Enhancing HIV Self-Testing Among Nigerian Youth: Feasibility and Preliminary Efficacy of the 4 Youth by Youth Study Using Crowdsourced Youth-Led Strategies

Drug use and needle sharing among adolescents and young adults in Nigeria: A cross-sectional secondary analysis of data from a multi-site clinical trial

BACKGROUND

Adolescents and young adults (AYA, 14-24 years old) have the highest rates of drug use in most low- and middle-income countries. Little is known about the drivers of drug use among AYA in Nigeria and harm reduction services are limited.

METHODS

A secondary data analysis was performed of the baseline survey of the 'I-TEST' study involving AYA in Nigeria. The two primary outcomes of interest were lifetime measures of drug use and needle sharing. Logistic regression analyses were performed to obtain odds ratios for the associations between socio-demographic exposures and the two primary outcomes. Odds ratios were subsequently adjusted for age and sex.

RESULTS

1500 AYA survey responses were analysed. Respondents were mostly unemployed, students, and living in southern Nigeria. Drug use was reported by 301/1500(20.3 %) AYA. Among these, 213/301(71.5 %) reported needle sharing. Drug use did not vary by age (OR:0.94, 95 %CI:0.73-1.22) or sex (OR:1.00, 95 %CI:0.77-1.28). AYA in the North-Central zone had higher odds of drug use (OR:1.86, 95 %CI:1.28-2.69) and needle sharing (OR:2.51, 95 %CI:1.07-5.91) compared to AYA in the South-West zone of Nigeria. AYA aged 14-19 had higher odds of needle sharing compared to those aged 20-24 (OR:3.49, 95 %CI:1.94-6.26). Female AYA had higher odds of needle sharing compared to males (OR:5.05, 95 %CI:2.85-8.95).

CONCLUSIONS

Drug use and needle sharing are common among AYA in Nigeria. There is an urgent need for harm reduction services and research informed by AYA.

For girls and women (4GW) HPV RCT protocol: a crowdsourced, pragmatic stepped-wedge cluster randomized trial to improve uptake of HPV vaccination and screening among mother-daughter dyads in Nigeria

BACKGROUND

Expanding human papillomavirus (HPV) vaccination for girls and HPV self-collection for women can reduce the global burden of cervical cancer. However, HPV vaccination and self-collection services are rarely implemented simultaneously in mother-daughter dyads, leaving a critical gap in cervical cancer prevention. From 2023 to 2024, a community-engaged model for combined HPV vaccination and screening was co-designed using crowdsourcing open calls and designathons with mother-daughter teams and pilot-tested by trained research facilitators. This study explores the impact of this crowdsourced, community-engaged mother-daughter campaign and implementation strategy bundle on HPV vaccination among girls and HPV screening among their mothers in Nigeria over 6 months in 18 Nigerian local government areas (LGAs).

METHODS

A hybrid effectiveness-implementation type II pragmatic stepped-wedge cluster randomized control trial has been employed to the effectiveness of an implementation strategy bundle; a crowdsourced, tailored, community-engaged, mother-daughter HPV campaign on increasing uptake of HPV vaccination among girls aged 9-14 and HPV screening uptake among women aged 30-49 in Nigeria. The mother-daughter campaign will be tailored to local sites and conducted among 612 mother-daughter dyads (1,224 participants) recruited from 18 LGAs in six geopolitical zones of Nigeria. Trained community health workers will collect baseline data and implement a mother-daughter campaign that will provide education on cervical cancer control and access to onsite services for HPV vaccination and screening in a private area while engaging mothers and daughters simultaneously to increase uptake of the services. A mixed-methods evaluative and iterative assessment will be conducted using Proctor's Implementation Outcomes Framework and the PEN- 3 cultural model. The primary outcomes are the uptake of HPV preventive measures-HPV vaccination (one dose) among girls (ascertained by onsite clinical records of vaccine uptake) and HPV self-collection completion among mothers (ascertained by laboratory receipt of self-collected specimens) within six months of trial enrollment. Pre-post effectiveness and cost of study components are embedded in the implementation and sustainment phases, compared to pre-implementation data assessed for each LGA.

