Oladele David Ayoola, Iwelunmor Juliet, Gbajabiamila Titilola, Obiezu-Umeh Chisom, Okwuzu Jane Ogoamaka, Nwaozuru Ucheoma, Musa Adesola Zaidat, Tahlil Kadija, Idigbe Ifeoma, Ong Jason, Tang Weiming, Tucker Joseph, Ezechi Oliver
Department of Behavioral Science and Health Education, Saint Louis University, Saint Louis, MO, United States.
Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria.
JMIR Form Res. 2023 Sep 25;7:e44402. doi: 10.2196/44402.
Mobile health (mHealth) interventions among adolescents and young adults (AYAs) are increasingly available in African low- and middle-income countries (LMICs). For example, the unstructured supplementary service data (USSD) could be used to verify HIV self-testing (HIVST) among AYAs with poor bandwidth.
The aim of this study is to describe the creation of an USSD platform and determine its feasibility and usability to promote the verification of HIVST results among AYAs in Nigeria.
We developed and evaluated a USSD platform to verify HIVST results using a user-centered approach. The USSD platform guided AYAs in performing HIVST, interpreting the result, and providing linkage to care after the test. Following the usability assessment, the USSD platform was piloted. We used a mixed methods study to assess the platform's usability through a process of quantitative heuristic assessment, a qualitative think-aloud method, and an exit interview. Descriptive statistics of quantitative data and inductive thematic analysis of qualitative variables were organized.
A total of 19 AYAs participated in the usability test, with a median age of 19 (IQR 16-23) years. There were 11 females, 8 males, and 0 nonbinary individuals. All individuals were out-of-school AYAs. Seven of the 10 Nielsen usability heuristics assessed yielded positive results. The participants found the USSD platform easy to use, preferred the simplicity of the system, felt no need for a major improvement in the design of the platform, and were happy the system provided linkage to care following the interpretation of the HIVST results. The pilot field test of the platform enrolled 164 out-of-school AYAs, mostly young girls and women (101, 61.6%). The mean age was 17.5 (SD 3.18) years, and 92.1% (151/164) of the participants reported that they were heterosexual, while 7.9% (13/164) reported that they were gay. All the participants in the pilot study were able to conduct HIVST, interpret their results, and use the linkage to care feature of the USSD platform without any challenge. A total of 7.9% (13/164) of the AYAs had positive HIV results (reactive to the OraQuick kit).
This study demonstrated the usability and feasibility of using a USSD system as an alternative to mobile phone apps to verify HIVST results among Nigerian youth without smartphone access. Therefore, the use of a USSD platform has implications for the verification of HIVST in areas with low internet bandwidth. Further pragmatic trials are needed to scale up this approach.
在非洲低收入和中等收入国家（LMICs），针对青少年和青年成人（AYAs）的移动健康（mHealth）干预措施越来越多。例如，非结构化补充服务数据（USSD）可用于在带宽较差的AYAs中验证HIV自我检测（HIVST）结果。
本研究的目的是描述一个USSD平台的创建，并确定其在尼日利亚促进AYAs中HIVST结果验证的可行性和可用性。
我们采用以用户为中心的方法开发并评估了一个用于验证HIVST结果的USSD平台。该USSD平台指导AYAs进行HIVST、解读结果，并在检测后提供护理联系。在可用性评估之后，对USSD平台进行了试点。我们使用混合方法研究，通过定量启发式评估、定性出声思考法和退出访谈的过程来评估平台的可用性。对定量数据进行描述性统计，并对定性变量进行归纳主题分析。
共有19名AYAs参与了可用性测试，中位年龄为19岁（四分位间距16 - 23岁）。其中有11名女性、8名男性和0名非二元性别个体。所有个体均为失学的AYAs。在评估的10条尼尔森可用性启发式原则中，有7条产生了积极结果。参与者发现USSD平台易于使用，更喜欢系统的简单性，认为平台设计无需重大改进，并且很高兴系统在解读HIVST结果后提供护理联系。该平台的试点现场测试招募了164名失学的AYAs，大多数是年轻女孩和女性（101名，61.6%）。平均年龄为17.5岁（标准差3.18），92.1%（151/164）的参与者报告他们是异性恋，而7.9%（13/164）报告他们是同性恋。试点研究中的所有参与者都能够进行HIVST、解读结果，并毫无困难地使用USSD平台的护理联系功能。共有7.9%（13/164）的AYAs HIV检测结果呈阳性（对OraQuick试剂盒呈反应性）。
本研究证明了使用USSD系统作为手机应用程序的替代方案，在无法使用智能手机的尼日利亚青年中验证HIVST结果的可用性和可行性。因此，USSD平台的使用对低互联网带宽地区的HIVST验证具有重要意义。需要进一步进行务实试验以扩大这种方法的应用。
