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

Abstract

Although HIV self-testing (HIVST) has expanded in many regions, a few HIVST services have been tailored for and organized by youth. Innovative HIVST models are needed to differentiate testing services and generate local demand for HIVST among youth. The current pilot study aimed at examining the feasibility and efficacy of crowdsourced youth-led strategies to enhance HIVST as well as sexually transmitted infection (STI) testing. Teams of youth iteratively developed HIVST interventions using crowdsourcing approaches and apprenticeship training. Five interventions were selected and then evaluated among youth (ages 14–24) from September 2019 to March 2020. Given the similar outcomes and approaches, we present cumulative data from the completed interventions. We assessed HIVST uptake (self-report), STI uptake (facility reports for gonorrhea, syphilis, hepatitis B, and chlamydia testing), and quality of youth participation. Mixed-effect logistic regression models estimated intervention effects at baseline and 6 months. Of the 388 youths enrolled, 25.3% were aged 14–19, 58.0% were male, and 54.1% had completed secondary education. We observed a significant increase in HIVST from 3 months compared with 6 months (20% vs. 90%; p < 0.001). Among those who received an HIVST at 3 months, 324 out of 388 were re-tested at 6 months. We also observed significant increases in testing for all four STIs: syphilis (5–48%), gonorrhea (5–43%), chlamydia (1–45%), and hepatitis B testing (14–55%) from baseline to the 6-month follow-up. Youth participation in the intervention was robust. Youth-led HIVST intervention approaches were feasible and resulted in increased HIV/STI test uptake. Further research on the effectiveness of these HIVST services is needed.

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

“…In the absence of social safety nets, as some of our informants reflected, some individuals might find it difficult, irrespective of their intrinsic healthcare-seeking motivations, to adhere to the recommended behaviours that should follow a reactive self-test result. In this regard, Nigeria could consider its own experiences with the distribution of HIV self-testing [ 40 , 41 ], and could consider how access to SARS-CoV-2 self-testing was fully subsidised in countries such as Austria [ 42 ] or Greece [ 43 ]. Evaluations of the cost-effectiveness and impact of these self-testing programmes might provide guidance for Nigerian health authorities to take evidence-based decisions regarding up to what extend self-test devices could be subsidised in the country, what type of safety nets provision could be prioritised to promote home isolation and contact warning after interpreting a self-test result as reactive, as well as to how to plan a socio-economic evaluation of the delivery of self-testing to the public as a complementary approach to curve down the SARS-CoV-2 incidence in the Nigerian territory.…”

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

“…In collaboration with NIMR, the five teams pilot tested their HIVST packages across seven local government areas in Nigeria from September 2019 to March 2020. Lastly, based on the pilot data as well as feedback from the AYA participants [ 33 ], we then incorporated key components of the five HIVST service packages into a combination intervention strategy that is now being evaluated in a pragmatic, stepped-wedge, cluster randomized controlled trial across 32 local government areas in Nigeria. The resulting intervention included (1) HIVST bundle consisting of HIVST kits and photo verification and and/or the Unstructured Supplementary Service Data (USSD) system to verify the HIVST result and facilitate linkage to STI services; (2) a participatory learning community to identify and resolve implementation challenges real-time; (3) peer to peer support and technical assistance from the youth advisory board as well as the local study team; and (4) on-site supervision and performance feedback to improve uptake and sustainability of HIVST and enhance linkage to youth-friendly health clinics for confirmatory HIV testing where needed, sexually transmitted infection (STI) testing (i.e.…”

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

“…No gray literature or unpublished manuscripts were identified. As indicated in Table 1, eight studies met the criteria for inclusion [11][12][13][14][15][16][17][18]. Each of these included studies focused on oral HIV self-testing, with two specifically reporting on OraQuick [14,17].…”

“…Six of the eight studies provided information on the period of participants' recruitment, spanning from April 2002 to December 2020 [12,13,[15][16][17][18]. The study designs included five cross-sectional studies [11][12][13][14]16], one cohort study [18], and two quasi-experimental studies [15,17]. Babatunde et al [12] conducted an online assessment.…”