DISCUSSION

This study is a unique dyadic intervention focused on both girls and their mothers or female caregivers to drive cervical cancer control in Africa. Findings have the potential to inform local and global policies aimed at reducing the cervical cancer burden in African countries like Nigeria, eliminating missed opportunities by closing the research-to-translation gap. The protocol was registered with clinicaltrials.gov under registration NCT06728085.

The 4 youth by youth (4YBY) crowdsourced HIV prevention intervention: A stepped-wedge longitudinal trial on HIV self-testing uptake among adolescents and young people in Nigeria

Adolescents and young adults (AYAs) participatory approaches for HIV control have increased across LMICs, but there are few trials to evaluate effectiveness. We assessed a crowdsourced HIV self-testing (HIVST) intervention among a cohort of AYA in Nigeria.

METHODS

We conducted a pragmatic stepped-wedge cluster randomized control trial recruiting participants (aged 14-24 years) from 32 local government areas across four geo-political zones in Nigeria. Eligible AYA were HIV negative or unknown HIV status, residing in study sites, spoke English, and consented. Areas were randomly assigned to one of four steps and AYA were followed for 24 months. AYA research facilitators implemented a 4YBY crowdsourced HIV prevention bundle. The primary outcome was self-reported HIVST uptake. We compared the probability of HIVST between the control and intervention periods using a generalized linear mixed model. We examined the fixed cost and per capita cost of the intervention. The protocol was registered with Clinical Trials.gov on January 15, 2021, under registration NCT04710784.

RESULTS

2652 AYA were screened, and 1500 were enrolled in the study (March 10, 2021- August 31, 2023). 1333/1500 (89 %) were followed up at 24 months. The mean age of AYA was 20 ± 2.65 years old, most were students (1155/1500, 77 %), and unemployed (915/1500, 61 %). The intervention led to a 9.96-fold increase in HIV self-testing uptake compared to the control period (95 % CI: 8.36-11.85, p < 0.0001). The annual fixed cost of the intervention was estimated at US$42,237, with a per capita testing cost of US$14.8. No significant adverse events were reported.

CONCLUSION

A crowdsourced HIV prevention intervention increased HIVST uptake among Nigerian AYA. Greater participation of AYA in the design and implementation of clinical trials is needed to achieve UNAIDS targets.

Strategies to sustain HIV prevention interventions among adolescents and young adults: analysis of data from a crowdsourcing open call in Nigeria

Background Crowdsourcing is a process whereby a large group, including experts and non-experts, collaborate to solve a problem and then share the solution with the public. Crowdsourcing can be used to identify strategies to sustain HIV services in low-and-middle-income countries. This study aims to identify innovative adolescent and young adult (AYA) solutions through a crowdsourcing open call to sustain HIV services. Methods Building on HIV prevention services developed by AYA from an initial open call, we organized a crowdsourcing open call to identify innovative, AYA-led strategies to sustain these services through partnerships with the community. The open call question was, 'How might we sustain the 4 Youth by Youth HIV prevention services while nurturing our existing relationships, practices, procedures and services that will last in our communities?'. All submissions were assessed based on prespecified judging criteria. Qualitative data were analyzed using thematic analysis and categorized into strategies for sustaining AYA-friendly HIV prevention services in Nigeria. Results We received 102 eligible submissions from AYA. Twenty-three submissions met the mean score threshold and were qualitatively analyzed. Through this analysis, we identified four strategies for sustaining AYA-friendly HIV prevention services in Nigeria: AYA engagement and leadership in research, digital health solutions, financing and efficiency, and partnerships. Conclusion This open call highlights how strategies developed by AYA may sustain AYA-friendly HIV prevention services. Our findings offer key insights for maintaining HIV prevention services in Nigeria and other similar settings.

Co-creating strategies to promote uptake of HIV self-testing among young adults in Mecklenburg county, North Carolina: a protocol for a pilot implementation study

Background

HIV testing is the gateway to entering HIV care and prevention services. However, HIV testing rates remain low among young adults (18-29 years old) in Mecklenburg County, North Carolina (NC), an ending the HIV epidemic (EHE) priority jurisdiction. We aim to utilize community-engaged and participatory approaches to co-create implementation strategies to promote the reach and uptake of HIV self-testing (HIVST) among young adults in the region. This study protocol outlines the phases of the project and the proposed outcomes.

