Background:
An estimated 3.9 million[ 2.1–5.7 million] youth were living with HIV (YLWH) globally in 2017, most of whom live in sub-Saharan Africa (Avert.Org, 2019; UNAIDS, 2018b). Young people are the only population group in which AIDS-related deaths are increasing (UNAIDS, 2019a). AIDS is the leading cause of death among young people in sub-Saharan Africa (Avert.Org, 2019).
In Uganda, there were 160,000 YLWH in 2018 (UNAIDS, 2019b). An estimated 53,000 new HIV infections occurred among youth in 2018, accounting for 26% of HIV incidence in the country (Avert.Org, 2019).
Adherence to antiretroviral therapy (ART) is the principal determinant for achieving and sustaining viral suppression, which decreases progression to AIDS and reduces risk of mortality (CDC, 1998). Few studies have evaluated mHealth adherence tools among youths in resource-limited settings. This study aims to evaluate whether the CFLU mHealth tool improves ART adherence outcomes among youth receiving ART at a rural hospital in Western Uganda.
Corona virus disease (COVID-19) was first declared in December 2019, in Wuhan city, China. The virus spreads through droplet infection from person to person through sneezing or coughing and contact with contaminated surfaces. The outbreak was announced a Public Health Emergency of International concern on 30th Jan 2020 (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events); and declared a global pandemic by World Health Organization on 11th Mar, 2020. (https://www.health.go.ug/covid/about-corona-virus).
General objective:
To assess acceptability, effect and cost of the CFLU mHealth tool on ART adherence and knowledge of COVID-19among youth initiating and on ART at Kiryandongo District.
Specific Objectives
1a: To assess barriers, enablers of adherence among youth living with HIV in Kiryandongo District at baseline & study end.
1b: To assess acceptability of mHealth for HIV adherence support among YLWH in Kiryandongo District at baseline and study end.
2: To assess and effect of the CFLU mHealth tool on ART adherence knowledge on COVID-19 among youths initiating or on ART at 6 and 12 months.
3: To evaluate the cost of the CFLU mHealth adherence tool in comparison to Standard of Care.
Methods
This is a mixed methods sequential explanatory study, with the qualitative study conducted first followed by a randomized control trial and healthcare cost evaluation. The first study is a qualitative study to assess barriers, enablers of adherence and acceptability of mHealth among youths receiving care at three centres in Kiryandongo District. The sample size for this study will be a total of 8 focus group discussions (4 at the study start and 4 at study end) or until data saturation occurs, whichever comes first.
The second study is a randomized control trial of YLWH initiating ART to determine the effect of the CFLU mHealth tool on ART adherence. A total of 206 YLWH will be randomized to either Standard of Care (SoC) or CFLU plus SoC. Through the CFLU mHealth tool, participants will interact with a computer through IVR. Participants in the intervention arm will receive pill reminders, clinic visit reminders, health tips messages and functionality to support self-reported symptoms in addition to standard of care. During this second part of the research, youths will be assessed on knowledge of COVID-19 at baseline only.
The third study is nested within the randomized control trial and will assess the cost of the CFLU intervention when compared to SoC.
Conclusion
This project will determine acceptability, effectiveness, knowledge of COVID-19 and cost of delivering pill and clinic visit reminders, and messages on health tips to a population with suboptimal ART adherence. Results from this research will provide valuable insights into mHealth adherence interventions for YLWH and knowledge of COVID-19 in resource-limited settings