An Unstructured Supplementary Service Data System to Verify HIV Self Testing among Nigerian Youth: A Mixed Methods Analysis of Usability and Feasibility (Preprint)

BACKGROUND Mobile health (mhealth) interventions among Adolescents and Young Adults (AYA) are increasingly available in African Low- and Middle-Income Countries (LMIC). Its use in overcoming the challenge of verification of HIV self-testing (HIVST) results has improved the scale-up of HIVST services among AYAs. However, there is a challenge in reaching AYAs without access to smartphones. OBJECTIVE The study, therefore, described the creation of an Unstructured Supplementary Service Data (USSD) platform and determined its feasibility and usability to promote HIVST among AYA in Nigeria. METHODS Through a user-centered approach, we developed, assessed usability, and implemented an Unstructured Supplementary Service Data (USSD) platform to verify HIVST results. We used a mixed method study to assess the usability of the platform through a process of quantitative heuristic assessment, qualitative think-aloud method, and exit interview. USSD platform guided AYA in performing HIVST, interpreting the result, and providing linkage to care. Descriptive statistics of quantitative data and inductive thematic analysis of qualitative variables were done. RESULTS A total of 19 AYA participated in the usability test with a median age of 19 years (Range 16-23 years). There were 11 women, eight men, and no non-binary individuals. They were out-of-school AYAs. A total of seven of the 10 Nielsen usability heuristics 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, and were happy the system provided linkage to care following the interpretation of the HIVST result. The pilot field test of the platform enrolled 164 out-of-school AYAs, with females in the majority(61.6%). The mean age of 17.53.18 years, and 92.1% of the participants reported that they were heterosexual, while 7.9% reported that they were gay. A total of 13/164 (7.9%) youth had positive HIV results (reactive to OraQuik kit). However, none of the 13 reactive persons were confirmed HIV positive. CONCLUSIONS This study demonstrated the usability and feasibility of using a USSD system as an alternative to mobile phone applications to verify HIVST results among Nigerian youth without access to smartphones. It, therefore, recommends the scale-up of this system to promote HIVST among young persons in Nigeria