Methods

The Community-engaged Approaches to Expand HIV Self-Testing among Young Adults in Mecklenburg County, North Carolina (CATEST) project will be conducted in three phases, guided by the Consolidated Framework for Implementation Research (CFIR), Community-based Participatory Research (CBPR), and Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) frameworks. The formative phase of the study, guided by CFIR, will focus on understanding the barriers, facilitators, and opportunities for implementing HIVST among young adults in Mecklenburg County, North Carolina. The second phase, guided by CBPR, will utilize participatory approaches such as crowdsourcing open calls and charrettes to co-create implementation strategies for HIVST. Then, the final pilot implementation phase, guided by CFIR and RE-AIM, will use mixed methods to evaluate the success of the co-created HIVST implementation strategies using a pre-post design. Participants in the study will complete a baseline survey and a follow-up survey immediately following intervention completion. In addition, a purposive sample of participants and representatives at the participating community organization will complete qualitative exit interviews within 1 month of intervention completion.

Discussion

This study protocol outlines the co-creation of implementation strategies, tests their feasibility, and explores preliminary effectiveness in promoting HIVST uptake among young adults in Mecklenburg County, NC. The study will yield insights on the feasibility of leveraging the capabilities of community and youth innovation to promote young adults-centered implementation strategies to advance the reach and adoption of HIVST among young adults.

Registration

Registered on Open Science Forum-DOI 10.17605/OSF.IO/2BZWV.

Preventing Unintended Pregnancies and HIV Through Self-Care Interventions in East and Southern Africa: Findings From a Structured Review

Objective

To identify promising interventions targeting young people in East and Southern Africa through self-care practices, with a focus on prevention of unintended pregnancies and HIV and develop four evidence-based self-care models.

Methods

A structured literature review was conducted followed by a consultation with key stakeholders and youth networks from Malawi, South Africa, Zambia and Zimbabwe. Of the 2,890 published articles identified, 464 were fully reviewed and 59 were included in the final analysis along with 48 pieces of grey literature. A total of 31 youths participated in the consultation sessions.

Results

Self-care interventions with high levels of feasibility, acceptability, and scalability included HIV self-testing, self-management of contraceptives, and self-awareness for improved and safer sex behaviours and sexual health. Key features of these interventions included the use of non-clinical environments, regular follow ups to reinforce practice, use of digital solutions, linkage to in person care, and participatory approaches involving young people from ideation to implementation.

Conclusion

Self-care models that promote distribution, access, support through multiple mechanisms in non-clinical environments are more acceptable and more effective in reaching young people.

A digital citizen science intervention to reduce HIV stigma and promote HIV testing: a randomized clinical trial among adolescents and young adults in Kazakhstan

Background Kazakhstan has a high HIV incidence among adolescents and young adults (AYA), and high HIV stigma contributing to low HIV testing uptake. We examined whether an AYA-developed digital crowdsourced intervention reduced HIV stigma compared with conventional public health materials among AYA in Almaty, Kazakhstan. Methods A total of 216 AYA (females:116/males:110) aged 16-24 years were recruited to the online study cohort and randomized 1:1 to the intervention or control arm. AYA were exposed to the crowdsourced intervention or control materials once a week for 5weeks, with equivalent exposures between arms. Outcomes included a total HIV stigma score assessed at baseline, immediately post-intervention and 2months post-intervention from January to August 2023. We conducted multilevel mixed models to compare changes over time by arm and sex. Results AYA in the intervention arm had significantly lower HIV testing stigma 2months post-intervention (adjusted mean change (AMC): -0.73 (-1.07, -0.39)) than AYA in the control arm (AMC: -0.06 (-0.42, 0.30); P =0.032). Female AYA in the intervention arm had significantly lower total HIV stigma immediately post-intervention (AMC: -4.91 (-7.25, -2.58)) and 2months post-intervention (AMC: -5.16 (-7.48, -2.84)) than females in the control arm (immediately post-intervention AMC: -0.03 (-2.63, 2.57) and 2-months post-intervention AMC: -0.07 (-2.70, 2.56); P =0.012, P =0.012). Conclusions The AYA-developed crowdsourced intervention decreased HIV testing stigma, although this effect was moderated by sex, and decreased total HIV stigma among female AYA. Crowdsourced interventions may be a promising way to engage communities to develop interventions to decrease HIV stigma.

