Using a Designathon to Develop an HIV Self-Testing Intervention to Improve Linkage to Care Among Youths in Nigeria: Qualitative Approach Based on a Participatory Research Action Framework

Abstract

Background UNAIDS (Joint United Nations Programme on HIV and AIDS) and the Nigeria National HIV/AIDS Strategic Framework recommend HIV self-testing and youth-friendly services to enhance HIV testing, linkage to health services, and prevention. However, the voices of youths are seldom incorporated into interventions. We examined qualitative data generated from a series of participatory events in partnership with Nigerian youths focused on enhancing linkage to care. Objective The aim of this study was to assess youth-initiated interventions developed during a designathon to improve linkage to care and sexually transmitted infection services. Methods This study conducted a designathon informed by crowdsourcing principles and the participatory research action framework. A designathon is a multistage process including an open call, a sprint event, and follow-up activities. The open call solicited Nigerian youths (14-24 years old) to develop intervention strategies for linkage to care and youth-friendly health services. A total of 79 entries were received; from this, a subset of 13 teams responded to the open call and was invited to participate in a sprint event over 72 hours. Narratives from the open-call proposals were analyzed using grounded theory to identify emergent themes focused on youth-proposed interventions for linkage to care and youth-friendly services. Results A total of 79 entries (through the web=26; offline=53) were submitted. Women or girls submitted 40 of the 79 (51%) submissions. The average age of participants was 17 (SD 2.7) years, and 64 of 79 (81%) participants had secondary education or less. Two main themes highlighted strategies for enhancing youths’ HIV linkage to care: digital interventions and collaboration with youth influencers. A total of 76 participants suggested digital interventions that would facilitate anonymous web-based counseling, text prompt referrals, and related services. In addition, 16 participants noted that collaboration with youth influencers would be useful. This could involve working in partnership with celebrities, gatekeepers, or others who have a large youth audience to enhance the promotion of messages on HIV self-testing and linkage. The facilitators of youths’ linkage included health facility restructuring, dedicated space for youths, youth-trained staff, youth-friendly amenities, and subsidized fees. Barriers to HIV linkage to care among youths included a lack of privacy at clinics and concerns about the potential for breaching confidentiality. Conclusions Our data suggest specific strategies that may be useful for enhancing HIV linkage to care for Nigerian youths, but further research is needed to assess the feasibility and implementation of these strategies. Designathons are an effective way to generate ideas from youths.

Designathons in health research: a global systematic review

“…We retrieved 127 publications from additional searches (ie, citation searching and the complementary open call), with a further 11 publications included in this review. In total, we included 42 studies in this review,7 8 18–57 with 39 studies (93%) focusing on developing social innovations 7 8 18–20 22–42 44–53 55–57. The PRISMA flowchart is presented in online supplemental figure 1.…”

“…In total, 41 studies (98%) reported the number of designathon participants 7 8 18–53 55–57. The median number of individuals participating in designathons was 49 (IQR 34–90, range 6–434), and the median number of teams was 8 (IQR 5–14.5, range 2–40).…”

“…In total, 37 studies (88%) reported the duration of the intensive collaboration part, ranging from 3 hours to 7 days (online supplemental table 3). 7 8 18 21–24 26–29 31–53 55–57…”

“…In total, 28 studies (67%) reported the number of final outputs developed during the event 7 8 18–20 22–27 29 30 35 36 38–40 42 44–47 50 52 55 57. The median number of outputs was 8 (IQR 6–13, range 2–40).…”

“…The median number of outputs was 8 (IQR 6–13, range 2–40). The final output from designathons were ideas (n=20, 48%)7 8 18 19 21–23 25 26 32 40 41 47–51 54–56 and prototypes (n=20, 48%) 20 24 27–31 33 35 36 38 39 42–46 52 53 57. The final outputs reported from 34 studies (81%) included the following: (1) educational programmes (n=7, 17%), such as wellness and healthy choice programmes18 21–23 25 43 54; (2) mobile phone applications (n=7, 17%), such as management of opioids and support mental health24 26 27 31 38 39 45; (3) medical devices (n=4, 10%), such as breast pumps and humanitarian surgical care20 32 42 46; and (4) other outputs (n=16, 38%), such as telehealth service, HIV self-testing platforms and campaign packages (figure 1 and online supplemental table 4).…”