An Unstructured Supplementary Service Data System to Verify HIV Self-Testing Among Nigerian Youths: Mixed Methods Analysis of Usability and Feasibility

Abstract

Background Mobile health (mHealth) interventions among adolescents and young adults (AYAs) are increasingly available in African low- and middle-income countries (LMICs). For example, the unstructured supplementary service data (USSD) could be used to verify HIV self-testing (HIVST) among AYAs with poor bandwidth. Objective The aim of this study is to describe the creation of an USSD platform and determine its feasibility and usability to promote the verification of HIVST results among AYAs in Nigeria. Methods We developed and evaluated a USSD platform to verify HIVST results using a user-centered approach. The USSD platform guided AYAs in performing HIVST, interpreting the result, and providing linkage to care after the test. Following the usability assessment, the USSD platform was piloted. We used a mixed methods study to assess the platform’s usability through a process of quantitative heuristic assessment, a qualitative think-aloud method, and an exit interview. Descriptive statistics of quantitative data and inductive thematic analysis of qualitative variables were organized. Results A total of 19 AYAs participated in the usability test, with a median age of 19 (IQR 16-23) years. There were 11 females, 8 males, and 0 nonbinary individuals. All individuals were out-of-school AYAs. Seven of the 10 Nielsen usability heuristics assessed yielded positive results. The participants found the USSD platform easy to use, preferred the simplicity of the system, felt no need for a major improvement in the design of the platform, and were happy the system provided linkage to care following the interpretation of the HIVST results. The pilot field test of the platform enrolled 164 out-of-school AYAs, mostly young girls and women (101, 61.6%). The mean age was 17.5 (SD 3.18) years, and 92.1% (151/164) of the participants reported that they were heterosexual, while 7.9% (13/164) reported that they were gay. All the participants in the pilot study were able to conduct HIVST, interpret their results, and use the linkage to care feature of the USSD platform without any challenge. A total of 7.9% (13/164) of the AYAs had positive HIV results (reactive to the OraQuick kit). Conclusions This study demonstrated the usability and feasibility of using a USSD system as an alternative to mobile phone apps to verify HIVST results among Nigerian youth without smartphone access. Therefore, the use of a USSD platform has implications for the verification of HIVST in areas with low internet bandwidth. Further pragmatic trials are needed to scale up this approach.

Assessing the Impact of use of HIV self-testing on the incidence of HIV Infection in Nigeria: a systematic review and meta-analysis

“…A repeat test can be done in a clinic to confirm the result from self-testing testing to validate a positive result and facilitate appropriate linkage to prevention, treatment, and care [46]. For contexts like Nigeria where the prevalence of HIV risk behaviour is high and there is limit access to safer sex practices, repeat HIV testing is important for early detection of HIV infection and prompt access to HIV treatment [47], and for sustained effectiveness of prevention programs [48]. Though repeat testing is higher with the use of HIV self-testing than with standard HIV testing [6] the low rate of repeat testing in the current study, despite these been under experimental conditions [12, 17], is a dire call for further studies to understand the reason for the observation.…”

Tiny Guardian—Monitoring Antimicrobial Childhood Exposure in Low-Resource Settings

“…USSD, or 'Unstructured Supplementary Service Data', is a real-time communication platform used on any type of mobile phones. Its simplicity and reach have proven effective in Sub-Saharan Africa for healthcare information dissemination and data quality improvement, showcased in various studies, especially in resource-constrained, remote areas and even on basic phones [6][7][8][9]. With cell phone network coverage at 87% in Africa in 2022 but only 45% internet access, USSD is ideal, even more so with its offline capabilities [10].…”