Factors associated with HIV self-testing and PrEP use among Nigerian youth: Baseline outcomes of a pragmatic, stepped-wedge, cluster-randomized controlled trial

INTRODUCTION

Adolescents and young adults (AYA, 14-24 years) bear a disproportionate burden of new HIV infections in Nigeria and are more likely to have worse HIV outcomes compared to other age groups. However, little is known about their access to recommended sexual health care services, including HIV self-testing (HIVST), sexually transmitted infections (STI) testing, sexual behavior patterns, awareness and or access to pre-exposure prophylaxis (PrEP), and overall risk for HIV.

METHODS

We present a baseline analysis of the 4 Youth by Youth randomized controlled trial aimed to evaluate the uptake and sustainability of crowdsourced HIVST strategies led by and for young people across 14 states in Nigeria. None of the participants had received intervention at the time of completing this self-reported behavioral survey. We conducted a descriptive analysis to summarize participants' characteristics, sexual behavior, HIV testing, STI testing, and knowledge of PrEP and use across the study sample of the AYAs. We conducted a chi-square test, and the level of significance was set at ≤0.05.

RESULTS

A total of 1551 participants completed the baseline survey comprising males (777, 50.1 %) and females (774, 49.9 %). The majority (77 %) of the participants were students at enrollment. Very few of the participants had ever tested for syphilis, 47 (3.1 %), gonorrhea, 49 (3.2 %), chlamydia, 31 (2.0 %), and hepatitis B, 106 (6.9 %). 678 (43.8 %) of the participants reported to be sexually active at the time of enrolment into the study, of which about 38 % of them engaged in condomless sex. Paying for sex, alcohol use, and drug use are all significant sexual behaviors (p < 0.01). Only 14 (1 %) have ever used PrEP. 481 (31.4 %) have ever tested for HIV, and 104 (6.8 %) have ever used an HIV self-testing kit at baseline. 457 (38.6 %) were eligible for PrEP.

CONCLUSIONS

HIVST and STI uptake were low at baseline among the AYA in this study. Most AYAs also do not receive recommended sexual health care services, including STI testing services. This underlines the need for interventions to increase the uptake of HIV/STI prevention services among Nigerian AYA.

An innovation bootcamp model for developing youth-led HIV self-testing delivery strategies in Nigeria: post-designathon capacity building

Introduction

Many designathons, hackathons, and similar participatory events suffer from minimal training and support after the events. Responding to this need, we organized a health innovation bootcamp: an intensive, team-based apprenticeship training with research and entrepreneurial rigor among young people in Nigeria to develop HIV self-testing (HIVST) delivery strategies for Nigerian youth. The purpose of this paper was to describe an innovation bootcamp that aimed to develop HIVST delivery strategies for Nigerian youth.

Methods

The four-week, in-person innovation bootcamp, informed by youth participatory action research and comprised a series of workshops, took place in Lagos, Nigeria. The goal was to build research and entrepreneurial capacities among young people to develop and implement HIVST strategies. A qualitative content analysis informed by an adapted World Health Organization's HIVST delivery framework explored key elements of the proposed HIVST service delivery strategies developed at the bootcamp.

Results

Twenty participants, aged 18-24 years, from five teams completed the innovation bootcamp. The five teams developed HIV service delivery strategies that included an element of repacking HIVST kits to make them more appealing to young people. Other strategies that emerged included leveraging community engagement platforms (e.g., vocational skills training and youth community events) to promote HIVST, and the use of reward-referral system to encourage HIVST uptake among young people. All strategies included ways to ensure privacy protection for recipients of the HIVST delivery package.

Conclusion

This study demonstrated the feasibility and acceptability of the health innovation bootcamp model to create HIVST designed for and led by young people. This suggests a way to build capacity after participatory events to sustain youth-led research, which could have implications for post-designathon training.

Acceptability and use of HIV self-testing among young people in sub-Saharan Africa: a mixed methods systematic review

BACKGROUND

Young people (YP) are disproportionately affected by the HIV pandemic in sub-Saharan Africa (SSA), but testing rates remain low despite global targets of testing 95% of people with HIV infection by 2030. HIV self-testing (HIVST) has been recently introduced to reach high-risk population groups such as these. Thus, synthesis of emerging evidence on the acceptability and use of HIVST among YP in SSA is needed so that comprehensive information can be generated to inform policy and practice.

