JMIR Publications

ABSTRACT

Background:

Sub-Saharan Africa has the highest HIV incidence and prevalence in the world, with adolescents and young adults (AYA) at greatest risk. Despite effective combination prevention tools, including recent availability of pre-exposure prophylaxis (PrEP), HIV incidence for AYA in Uganda remains high and PrEP use remains low. Mental health and substance use (i.e., behavioral health) play a role in sexual risk behavior and decision-making, contributing to an increase in risk for acquiring HIV. Interventions that target multiple HIV risk factors, including sexual and mental health and problematic substance use, are crucial to ending the HIV epidemic. Yet, few interventions currently exist that address health disparities and comorbidities among AYA in sub-Saharan Africa.

Objective:

This study will evaluate the acceptability and feasibility of Kirabo, a text message intervention informed by the Information, Motivation, and Behavior (IMB) model, to be disseminated through secondary schools. We will gather preliminary estimates of Kirabo’s effectiveness at increasing HIV testing and linkage to mental health counselors.

Methods:

We identified Mobile 4 Reproductive Health (m4RH) as a promising candidate for adaptation using the ADAPT-ITT framework. M4RH is an evidence-based automated two-way text messaging and interactive voice response (IVR) platform that offers SRH information and links users to HIV clinics in East Africa. Through ADAPT-ITT, including a pretest with (N=24 AYA), we refined our approach and created Kirabo, a text-message based intervention to link AYA to health services including HIV testing and mental health counseling. Next, as described in this protocol we will conduct a 2-arm, randomized controlled trial (RCT) in Masaka, Uganda. AYA (N=200) will be recruited from local schools. Baseline sociodemographic characteristics, HIV test history and behavioral health symptoms will be assessed. Twice per week during the intervention, Kirabo will send enrolled AYA a text message focused on HIV testing, PrEP and behavioral health. Texting with the platform is free in Uganda. We will evaluate acceptability and feasibility using surveys, interviews, and mobile phone data. Preliminary efficacy of Kirabo to increase HIV testing and link with mental health counselors will be evaluated immediately post intervention and 3-month follow up. We also will assess the intervention’s impact on self-efficacy to HIV test, uptake PrEP, and link with a mental health counselor.

Results:

Intervention adaptation began in 2019. A pre-test was conducted in 2021. The RCT, including usability and feasibility assessments, and effectiveness measurement, commenced in August 2023.

Conclusions:

Kirabo is a tool to assist in efforts to end the HIV epidemic by targeting health disparities and comorbidities among adolescents in Uganda. The intervention includes local HIV clinic information, PrEP information and behavioral health screening, with referral as needed. Increasing access to prevention, and reducing factors that make AYA vulnerable to HIV acquisition can contribute to global efforts end the HIV epidemic. Clinical Trial: This trial is registered at https://clinicaltrials.gov/study/NCT05130151.