World AIDS Day 2015: HIV Testing and Counselling in Zimbabwe using U-Report

Launched: December 2015


HIV Testing and Counselling (HTC) is ultimately the entry to HIV prevention, treatment and care. Uptake of HTC remains low among adolescents and youths in Zimbabwe. During the World AIDS Day (WAD) commemorations UNICEF Zimbabwe, the Zimbabwe Youth Council (ZYC) and AFRICAID (A local NGO working with adolescents living with HIV) modelled the use of free, confidential and interactive mobile phone SMS campaign to generate demand for HTC among young people (U-Reporters) in Zimbabwe.

 

Methods

Zimbabwe U-Report is an SMS-based platform for young people that became operational in May 2015 with 18,000 U-Reporters to date. During the WAD 2015 commemorations, a package of SMS tailored to the baseline profile of U-Reporters was designed and delivered in three days (one SMS per day) beginning Friday 30 November 2015 to all U-Reporters in Zimbabwe. On 01 December which happens to be World AIDS Day this triggered a two-way interactive SMS counselling between U-Reporters and trained peer educators/counsellors from Africaid (Zvandiri program). SMS counsellors helped U-Reporters to understand the causes of HIV and how to deal with the various challenges facing adolescents as far as HIV/AIDS is concerned. In addition, the counsellors referred U-Reporters to the nearest HTC site in their location. A number of poll questions asked HTC uptake among U-Reporters and wanted to understand the reasons behind uptake or refusal thereof. Prior to the WAD counselling session, the counsellor were training on case management in Rapid Pro (the software being used to run the U-Report) 

 

Results

A total of 7,379 (representing a 42 per cent response rate) U-Reporters were reached via SMS with the WAD polls. A total of 92 per cent of the respondents agreed that they would like to get tested but indicated the lack of information and friendly services in their communities as the most constraining factor preventing them from doing so. For those who said NO (8 per cent), cited fear as the major reason preventing them from going for testing. During the WAD celebrations the U-Report also provided confidential, free of charge, individualized and interactive counselling services on HIV and STIs to the 18,000 adolescents and youth. A total of 2576 (1089 females and 1487 males) and cases were opened and responded to by the ten (10) young Zvandiri counsellors who were hosted at the UNICEF Offices.

 

The counsellor web-interface allowed for quality control of the SMS counselling and ensured that the right knowledge in relation to how HIV is transmitted, the challenges of having unprotected sex, adhering to ART medication and the problem of multiple partners among others was provided to the U-Reporters. Below are some examples of some of the questions that were asked:

  1. “Let’s say i'm negative and fell pregnant, then i get infected when the pregnancy is 8 mnths what can i do? is the option b plus given to both positive and negative mothers,” FEMALE U-REPORTER, Mashonaland East Province.
  2. Let’s say i am married and my husband refuses 2 tak an h i v test bt he does nt wnt 2 use protection wat am i 2 do? – FEMALE U-REPORTER, Midlands Province.
  3. If I am circumcised and have hiv and have sex with a woman who is hiv negative does that mean she would be infected? – MALE U-REPORTER, Bulawayo Province.

The platform also enabled tailored SMS demand creation for available services, and referral to the U-Reporter’s closest location for HIV Testing and Counselling, Voluntary Medicalised Male Circumcision and Anti-Retroviral Treatment. The incoming SMS traffic was analysed and it seems there are key knowledge gaps as far as Prevention of Mother to Child Transmission (PMTCT), young people born with HIV, HIV and circumcision, inter-generational relationships, religion and HIV and emerging issues related to HIV and STIs among young people.

 

Conclusion

Zimbabwe U-Report has the potential to provide targeted demand creation for HTC among young people using interactive SMS counselling. Further evaluation of its efficacy is warranted.