METHODS

We employed a mixed methods systematic review of quantitative and qualitative literature reporting on HIVST among YP involving any design and published in English by 31st of October 2023. The review synthesized quantitative evidence on acceptability and use of HIVST, and qualitative evidence on perspectives of YP about HIVST. We searched databases of published articles (e.g. MEDLINE, CINAHL) and Gray literature sources (e.g. Google, Google Scholar). The concepts for the search included self-testing, HIV/AIDS, and countries in SSA. Two authors independently screened, retrieved full-text, and assessed quality of the studies.

RESULTS

A total of 4150 studies were retrieved and 32 studies were finally included in the review. Acceptability of HIVST computed from a single item asking YP on their preference or willingness or demand for HIVST was moderate (34-67%) to high (≥ 67%) among YP in SSA. Nine of the fourteen studies that reported on acceptability found high acceptability of HIVST. Use of HIVST ranged from 0.8 to 100% while in most studies the use rate was below 50%. Key barriers to HIVST use were coping with a positive test in the absence of counselling and support, physical discomfort, and cost of kits. Perceived enablers included perceptions of HIVST as promoting personal empowerment and autonomy; privacy and confidentiality; and convenience in location, time, and skill.

CONCLUSIONS

HIVST was highly accepted but not well utilized among YP in SSA. YP showed diversified needs with mixed preferences for location, and modalities of service provision. Overall, the review identified heterogeneous evidence in terms of methods, population, outcome measures, and results. The review was registered in the International Prospective Registry of Systematic Reviews (PROSPERO: ID = CRD42021278919).

Awareness of, willingness to use, and experiences with Pre-exposure prophylaxis among youth in Nigeria

BACKGROUND

Youth (ages 14-24) in Nigeria have disproportionately high rates of new HIV infection. Pre-exposure prophylaxis could substantially reduce new infections among youth but has not been scaled up. This cross-sectional study aimed to assess Pre-exposure prophylaxis awareness, willingness to use, and prior use of Pre-exposure prophylaxis among youth in Nigeria.

METHODS

This is a secondary analysis of cross-sectional data from a quasi-experimental pilot study (clinical trial NCT04070287). The analysis focused on Pre-exposure prophylaxis awareness, willingness to use, and prior use among 324 youth recruited between September 2019 to March 2020. Descriptive statistics were calculated as frequencies and percentages for categorical variables and means and standard deviations for continuous variables.

RESULTS

Of the 324 participants, the mean age and standard deviation were 21.17 (± 2.20) years. The majority were 20-24 years old (75.9%) and male (57.7%). Only 30.7% used condoms consistently over three months. Regarding Pre-exposure prophylaxis awareness and willingness, 62.6% had never heard of Pre-exposure prophylaxis, and 158 (50.1%) reported willingness to use Pre-exposure prophylaxis. Only 10 (3.2%) reported having used Pre-exposure prophylaxis.

CONCLUSION

Nigerian youth have low awareness of and prior use of Pre-exposure prophylaxis. Given the gap between prior use and willingness to use Pre-exposure prophylaxis, our findings suggest missed opportunities to prevent new HIV infections among youth in Nigeria. Efforts to increase awareness and uptake of Pre-exposure prophylaxis among this population should consider youth-led Pre-exposure prophylaxis outreach efforts and effectively communicate the benefits of Pre-exposure prophylaxis to this population.

TRIAL REGISTRATION

NCT04070287, the Date of registration of the trial is 20-07-2019.

A designathon to co-create HPV screening and vaccination approaches for mothers and daughters in Nigeria: findings from a community-led participatory event

BACKGROUND

Oncogenic types of human Papillomavirus (HPV) infection cause substantial morbidity and mortality in Nigeria. Nigeria has low cervical cancer screening and vaccination rates, suggesting the need for community engagement to enhance reach and uptake. We organised a designathon to identify community-led, innovative approaches to promote HPV screening and vaccination for women and girls, respectively, in Nigeria. A designathon is a three-phase participatory process informed by design thinking that includes the preparation phase that includes soliciting innovative ideas from end-users, an intensive collaborative event to co-create intervention components, and follow-up activities.

