Grant: Project Grant

The Issue: HIV is the leading cause of death for adolescents aged 10-19 years in Sub-Saharan Africa (SSA). Uganda's 2017 HIV prevalence among adolescent girls is three times (9.1%) that of adolescent boys. Only 53.6% of adolescent girls in Uganda know their HIV status, far below the UNAIDS goal of 90% of persons living with HIV knowing their status by 2020. Uganda hosts 1 million refugees/displaced persons, and 98,000 live in Kampala, most in slums. Urban refugee/displaced adolescent girls have increased HIV risks due to poverty, violence, and limited healthcare. Yet we know little of HIV testing and prevention needs with displaced/refugee adolescent girls living in Kampala's slums. Our idea: We plan to develop, implement and evaluate an oral HIV-self testing (HIVST) intervention with displaced/refugee girls aged 15-19 in Kampala. HIVST is acceptable and properly used with adolescents in other SSA regions, yet we do not know the best way to link HIVST to HIV care. We explore how m-health (healthcare delivered on mobile-phones), congruent with how adolescents learn and socialize, can improve linkage to care with HIVST. Our Approach: Our 3-phase project involves: 1) working with refugee/displaced peer navigators to develop an m-health intervention (2-way supportive text messages; WhatsApp discussion groups); 2) implementing a cluster randomized trial with displaced/refugee girls aged 15-19 in 3 slums in Kampala (Arm 1: HIVST; Arm 2: HIVST + m-health; Arm 3: standard of care). We will assess changes in HIV testing, HIV status knowledge, and linkage to HIV care between the 3 arms. Phase 3 involves a process evaluation and participatory knowledge mobilization. Impact: We build on our CIHR planning grant that highlights the urgent need for HIV testing and prevention with urban refugee/displaced girls in Kampala. Findings will highlight optimal HIVST delivery approaches that can be expanded to other refugee/displaced adolescents in Uganda, SSA and humanitarian contexts.