JMIR Publications

ABSTRACT

Background:

Tailored interventions are needed to contain Ukraine’s HIV epidemic, especially in wartime. The CASI-Plus study sought to develop and test a mHealth tool to support HIV testing targeted to people most at risk of HIV exposure, namely the sexual and needle-sharing partners of people who have been newly-diagnosed with HIV. The tool provides client-facing information on how HIV index testing works and uses a standardized self-guided questionnaire with non-judgmental language for clients to list partners who would benefit from HIV testing. The tool also enables healthcare workers (HCWs) to see summarized data about named partners, to facilitate their tracking and follow-up. Given wartime population displacement, trauma, and disruption of health services, it was important to gather both client and healthcare worker input on the designs of this mHealth CASI-Plus tool to ensure acceptability, feasibility, and usability.

Objective:

This formative research study sought to gather input to prioritize features and test usability of CASI-Plus with healthcare workers and clients living with HIV who are engaged with HIV services in public health clinics in wartime Ukraine.

Methods:

The CASI-Plus study’s formative phase, carried out in May 2023-July 2024, utilized adapted, human-centered design (HCD) methods grounded in principles of empathy, iteration, and creative ideation. The study included three steps: 1) human centered design, including in-depth individual interviews with 10 clients, including men who have sex with men (MSM) and people who inject drugs (PWID), and virtual design workshops with 22 HCWs from rural and urban HIV clinics in Chernihiv and Dnipro; 2) formative development and heuristic evaluation, including assessment of open-source mHealth platforms against CASI-Plus requirements, prototype development, and testing of the REDCap prototype based on usability heuristics; and 3) usability walk-throughs, including simulated cases with HCWs and clients.

Results:

The formative research phase of the CASI-Plus study demonstrated how simplified HCD methods, adapted to the wartime context, gathered rich input on the prioritized features and design of the CASI-Plus tool. The CASI-Plus design reflected features that are both culturally sensitive and align with the constraints of Ukraine’s wartime setting. Prioritized features included information about benefits of HIV index testing, a non-judgmental self-guided questionnaire to report partners, client stories, and bright images to accompany text. Two-way SMS messaging between clients and HCW was not considered feasible to integrate within the workflow of understaffed public health clinics.

Conclusions:

It was feasible to conduct HCD research in Ukraine even in a wartime setting, and the CASI-Plus mHealth tool was acceptable to both HCW and clients. The next step for the research is a randomized clinical trial of the effect of the REDCap-based CASI-Plus on the number of partners named and the rate of partners completing HIV testing. Clinical Trial: This trial is registered via ClinicalTrials.gov # NCT05826977.