METHODS

We organised a three-phase designathon for women (30-65yrs) and girls (11-26yrs) in Nigeria. First, we launched a national crowdsourcing open call for ideas on community-driven strategies to support HPV screening among women and vaccination among girls. The open call was promoted widely on social media and at in-person gatherings. All eligible entries were graded by judges and 16 exceptional teams (with 4-6members each). All six geo-political zones of Nigeria were invited to join an in-person event held over three days in Lagos to refine their ideas and present them to a panel of expert judges. The ideas from teams were reviewed and scored based on relevance, feasibility, innovation, potential impact, and mother-daughter team dynamics. We present quantitative data on people who submitted and themes from the textual submissions.

RESULTS

We received a total of 612 submissions to the open call from mother-daughter dyads. Participants submitted ideas via a website designated for the contest (n = 392), in-person (n = 99), email (n = 31), or via an instant messaging application (n = 92). Overall, 470 were eligible for judging after initial screening. The average age of participants for daughters was 19 years and 39 years for mothers. Themes from the top 16 proposals included leveraging local leaders (5/16), faith-based networks (4/16), educational systems (4/16), and other community networks (7/16) to promote awareness of cervical cancer prevention services. After an in-person collaborative event, eight teams were selected to join an innovation training boot camp, for capacity building to implement ideas.

CONCLUSIONS

Innovative strategies are needed to promote HPV screening for mothers and vaccination for girls in Nigeria. Our designathon was able to facilitate Nigerian mother-daughter teams to develop cervical cancer prevention strategies. Implementation research is needed to assess the effectiveness of these strategies.

Feasibility, acceptability and preliminary effect of a community-led HIV self-testing model among adolescent girls and young women in Rural Northern Uganda: a quasi-experimental study protocol

BACKGROUND

Adolescent girls and young women (AGYW) in sub-Saharan Africa face a disproportionately higher HIV/AIDS burden despite the global decline in incidence. Existing interventions often fail to adequately address their unique social, economic, and cultural challenges, limiting access to essential HIV/AIDS services, including HIV testing. Emerging evidence indicates that HIV self-testing, a user-friendly and confidential method, enhances HIV diagnosis and linkage to care by targeting these barriers. This study aims to assess the feasibility, acceptability, and preliminary impact of a peer-delivered, community-health worker (CHW)-facilitated HIV self-testing intervention for AGYW in Northern Uganda.

METHODS

This mixed-methods quasi-experimental implementation science study will employ a three-fold approach. Firstly, we will conduct baseline formative qualitative research with 50 AGYW, 50 parents/partners to AGYW, 30 CHWs, 15 community leaders, and the district health office to inform the design of a peer-delivered CHW-facilitated HIV self-testing intervention tailored to AGYW's needs in Northern Uganda. Secondly, we will implement a mixed-methods pilot study to assess the intervention's feasibility and acceptability, involving 415 AGYW, 30 AGYW peer leaders, and 10 CHWs in selected parishes and villages in Omoro district, Northern Uganda. Lastly, we will evaluate the implementation outcomes and preliminary impact of the intervention on HIV self-testing rates and linkage to care by collecting and analyzing quantitative data pre- and post-intervention, laying the groundwork for a future robust randomized controlled trial.

DISCUSSION

Our intervention combines CHWs and peer-led strategies to address the unique challenges of AGYW in Northern Uganda, leveraging community resilience and peer influence. Successful completion of this project will provide a scalable model to be evaluated in a randomized trial and replicated in similar contexts.

TRIAL REGISTRATION NUMBER

PACTR202404851907736. Registered with the Pan-African Clinical Trials Registry on April 22, 2024.

Designathons in health research: a global systematic review

INTRODUCTION

A designathon is a three-stage participatory activity informed by design thinking. There is a growing literature on designathons in health. This study synthesised designathons' effectiveness and implementation-related factors to address health challenges.

METHODS

We searched Cochrane Library, Embase, PubMed, Scopus and the ClinicalTrials.gov registry for articles containing primary data on designathons for health from their dates of inception to 29 November 2022. We retrieved additional studies from citation searching and a complementary open call. We synthesised data on designathons' effectiveness (ie, engagement, outputs and implementation), required resources and implementation-related factors (ie, resources, facilitators, barriers, strengths and limitations). We assessed the risk of bias using a checklist adapted from Joanna Briggs Institute Critical Appraisal tools.

