Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, Tanzania.
BMC Health Serv Res. 2022 Jul 4;22(1):859. doi: 10.1186/s12913-022-08245-2.
There is evidence that pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission, and PrEP is recommended by the World Health organization (WHO) for use by individuals at high risk of HIV infection. However, low adherence has been reported to hamper its effectiveness. Some evidence indicates that mHealth interventions may be a promising way of promoting PrEP adherence. Nevertheless, evaluations of mHealth interventions in Africa, the region most affected by HIV, are scarce. This study aimed at identifying the extent of and predictors for use of a smartphone based mHealth application among female sex workers in Dar es Salaam, Tanzania.
As part of a quasi-experimental study in Tanzania, 470 female sex workers who were eligible for PrEP and who owned a smartphone were recruited using respondent driven sampling. All participants were provided with an mHealth application called Jichunge, a smartphone-based app designed to promote adherence to PrEP by offering users information, advise and support during start-up and use of PrEP. We collected data through structured interviews at baseline and extracted user data from the app for a period of 30 days. Modified Poisson regression model with robust standard errors was used to identify predictors for the optimal use of the Jichunge app.
Overall, the optimal use of the Jichunge app was 46.4%. Optimal use was significantly higher among women who were older (aPR = 1.3, 95% CI: 1.10-1.65, p = 0.004 for age 25-34 years, and aPR = 1.6, 95% CI: 1.19-2.07, p = 0.001 for age at least 35 years), who had secondary education or higher (aPR = 1.8, 95% CI: 1.08-2.94, p = 0.023), who had suboptimal social support (aPR = 1.2, 95% CI: 1.02-1.48, p = 0.030), who had high awareness of PrEP (aPR = 1.3, 95% CI: 1.08-1.55, p = 0.005), and who had experience using common mainstream social media applications (aPR = 1.4, 95% CI: 1.08-1.71, p = 0.009).
Optimal use of the Jichunge app was substantially higher among women with higher age, higher education, higher PrEP awareness, less social support, and experience using common social media applications. Individual and interpersonal factors should be considered in planning mHealth interventions. Further studies to determine predictors of longer-term mHealth engagement are needed.
International Clinical Trials Registry Platform PACTR202003823226570 ; 04.03.2020.
有证据表明，暴露前预防（PrEP）在预防 HIV 传播方面是有效的，世界卫生组织（WHO）建议高危 HIV 感染人群使用 PrEP。然而，据报道，低依从性会阻碍其效果。一些证据表明，移动健康干预可能是促进 PrEP 依从性的一种有前途的方法。然而，在受 HIV 影响最严重的非洲地区，对移动健康干预的评估很少。本研究旨在确定坦桑尼亚达累斯萨拉姆的女性性工作者使用基于智能手机的移动健康应用程序的程度和预测因素。
作为坦桑尼亚一项准实验研究的一部分，招募了 470 名符合 PrEP 条件且拥有智能手机的女性性工作者，使用应答驱动抽样法进行招募。所有参与者都获得了一款名为 Jichunge 的移动健康应用程序，这是一款基于智能手机的应用程序，旨在通过在开始和使用 PrEP 时为用户提供信息、建议和支持，促进 PrEP 的依从性。我们在基线时通过结构化访谈收集数据，并在 30 天内从应用程序中提取用户数据。使用具有稳健标准误差的修正泊松回归模型来确定 Jichunge 应用程序最佳使用的预测因素。
总体而言，Jichunge 应用程序的最佳使用比例为 46.4%。年龄较大（年龄在 25-34 岁的最佳使用 aPR=1.3，95%CI：1.10-1.65，p=0.004；年龄至少 35 岁的最佳使用 aPR=1.6，95%CI：1.19-2.07，p=0.001）、受过中等或高等教育（最佳使用 aPR=1.8，95%CI：1.08-2.94，p=0.023）、社会支持不足（最佳使用 aPR=1.2，95%CI：1.02-1.48，p=0.030）、对 PrEP 认识较高（最佳使用 aPR=1.3，95%CI：1.08-1.55，p=0.005）和有使用常见主流社交媒体应用程序经验（最佳使用 aPR=1.4，95%CI：1.08-1.71，p=0.009）的女性，其 Jichunge 应用程序的最佳使用比例明显更高。
年龄较大、教育程度较高、PrEP 意识较高、社会支持较少、使用常见社交媒体应用程序经验丰富的女性，其 Jichunge 应用程序的最佳使用比例明显更高。在规划移动健康干预措施时，应考虑个体和人际因素。需要进一步研究确定移动健康参与的长期预测因素。
国际临床试验注册平台 PACTR202003823226570；2020 年 3 月 4 日。
