JMIR Publications

ABSTRACT

Background:

In 2022, 3100 adolescent girls and young women (AGYW) in sub-Saharan Africa experienced new HIV infections each week. HIV Pre-Exposure Prophylaxis (PrEP) is highly effective at preventing HIV but has had limited uptake and persistence among AGYW. Mobile health (mHealth) interventions can improve PrEP adherence among sexual and gender minority men and increase antiretroviral adherence for AGYW living with HIV, however the utility of mHealth interventions to improve PrEP adherence among uninfected AGYW is not well-established.

Objective:

The objectives of this scoping review are to synthesize current evidence supporting the utility and impact of mHealth for PrEP among AGYW in sub-Saharan Africa and to identify promising strategies for further evaluation.

Methods:

A literature search was conducted via PubMed and Google Scholar, expert referrals and reference searches using the following eligibility criteria: (1) original research study or protocol; (2) English-language; (3) published 1 January 2012 through 31 August 2023; (4) inclusive of AGYW; (5) conducted in sub-Saharan Africa; and (6) mHealth tool(s) used to (7) promote PrEP uptake, adherence or persistence. Titles and abstracts were screened for potential relevance by two independent researchers. The remaining full-text manuscripts were reviewed against all eligibility criteria to determine final included studies. Study characteristics and results of included studies were abstracted and synthesized by mHealth tool type.

Results:

Search results identified 482 unique citations. Title/abstract review removed 380 citations primarily for not including AGYW or being conducted outside sub-Saharan Africa. The remaining 102 articles underwent full-text review yielding 31 eligible publications reporting on 21 unique studies that used mHealth tools. The most common mHealth tool was SMS (n=11 interventions), followed by applications (apps) (n=9), telehealth (n=3), websites (n=4), and videos (n=1). Few publications evaluated effectiveness, and results were mixed; one study found SMS reminders improved PrEP adherence, and one concluded SMS reminders did not show significant impact. Two studies found that differentiated service delivery, which included mHealth components, improved PrEP uptake or persistence, however findings could not be attributed solely to the mHealth components. Lastly, one website was also shown to improve PrEP persistence. Several earlier-stage studies focused on values and preferences towards mHealth without reporting the impact on PrEP.

Conclusions:

This scoping review found few implemented and rigorously evaluated mHealth interventions for supporting PrEP among AGYW, inhibiting the ability to draw conclusions on its effectiveness. Studies documented high usability and acceptability, but limited assessment of impact on health outcomes. Secondary uses of mHealth were also found for data collection and components of standard-of-care. There is substantial room for growth in the innovative use of mHealth to support PrEP among AGYW. Careful consideration of the strengths and limitations of specific mHealth tools in the local setting, review of past lessons learned, and intentional study design allowing for measurement of mHealth exposure and utilization could help advance this growing field.