Tushirikiane 'Supporting each other'

Role: Co-investigator

Funder: Canadian Institutes of Health Research (project grant 389142).

Project lead: Funding awarded to Prof Carmen Logie, University of Toronto.

Dates: September 2017 to August 2020

Background

HIV is the leading cause of mortality among adolescents aged 15-19 years in sub-Saharan Africa. Uganda hosts over 1.43 million refugees, and more than 83,000 live in the capital Kampala, largely in informal settlements. Urban displaced and refugee adolescents in Kampala are at elevated risk of HIV and are currently underserved by HIV prevention strategies. This study aimed to evaluate the feasibility and effectiveness of two HIV self-testing implementation strategies for this population in comparison to standard of care in terms of HIV testing outcomes.

What did we do?

We conducted a cluster randomised controlled trial (RCT) across five informal settlements in Kampala. Participants (displaced and refugee adolescents aged 15-19) were randomised to one of two interventions (HIV self-testing intervention alone (HIVST)and HIV self-testing combined with an mHealth intervention(HIVST+)) or standard of care (SOC) (1:1:1). Data collected at three time points: baseline, 8 months (T1), and 12 months (T2). Primary outcomes: HIV testing and HIV status knowledge.

What did we find?

450 participants enrolled in the study, 31.2% of whom reported HIV testing in past year (balanced across arms). At T1, testing uptake as follows: SOC 24.8%, HIVST 91.2%, HIVST+ 94.2%; Odds of reporting HIV test since T0 was significantly higher in both intervention arms compared to SOC (p<0.001); the effect persisted at T2. At T2, HIV status knowledge in intervention arms (HIVST arm: 100%, HIVST+ arm: 97.9%) was significantly higher than SOC (61.5%) (p<0.001). Moderate effects on some secondary outcomes observed (such as HIV stigma, depression, condom use) which present a mixed picture in terms of the potential benefit of HIVST and HIVST+ over SOC. Whilst the findings are promising (in terms of the value of HIVST in increasing HIV testing and knowledge of HV status in humanitarian settings), a larger trial that addresses some important study limitations is needed.

Publications

Study protocol '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)' is published in JMIR Research Protocols and can be accessed here.

Paper reporting on the study findings 'Findings from the Tushirikiane mobile health (mHealth) HIV self-testing pragmatic trial with refugee adolescents and youth living in informal settlements in Kampala, Uganda' is published in Journal of the International AIDS Society and can be accessed here.