‘I am a stakeholder who counts’: A qualitative analysis of youth-led strategies for HIV linkage to care following HIV self-testing (Preprint)

BACKGROUND UNAIDS and the Nigeria National HIV/AIDS Strategic Framework recommend HIV self-testing (HIVST) and youth-friendly services to enhance HIV testing, linkage to health services, and prevention. However, the voices of youths are seldom incorporated into interventions. OBJECTIVE We examined qualitative data generated from a series of participatory events in partnership with Nigerian youth focused on enhancing linkage to care. METHODS Informed by a participatory research action framework and human-centered design, we organized a community-based designathon to increase youth engagement in HIV research. A designathon is a multi-stage process including an open call, a sprint event, and follow-up activities. The open call solicited Nigerian youth (14-24 years old) to develop intervention strategies for linkage to care and youth-friendly health services. A subset of people who responded to the open call were invited to participate in a sprint event over 72 hours in Lagos State, Nigeria. Narratives from the open call proposals were analyzed using grounded theory to identify emergent themes focused on youth-proposed interventions for linkage to care and youth-friendly services. RESULTS A total of 236 youth contributed 79 entries. Women or girls submitted 40/79 (51%) of submissions. The average age of participants was 14 years old (SD= ±1.4) and 64/79 (81%) of participants had secondary education or less. Two main themes highlighted strategies for enhancing youth HIV linkage to care: digital interventions and collaboration with youth influencers. Seventy-six participants suggested digital interventions that would facilitate anonymous online counseling, text prompt referrals, and related services. In addition, 16 participants noted that collaboration with youth influencers would be useful. This could involve working in partnership with celebrities, gatekeepers or others that have a large youth audience to enhance promotion of messages on HIVST and linkage. Facilitators of youth linkage included health facility restructuring, dedicated space for youths, youth-trained staff, youth-friendly amenities and subsidized fees. Barriers to HIV linkage to care among youth included a lack of privacy at clinics and concerns about the potential for breaching confidentiality. CONCLUSIONS Our data suggest specific strategies that may be useful for enhancing HIV linkage to care for Nigerian youth, but further research is needed to assess the feasibility and implementation of these strategies.