Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania.
Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, United Republic of Tanzania.
JMIR Mhealth Uhealth. 2023 Oct 17;11:e46853. doi: 10.2196/46853.
Increasing access to smartphones in sub-Saharan Africa offers an opportunity to leverage mobile health (mHealth) technology to improve access to health care in underserved populations. In the domain of HIV prevention, mHealth interventions can potentially contribute to solving the challenges of suboptimal adherence to pre-exposure prophylaxis (PrEP) and low retention in PrEP services among populations most vulnerable to HIV acquisition. However, there is a gap in the knowledge about the use of such interventions in sub-Saharan Africa.
This study aims to evaluate the extent and predictors of retention in an mHealth app (Jichunge) that aims to promote adherence to PrEP and retention in PrEP care among female sex workers in Dar es Salaam, Tanzania.
A prospective cohort of female sex workers residing in Dar es Salaam were recruited, using respondent-driven sampling. All participants were provided with the Jichunge app as they started PrEP. A questionnaire was used to collect data on sociodemographics and other structural factors, while app use data for the 60-day period following the first 150 days of being in the intervention arm were extracted from the app's back end. A multivariable log-binomial model was used to determine predictors of 6-month retention in the Jichunge app.
A total of 470 female sex workers were recruited. Nearly three-quarters of participants (206/284, 72.5%) who came to the 6-month follow-up interview no longer had the Jichunge app on their phones. The majority of these participants (193/206, 93.7%) no longer had access to the app because of issues related to their phones. Data extracted from the back end of the app showed that the use of the app declined over time, and only 13.4% (63/470) of the participants were retained (continued to use the app) after 6 months of intervention. At 6 months, women aged ≥35 years were >2 times more likely to use the app than women aged 18 to 24 years (adjusted risk ratio [aRR] 2.2, 95% CI 1.2-4.1; P=.01). Furthermore, retention in the app was higher among participants who demonstrated high PrEP awareness at baseline (aRR 1.8, 95% CI 1.1-3; P=.01) and among those who had experienced financial difficulties due to health care spending (aRR 1.9, 95% CI 1.2-3.2; P=.01).
Most female sex workers (206/284, 72.5%) who were enrolled in PrEP care in Tanzania no longer used the Jichunge app after 6 months. Retention in the app at 6 months was predicted by older age, high PrEP awareness, and financial difficulties due to health care spending. Strategies for the long-term retention of participants in mHealth apps, such as systems for reinstallations of apps, should be considered during the design phase.
撒哈拉以南非洲地区智能手机的普及为利用移动医疗（mHealth）技术改善服务不足人群的医疗服务提供了机会。在 HIV 预防领域，mHealth 干预措施有可能有助于解决 HIV 预防用药（PrEP）依从性差和 PrEP 服务保留率低的问题，而这些问题在 HIV 感染风险最高的人群中尤为突出。然而，在撒哈拉以南非洲地区，mHealth 干预措施的使用情况仍存在知识空白。
本研究旨在评估坦桑尼亚达累斯萨拉姆市的一款旨在促进女性性工作者（FSW）接受 PrEP 并保留 PrEP 护理的 mHealth 应用程序（Jichunge）的保留率及其影响因素。
采用应答驱动抽样法招募居住在达累斯萨拉姆市的 FSW 参与前瞻性队列研究。所有参与者在开始 PrEP 时均提供 Jichunge 应用程序。通过问卷调查收集社会人口统计学和其他结构因素的数据，同时从应用程序的后端提取前 150 天进入干预组后 60 天内的应用程序使用数据。采用多变量对数二项式模型确定 Jichunge 应用程序 6 个月保留率的预测因素。
共招募了 470 名 FSW。在参加 6 个月随访访谈的 284 名参与者中，有近四分之三（206/284，72.5%）的人手机上不再有 Jichunge 应用程序。这些参与者中的大多数（193/206，93.7%）由于手机问题而无法再使用该应用程序。从应用程序后端提取的数据显示，随着时间的推移，应用程序的使用量不断下降，只有 13.4%（63/470）的参与者在 6 个月的干预后仍然保留（继续使用应用程序）。在 6 个月时，年龄≥35 岁的女性使用该应用程序的可能性是 18 至 24 岁女性的 2 倍以上（调整后的风险比[ARR]2.2，95%CI 1.2-4.1；P=.01）。此外，在基线时 PrEP 意识较高（ARR 1.8，95%CI 1.1-3；P=.01）和因医疗保健支出而面临经济困难的参与者（ARR 1.9，95%CI 1.2-3.2；P=.01）中，该应用程序的保留率更高。
在坦桑尼亚接受 PrEP 护理的 284 名参与者中，有 206 名（72.5%）在 6 个月后不再使用 Jichunge 应用程序。该应用程序在 6 个月时的保留率由年龄较大、PrEP 意识较高和因医疗保健支出而面临经济困难决定。在设计阶段应考虑参与者长期保留 mHealth 应用程序的策略，例如应用程序重新安装系统。
