Juliet Iwelunmor1, Joseph D Tucker2, Chisom Obiezu-Umeh3, Titilola Gbaja-Biamila4, David Oladele4, Ucheoma Nwaozuru5, Adesola Z Musa6, Collins O Airhihenbuwa7, Kathryn Muessig8, Nora Rosenberg8, Rhonda BeLue3, Hong Xian3, Donaldson F Conserve9, Jason J Ong10, Lei Zhang11, Jamie Curley3, Susan Nkengasong12, Stacey Mason3, Weiming Tang13, Barry Bayus14, Gbenga Ogedegbe15, Oliver Ezechi4. 1. College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, USA. Electronic address: juliet.iwelunmor@slu.edu. 2. Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. 3. College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, USA. 4. College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, USA; Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria. 5. Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA. 6. Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria. 7. Heath Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA. 8. Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 9. Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA. 10. Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Central Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia. 11. Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia. 12. Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK. 13. Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 14. Kenan-Flagler Business School, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 15. Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University School of Medicine, NY, New York, USA.
Abstract
BACKGROUND: The World Health Organization recommends HIV self-testing (HIVST) as an additional approach to HIV testing and the Nigerian government is supportive of this policy recommendation. However, effectively increasing uptake and sustainability among Nigerian youth is unknown. The goal of this study is to conduct a full-powered type I hybrid effectiveness-implementation trial to test the effectiveness of youth-friendly implementation science strategies in increasing uptake and sustainability of HIVST led by and for Nigerian youth. METHODS: Our 4 Youth by Youth (4YBY) strategy combines four core elements: 1) HIVST bundle consisting of HIVST kits and photo verification system; 2) a participatory learning community; 3) peer to peer support and technical assistance; and 4) on-site supervision and performance feedback to improve uptake and sustainability of HIVST and enhance linkage to youth-friendly health clinics for confirmatory HIV testing where needed, sexually transmitted infection (STI) testing (i.e. syphilis, gonorrhea, chlamydia, and hepatitis, STI treatment, and PrEP referral. Utilizing a stepped-wedge, cluster-randomized controlled trial, a national cohort of youth aged 14-24 recruited from 32 local government areas across 14 states and four geo-political zones in Nigeria will receive the 4YBY implementation strategy. In addition, an economic evaluation will explore the incremental cost per quality adjusted life year gained. DISCUSSION: This study will add to the limited "how-to-do it literature" on implementation science strategies in a resource-limited setting targeting youth population traditionally underrepresented in implementation science literature. Study findings will also optimize uptake and sustainability of HIVST led by and for young people themselves. TRIAL REGISTRATION: This study is registered in ClinicalTrials.govNCT04710784 (on January 15, 2021).
BACKGROUND: The World Health Organization recommends HIV self-testing (HIVST) as an additional approach to HIV testing and the Nigerian government is supportive of this policy recommendation. However, effectively increasing uptake and sustainability among Nigerian youth is unknown. The goal of this study is to conduct a full-powered type I hybrid effectiveness-implementation trial to test the effectiveness of youth-friendly implementation science strategies in increasing uptake and sustainability of HIVST led by and for Nigerian youth. METHODS: Our 4 Youth by Youth (4YBY) strategy combines four core elements: 1) HIVST bundle consisting of HIVST kits and photo verification system; 2) a participatory learning community; 3) peer to peer support and technical assistance; and 4) on-site supervision and performance feedback to improve uptake and sustainability of HIVST and enhance linkage to youth-friendly health clinics for confirmatory HIV testing where needed, sexually transmitted infection (STI) testing (i.e. syphilis, gonorrhea, chlamydia, and hepatitis, STI treatment, and PrEP referral. Utilizing a stepped-wedge, cluster-randomized controlled trial, a national cohort of youth aged 14-24 recruited from 32 local government areas across 14 states and four geo-political zones in Nigeria will receive the 4YBY implementation strategy. In addition, an economic evaluation will explore the incremental cost per quality adjusted life year gained. DISCUSSION: This study will add to the limited "how-to-do it literature" on implementation science strategies in a resource-limited setting targeting youth population traditionally underrepresented in implementation science literature. Study findings will also optimize uptake and sustainability of HIVST led by and for young people themselves. TRIAL REGISTRATION: This study is registered in ClinicalTrials.govNCT04710784 (on January 15, 2021).
Authors: Kathryn Dovel; Frackson Shaba; O Agatha Offorjebe; Kelvin Balakasi; Mike Nyirenda; Khumbo Phiri; Sundeep K Gupta; Vincent Wong; Chi-Hong Tseng; Brooke E Nichols; Refiloe Cele; Eric Lungu; Tobias Masina; Thomas J Coates; Risa M Hoffman Journal: Lancet Glob Health Date: 2020-02 Impact factor: 26.763
Authors: Courtney C Kennedy; George Ioannidis; Lora M Giangregorio; Jonathan D Adachi; Lehana Thabane; Suzanne N Morin; Richard G Crilly; Sharon Marr; Robert G Josse; Lynne Lohfeld; Laura E Pickard; Susanne King; Mary-Lou van der Horst; Glenda Campbell; Jackie Stroud; Lisa Dolovich; Anna M Sawka; Ravi Jain; Lynn Nash; Alexandra Papaioannou Journal: Implement Sci Date: 2012-05-24 Impact factor: 7.327
Authors: Sarah E Asuquo; Kadija M Tahlil; Kathryn E Muessig; Donaldson F Conserve; Mesoma A Igbokwe; Kelechi P Chima; Ezienyi C Nwanunu; Lana P Elijah; Suzanne Day; Nora E Rosenberg; Jason J Ong; Susan Nkengasong; Weiming Tang; Chisom Obiezu-Umeh; Ucheoma Nwaozuru; Yesenia Merino; Titilola Gbaja-Biamila; David Oladele; Juliet Iwelunmor; Oliver Ezechi; Joseph D Tucker Journal: J Int AIDS Soc Date: 2021-02 Impact factor: 6.707
Authors: Juliet Iwelunmor; Oliver Ezechi; Chisom Obiezu-Umeh; Titilola Gbaja-Biamila; Ucheoma Nwaozuru; David Oladele; Adesola Z Musa; Ifeoma Idigbe; Florida Uzoaru; Collins Airhihenbuwa; Kathryn Muessig; Donaldson F Conserve; Bill Kapogiannis; Joseph D Tucker Journal: PLoS One Date: 2020-05-29 Impact factor: 3.240