, Chisom Obiezu-Umeh, Ucheoma Nwaozuru, Yesenia Merino, Titilola Gbaja-Biamila, David Oladele, Juliet Iwelunmor, Oliver Ezechi, Joseph D Tucker
Youth engagement in HIV research is generally recognized as essential, but often neglected or minimally implemented in practice. Engagement is a process of working collaboratively with diverse groups of people to address common issues. We conducted a scoping review of youth HIV prevention interventions in sub-Saharan Africa to identify and categorize forms and levels of youth engagement across the lifespan of intervention research.
We followed Arksey and O’Malley’s framework for organizing a scoping review. We searched seven databases for related articles on identified intervention studies through May 28th 2020. Included studies focused on youth (10 to 24 years old) HIV prevention interventions in sub-Saharan Africa. Two reviewers independently examined citations and full manuscripts for inclusion. Data were extracted on study characteristics, location, description of youth engagement and extent of engagement. Youth engagement approaches were categorized based on Hart’s ladder as substantial engagement (strong youth decision-making power), moderate engagement (shared decision making with adults), minimal engagement (no youth decision-making power) or no engagement.
We identified 3149 citations and included 112 studies reporting on 74 unique HIV interventions. Twenty-two interventions were in low-income countries, 49 in middle-income countries, and three were in both. Overall, only nine interventions (12%) had substantial or moderate youth engagement, two-thirds (48, 65%) had minimal youth engagement and 17 interventions (23%) had no youth engagement. We also identified specific engagement strategies (e.g. youth-led research, crowdsourcing) that were feasible in multiple settings and resulted in substantial engagement.
We found limited youth engagement in youth HIV prevention intervention studies in sub-Saharan Africa. However, several activities resulted in substantial youth engagement and could be relevant in many low-and-middle-income-country (LMIC) settings.
2017, May 17 | International Journal of Adolescent Medicine and Health
Sexual and reproductive health priorities of adolescent girls in Lagos, Nigeria: findings from free-listing interviews
Juliet Iwelunmor, Sarah Blackstone, Ucheoma Nwaozuru, Donaldson Conserve, Patricia Iwelunmor and John E. Ehiri
Adolescent girls in Nigeria experience a disproportionately high burden of sexual and reproductive health disparities that affect their well-being. Yet, little is known about adolescent girls’ own unique perspectives of the sexual and reproductive health challenges they face, and possible solutions to these challenges.
To explore top sexual and reproductive health concerns of female adolescents in Nigeria and their perceptions regarding potential solutions to these issues.
Eighty adolescent girls attending two public secondary schools in Lagos, Nigeria completed individual free-listing interviews. Items assessed their perceptions of the most important sexual and reproductive health issues and potential solutions to these issues at the individual and societal level. Data were analyzed using Anthropac 4.98 to sort the lists by item frequency as well as to determine Smith’s salience index (S).
The top five sexual and reproductive health concerns identified by participants were human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), followed by menstrual pain, vaginal infections, sexual abuse and teenage pregnancy. Adolescent girls stated that youth empowerment programs that provide access to skills-building opportunities and mentors was one potential strategy for addressing their sexual and reproductive health priorities. Other solutions identified were access to medical checkups, general health talks focused on their sexual and reproductive health concerns as well as access to health facilities and opportunities to build self-efficacy skills.
Adolescent girls in Nigeria need to be engaged in becoming powerful agents in improving their own sexual and reproductive health, and in crafting solutions that may be effective in enabling them to achieve their full potential and rights to health and well-being. The findings will be used to develop an intervention targeting the sexual and reproductive health priorities of adolescent girls in Lagos, Nigeria.
2019, December 27 | BMC Health Services Research
Preferences for HIV testing services among young people in Nigeria
Ucheoma Nwaozuru, Juliet Iwelunmor, Jason J. Ong, Sawsan Salah, Chisom Obiezu-Umeh, Oliver Ezechi, & Joseph Tucker
Despite high HIV incidence rates among young people in Nigeria, less than 24% of this population have ever tested for HIV. These low HIV testing rates suggest that current testing services may not align with their testing preferences. To address this gap, the objective of this study was to assess preferences for HIV testing options among young people in Nigeria.
We conducted a cross-sectional study using survey to assess preferences for HIV testing options among 113 youth aged 14–24 years residing in Nigeria. The survey included a series of hypothetical HIV testing options, comprised of six characteristics centered around HIV testing service (i.e. location of testing, test administrator, mode of pre-test, mode of post-test counseling, type of HIV test, and cost of HIV test). For each characteristic, participants were asked to select one of the options that they prefer or indicate none of the above. A descriptive analysis of the preferences made by participants was conducted, summarizing proportions of participants who selected different options for HIV testing.
The mean age of study participants was 19.5 years old (SD = 2.7). Most youth (73, 64.6%) had at least a secondary school degree. There was pronounced heterogeneity in HIV testing preferences among young people. Although most youth preferred free HIV testing, 14 (16.7%) reported preferring paying a small amount compared to free testing. More youth preferred blood-based HIV self-testing 39(48.8%) compared to facility-based HIV testing and oral HIV self-testing.
Our finding suggest that young people have a range of HIV testing preferences in Nigeria. This suggests that a “one-size-fits-all” approach to delivering services to youth may be challenging in this context. HIV testing services can be optimized to reach young people if a variety options are provided to meet their unique preferences.