Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Mar 21, 2023
Date Accepted: Aug 4, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Long-term optimal use of an mHealth app to promote the use of HIV pre-exposure prophylaxis among female sex workers in Dar es Salaam, Tanzania: A prospective cohort study
ABSTRACT
Background:
Increasing access to smartphones in sub-Saharan Africa offers an opportunity to leverage mHealth technology to improve access to healthcare in underserved populations. In the domain of HIV prevention, mHealth interventions can potentially contribute to solve the challenge of sub-optimal adherence to pre-exposure prophylaxis (PrEP) and low retention in PrEP services in populations most vulnerable to HIV acquisition. However, there is a gap in the knowledge about long-term use of such interventions in sub-Saharan Africa.
Objective:
This study aimed at evaluating the extent and predictors of long-term optimal use of an mHealth app (called Jichunge) which aims to promote adherence to PrEP and retention in PrEP care among female sex workers in Dar es Salaam, Tanzania.
Methods:
A prospective cohort of female sex workers residing in the city of Dar es Salaam were recruited using respondent-driven sampling. All participants were provided with the Jichunge app as they started PrEP. A questionnaire was used to collect data on sociodemographic and other structural factors, while data on app use were extracted from the backend of the app for a period of 60 days after six months. Multivariable log-binomial model was used to determine predictors for long-term optimal use of the Jichunge app.
Results:
A total of 470 female sex workers were recruited. A large majority of the study participants (193/206, 93.7%) who came back for the 6-month interview no longer had access to the Jichunge app because their phones had been lost, sold, stolen, changed or were in disrepair. The use of the app declined over time and only 75 (16%) of the participants were optimal users after six months. Women aged at least 35 years were two times more likely to use the app than women aged 18-24 years (aRR 2, 95% CI 1.1-3.5; P=.02). Furthermore, long-term use of the app was higher among participants who demonstrated high PrEP awareness at baseline (aRR 2, 95% CI 1.3-3.1; P=.003), and among those who had experienced financial difficulties due to healthcare spending (aRR 1.7, 95% CI 1.1-2.6; P=.02).
Conclusions:
Most female sex workers enrolled in PrEP care in Tanzania did no longer use the Jichunge app after six months. Long-term optimal use of the app was predicted by older age, high PrEP awareness and having experienced financial difficulties because of spending on healthcare. Strategies for long-term retention of participants in mHealth applications such as systems for re-installations of apps should be considered during the design phase. Clinical Trial: International Clinical Trials Registry Platform PACTR202003823226570; https://trialsearch.who.int/Trial2.aspx?TrialID=PACTR202003823226570
Citation