RESULTS

In total, 4973 citations were identified, and 42 studies were included. In total, 26 studies (62%) were from high-income countries. The median number of total participants was 49, divided into a median of 8 teams. The duration of the intensive collaboration phase ranged from 3 hours to 7 days. Common evaluation criteria were feasibility, innovation and impact. Idea and prototype outputs included mobile phone applications, educational programmes and medical devices. Interventions developed from a designathon was estimated to be highly cost-effective. The most common facilitators were interdisciplinary participants and high-quality mentorship. The most common barriers were suboptimal execution of the events, difficulties in balancing interdisciplinary participants across teams and limited support for participants along the process. There were limited data on required resources and further implementation of solutions after designathons.

CONCLUSION

Given designathons' adaptability in terms of budget, mode of delivery, type of output and involvement of diverse participants, including end users, designathons can be implemented in a wide range of contexts to address various health issues.

PROSPERO REGISTRATION NUMBER

CRD42023389685.

Acceptability and strategies for enhancing uptake of human immunodeficiency virus self-testing in Nigeria

BACKGROUND

In 2019, the Nigerian Ministry of Health published the first operational guidelines for human immunodeficiency virus self-testing (HIVST) to improve access to human immunodeficiency virus (HIV) testing services among undertested populations in the country. Also, as part of the campaign to increase HIV testing services in Nigeria, the Nigerian Ministry of Health developed standard operating procedures for using HIVST kits.

AIM

To systematically review the acceptability and strategies for enhancing the uptake of HIVST in Nigeria.

METHODS

The systematic review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Different databases were searched to get the necessary materials needed for this review. Standardized forms developed by the authors were used for data extraction to minimize the risk of bias and ensure that the articles used for the study were properly screened. Identified articles were first screened using the titles and their abstracts. The full papers were screened, and the similarities of the documents were determined. Qualitative, quantitative, and mixed-method studies were evaluated using the Critical Appraisal Skills Programme and Critical Appraisal Framework criteria.

RESULTS

All the publications reviewed were published between 2015 and 2022, with 33.3% published in 2021. Most (77.8%) of the studies were cross-sectional, 43.3% were conducted in Lagos State, and 26.3% were conducted among young people. The study revealed a high level of acceptability of HIVST. Certain factors, such as gender, sexual activity, and previous testing experience, influence the acceptability of HIV self-testing, with some individuals more likely to opt-out. The cost of the kit was reported as the strongest factor for choosing HIVST services, and this ranged from 200 to 4000 Naira (approximately United States Dollar 0.55-11.07), with the majority willing to pay 500 Naira (approximately United States Dollar 1.38). Privately-owned, registered pharmacies, youth-friendly centres, supermarkets, and online stores were the most cited access locations for HIVST. The least influential attribute was the type of specimen needed for HIVST. Strategies addressing cost and preferred access points and diverse needs for social media promotion, local translation of product use instructions, and HIVST distribution led by key opinion leaders for key populations were found to significantly enhance HIVST uptake and linkage to care.

CONCLUSION

HIVST acceptability is generally high from an intention-to-use perspective. Targeted strategies are required to improve the acceptability of HIV self-testing, especially among males, sexually active individuals, and first-time testers. Identified and proposed uptake-enhancing strategies need to be investigated in controlled settings and among different populations and distribution models in Nigeria.

Tracking adaptation strategies of an HIV prevention intervention among youth in Nigeria: a theoretically informed case study analysis of the 4 Youth by Youth Project

BACKGROUND

Although many behavioral interventions are adapted, little is known about the reasons for adaptations and the process and outcomes influencing adaptations. To address this gap, we explored the adaptations made to promote HIV prevention services, including HIV self-testing (HIVST), among Nigerian youth.

METHODS

The main objective of this qualitative case study design was to document the adaptations made over time using the Framework for Reporting Adaptations and Modifications - Expanded (FRAME). Between 2018 and 2020, we organized four participatory activities as part of the 4 Youth by Youth project to increase the uptake of HIVST services in Nigeria-an open call, a designathon, a capacity-building bootcamp and a pilot feasibility trial. We also began the process of implementing a final intervention using a pragmatic randomized control trial (RCT). The open call solicited creative strategies to promote HIVST among Nigerian youth and then had experts evaluate them. The designathon brought together youth teams to further develop their HIVST service strategies into implementation protocols. Teams determined to be exceptional were invited to a four-week capacity-building bootcamp. The five teams that emerged from the bootcamp were supported to pilot their HIVST service strategies over a 6-month period. The adapted intervention is currently being evaluated in a pragmatic RCT. We transcribed meeting reports and conducted document reviews of study protocols and training manuals.

