Designing drug shops for young women in Tanzania: applying human-centred design to facilitate access to HIV self-testing and contraception

Abstract

Adolescent and young adult women in sub-Saharan Africa experience barriers to sexual and reproductive health (SRH) services that elevate their risk of human immunodeficiency virus (HIV) acquisition and unintended pregnancy. Community drug shops may be effective distribution points to connect young women with SRH products. Thus, we used human-centred design (HCD) to create drug shops where young women could access HIV self-testing and contraception in Shinyanga, Tanzania. Enhancing the HCD process with behavioural science, we collected diverse data (i.e. 18 in-depth interviews, 9 ‘shadowing’ interviews, 6 shop observations, 6 focus groups) to understand the latent needs and motivations of young women and drug shopkeepers, brainstormed creative solutions and iteratively refined and tested solutions for acceptability, feasibility and cultural fit. We found a widespread moral imperative to control young women’s behaviour via misinformation about SRH, community gossip and financial control. Young women often engaged in mundane shopping at the behest of others. At drug shops, few SRH products were deemed appropriate for unmarried women, and many reactively sought SRH products only after engaging in higher risk behaviours. In response to these insights, we designed the ‘Malkia Klabu’ (‘Queen Club’) loyalty programme through which young women could earn mystery prizes by shopping at drug shops and discreetly request free SRH products, including HIV self-test kits, by pointing at symbols on loyalty cards. Our HCD approach increases the likelihood that the intervention will address the specific needs and preferences of both drug shopkeepers and young women. We will evaluate its effectiveness in a randomized trial.

Applications of Behavioral Economics to HIV Programs in Low and Middle Income Countries: A Scoping Review Using the EAST Framework

“…Over the course of the intervention, significantly more HIV self-test kits were distributed to AGYW in the ADDOs with the products compared to the AGYW in the control group who, despite the self-test kits also being free to them, had to overcome any discomfort and actively request one. 12,30…”

“…Tailoring images and branding was also an element of multiple nudge interventions that increased positive behaviors in AGYW. Co-design was used in the ‘Malika Kubla’ pilot in Tanzania that increased AGYW purchases of sexual and reproductive health products 12 and in the ‘Girl Champ’ program in Eswatini that increased the proportion of AGYW who attended HIV testing and counseling. 5…”

Study protocol for a type-II hybrid effectiveness-implementation trial to reach teenagers using mobile money shops to reduce unintended pregnancies in Uganda

“…As vendor customers frequently use multiple shops for their convenience, thus a randomised control trial is not feasible in this study. To design the vendor-based SRHR intervention for teenagers, we referred to the drug-shop-based intervention in Tanzania 39 40 Figure 1. shows the flow chart of the hybrid study.…”

“…Based on the results of the feasibility study and the methodology of the reference study in Tanzania,39 40 it was determined that 30 vendors would be sufficient to reach 600 participants, as it was anticipated that the number of daily teen users at each vendor would range from 20 to 80. Through field observations, it was also decided to divide Iganga into six blocks and Bugiri into four blocks according to the nature of the areas (rg, commercial, governmental and residential areas; the presence of hospitals, health centres, schools, etc).…”

“…To design the vendor-based SRHR intervention for teenagers, we referred to the drug-shop-based intervention in Tanzania. 39 40 Figure 1 shows the flow chart of the hybrid study. The detailed study components are shown in table 1 .…”