Sex in the pocket: Implementation of a mobile phone application in HIV Vaccine trials. The use of technology-based HIV programs, such as via the internet and mobile phone messaging, has overcome some of the individual and intervention-level barriers, such as discomfort with topics. Moreover, content can be easily tailored and updated to reflect current trends and changes in health information. The Perinatal HIV Research Unit (PHRU) is the first research site in South Africa that tested the use of a mobile phone messaging platform to collect sexual risk information within the context of HIV vaccine trials amongst 50 high-risk women aged 18-25 years, who were provided with study mobile phones for three month to transmit the daily data for the duration of their participation. The study staff perceptions on women's challenges and the feasibility of self-administered sexual risk data collection via a mobile phone will be presented.

1. Perceptions of study staff in
implementing a mobile phone survey
application answered by HIV-negative
women in Soweto, South Africa
Stefanie Hornschuh
Researcher
Perinatal HIV Research Unit,
University of the Witwatersrand,
Johannesburg, South Africa

2. Background (1)
HIV and the burden on young women
• Globally, young women 15–24 years old are
most vulnerable to HIV infection, with
infection rates twice as high as among men
the same age.
• At the end of 2010 it was estimated that of
the 34 million adults worldwide living with
HIV and AIDS, half were women.
• UNAIDS estimates that approximately
three-quarters of all women living with HIV
live in sub-Saharan Africa.

3. Background (2)

4. Our experience in using mobile phones for sexual risk assessments
• The Perinatal HIV Research Unit (PHRU) is the first research site in South
Africa to test the use of a mobile phone internet enabled messaging
platform to collect sensitive sexual risk information within the context of HIV
vaccine trials.
Study Overview:
• 50 high-risk, HIV-uninfected and sexually active women,
aged 18-25 years
• Recruited from Soweto, South Africa
• Were provided with mobile phones for three months
• Completed a survey daily on sexual activity
Background (3)

5. The mobile phone survey
Background (4)

6. Background (5)
Participants
were
shown the
full version
of the video
On site
training on
how to use
the smart
phone and
the survey
App
A take-
home user
manual
Telephone
and on site
support to
resolve
challenges
Daily SMS
reminders
Automatic
upload of
data
bundles to
submit
surveys
Automated
airtime
incentives
for each
successfully
submitted
survey
The mobile phone training and support

7. Objectives
To explore the
feasibility of survey
submissions looking at
sexual risk through a
mobile phone
messaging platform.
1 To establish user-
friendly ways to collect
self-administered
sensitive data for HIV
prevention trials.
2

8. Methods (1)
Study
Setting

11. • Qualitative study
• In-Depth Interviews (IDIs) with study staff (N=6)
• Informed consent prior to participation
• Interviews were audio recorded
• Interviews were conducted at a confidential room
at the PHRU
Methods (2)
Type of
Study
Data
Collection
Procedures

12. • Interviews were transcribed
• Transcripts were hand-coded using thematic
analysis
Methods (3)
Data
Analysis

13. Results (1)
Main Themes
•Challenges in the lives of the women that may have
impacted their ability to complete the survey1
•Structural issues that impacted survey default2
•Technology related reasons for survey default3
•Survey Successes4

14. Participant Characteristics
Results (2)
Females
Median age of 29.5 years
• 2 Counsellors
• 2 Study Nurses
• 1 Medical Officer
• 1 Research Assistant
Study staff, who was interviewed (N=6)

15. • Family members and partners were unaware of
participants participation in HVTN 915
• Participants who are in relationships with partners
who use drugs
• Women who lived with friends or shared a room with
a family member
• Women who lived in informal settlements
• Women who started a new relationship during their
study participation
Results (3)
Challenges in
the lives of the
women that
may have
impacted their
ability to
complete the
survey
1

16. • Long school and working hours
• Unusual working hours
• Over night stay at a friends place
• Being away for the entire weekend
• Sickness of the child and spending the day at
the hospital
• Being lazy after a night out
Results (4)
Structural
issues that
impacted
survey default
2

17. • Disabling of the network
• Delayed upload of data bundles
• Reminder SMS’s
• Phone reset
Results (5)
Technology
related
reasons for
survey default
3

18. Results (6)
• Touchscreen operation of the
smartphone
• Survey questions were short and
understandable
• Airtime incentives after each
completed survey record
• SMS reminders and follow-up calls
• Women were able to keep the
study phone if they completed the
study successfully
• AppLock
Survey
Successes
4

19. • Reporting bias
• Interviewer-participant relationship
Limitations

20. • Study staff’s understanding of the everyday challenges of
young women at risk for HIV acquisition in a low-income
setting was explored for consideration when developing a
mobile phone application to collect behavioural risk data
relevant to HIV trials.
Conclusions

21. HIV Vaccine Trials Network
Perinatal HIV Research Unit
HVTN 915 study staff
Prof Glenda Gray
Dr James Kublin
Dr Fatima Laher
Dr Erica Lazarus
Dr Janan Dietrich
Acknowledgements

22. Questions?
Contact: Stefanie Hornschuh, e-mail: hornschuhs@phru.co.za
Thank you for your attention!