RESULTS

Sixteen adaptations were identified and categorized into three domains: (1) modifications to the content of the intervention (i.e. photo verification system and/or Unstructured Supplementary Service Data (USSD) system to verify HIVST); (2) modifications to the delivery the intervention (i.e. implement participatory learning community sessions to provide supportive supervision and technical support); (3) modifications to the evaluation processes (i.e. economic evaluation to estimate the cost of implementing intervention on a larger scale). Frequent reasons for adaptation included increasing intervention reach, modifying interventions to enhance their appropriateness and fit with the recipient, and increasing the intervention's feasibility and acceptability. Most adaptations were planned and reactive, and the need for modifications was determined by the youths, 4YBY program staff, and advisory group.

CONCLUSIONS

Findings suggest that the nature of adaptations made throughout the implementation process reflects the necessity of evaluating services in context while adjusting to specific challenges as they are identified. Further research is needed to understand the effect of these adaptations on the overall intervention effect as well as the quality of youth engagement.

COVID-19 self-testing in Nigeria: Stakeholders' opinions and perspectives on its value for case detection

BACKGROUND

COVID-19 testing coverage is limited in Nigeria. Access to rapid SARS-CoV-2 antigen-detection self-testing kits may help improve the detection of asymptomatic and mildly symptomatic cases and increase the country's low rate of SARS-CoV-2 testing. Before implementing self-testing in Nigeria, assessing the population's perceptions regarding this approach is imperative. In mid-2021, an exploratory cross-sectional qualitative research was conducted to investigate stakeholders' values and preferences for SARS-CoV-2 self-testing in Nigeria.

METHODS

In-person and online semi-structured interviews and focus group discussions with healthcare workers, representatives of civil society, and potential implementors of self-testing delivery programs were used to explore values and perceptions around access to conventional provider-initiated COVID-19 testing. Topics included the public's values in relation to SARS-CoV-2 self-testing, the safe and effective use of SARS-CoV-2 self-testing, and likely actions upon receiving a positive SARS-CoV-2 self-test result. A thematic analysis approach was applied.

RESULTS

The 58 informants (29 female) reported that Nigeria has limited availability of conventional provider-delivered SARS-CoV-2 testing. While just a few informants were familiar with SARS-CoV-2 self-testing, they generally supported using self-testing as an approach that they felt could assist with early case detection and improve access to testing. Concerns relating to the use of self-testing mainly related to the ability of low-literate individuals to use and interpret the self-tests, the affordability of self-tests, equity of access, and the availability of healthcare system support for those who self-test positive.

CONCLUSION

Although the Nigerian public perceive multiple benefits associated with access to SARS-CoV-2 self-testing, the perceived inefficiency of the national health service delivery system may limit the access of users of the kits to psychosocial and clinical support. Nevertheless, in Nigeria, where COVID-19 vaccine coverage is low and the risk of further waves of COVID-19 is high, self-testing may assist in the prompt detection of cases and contribute to halting the spread of the virus.

Prioritizing syphilis control: Now is the time for action

Syphilis control programs and research received fewer resources and attention compared to HIV and other sexually transmitted infections (STIs) in the pre-pandemic era. The neglect of syphilis within comprehensive STI control efforts may be related to diagnostic (poor diagnostics), historical (legacies of racism in research), public health (limited partner services), and social problems (limited public engagement). At the same time, there are increasingly compelling reasons to prioritize syphilis control programs and research by harnessing lessons learned and advances during COVID-19. The closure of many STI facilities has accelerated new syphilis diagnostic pathways (e.g., syphilis self-testing), providing new ways for people to be screened outside of clinics. COVID-19 has underlined health inequities that fuel syphilis transmission, providing an opportunity to reckon with the historical legacy of racism that is linked to syphilis research. COVID-19 partner tracing efforts have also contributed to additional resources for partner services which may enhance syphilis control efforts. Finally, COVID-19 has demonstrated the importance of public engagement, making the case for greater public involvement in syphilis control and prevention programs. Urgent action is needed to prioritize syphilis control in a wide range of settings.