Technology in a gender-specific combination HIV prevention pilot study in Kenya
HIV infection disproportionately affects youth (15-24 years old) in sub-Saharan Africa. High coverage of HIV testing and counseling (HTC) is essential for early linkage to care for HIV positive youth. The MP3 Youth study aims to pilot a combination package of gender-specific interventions in western Kenya in a mobile health delivery format, mobile electronic health records, and mobile phone surveys to follow-up participants after the event.
The mobile health events are composed of 6 tents where gender specific interventions are offered on site. The package includes: for all youth, HIV testing as an entry point with linkage to care/antiretroviral therapy (ART) and increased condom use among newly HIV-diagnosed persons; for HIV negative, uncircumcised males, voluntary medical male circumcision (VMMC); for 20-24 year old HIV negative at risk females, PrEP; and for 15-19 year old HIV negative girls attending school, a conditional cash transfer (CCT).
Participants are identified by a biometric device connected to a tablet . The services one can access depend on clinical/behavioral eligibility collected in the tents. The tablets are connected via Bluetooth and sync every 5 minutes. Clients registered in tent 1 can be identified and their health records accessed in other tents. Participants complete an ODK survey that is pushed to the NYU server at the end of each day. Biometrics ensures that individuals access each service and receive incentives only once. RAs complete ODK checklists to ensure all services were offered. Youth who are HIV positive are enrolled in a cohort to evaluate the barriers and facilitators to accessing care and adhering to treatment. A USSD survey is pushed to the participants every 3 months. The platform protects participant confidentiality by not storing data on the device. No questions or responses are stored on the device. Upon survey completion, a mobile money transfer is sent via mPESA.
Combination HIV prevention can significantly reduce HIV risk among youth. However, to be effective in the overall population, interventions need to be implemented at high coverage levels.