STEM V: Innovation and Appropriate Technology in Africa 18-20 October, 2019, University of Michigan, Ann Arbor A conference intended, in part, as a tribute to Dr. Moses Musaazi, late of Makerere University, a serial inventor and master of the “Appropriate Technology” approach that serves as the central conference theme. Dr. Musaazi was driven by a concern to empower communities, to unlock their creative potential, circumventing systemic hurdles to such potential from the global marketplace or inequitable local mores. This conference brings together leading experts and practitioners who will present work broadly related to systems, processes, and product innovation and technology with application in Africa.

1. ABSTRACT
BACKGROUND
OBJECTIVE
METHODS RESULTS
DISCUSSION
REFERENCES AND ACKNOWLEDGEMENTS
Examining the feasibility and acceptability a web-based self-management
program for HIV-infected adolescents and young adults in Uganda
Anudeeta Gautam1
, Anjali Vaishnav2
, Sophia Jacobs3
, Massy Mutumba4
PhD, MPH, BSN
1
U-M College of Literature, Sciences, and the Arts, 2
U-M School of Public Health, 3
U-M School of Information, 4
U-M Department of Health Behavior and Biological Sciences
ACKNOWLEDGEMENTS
We would like to thank the consultants from the People in Need Agency Uganda (PINA), Asia Namusoke Mbajja,
Robinah Babirye, Suubi Ruth Bulya, and Leilah Richter Nakimbugwe, as well as Dr. Henry Mugerwa from the Joint
Clinical Research Centre (JCRC), Namungongo Fund for Special Children, Children’s AIDS Fund, and Kasenyi Landing
Site for welcoming our project. We would also like to thank the University of Michigan School of Nursing for funding
this project.
In sub-Saharan Africa, approximately 23.5 million people live with HIV, and that
population is expected to increase. There are 1.5 million people living with HIV in
Uganda, and of those, approximately 300,000 adolescents and young adults living
with HIV (AYLHIV) in Uganda. 96,000 positive children are under the age of 14 and
approx. 150,000 are between the ages of 15 and 24. Previous studies have found
that AYLHIV face numerous psychosocial challenges including psychological distress,
non-adherence to antiretroviral therapy (ART), and social stigma, among many
other consequences that impact these adolescents. However, access to
developmentally appropriate psychosocial support for AYLHIV remains limited.
Moreover, AYLHIV have reported provider mistrust, lack of privacy and
geographical factors as factors that limit accessibility to psychosocial support, while
healthcare providers highlight high caseloads, limited resources and lack of skills as
barriers to providing adequate psychosocial support. The increasing rates of
AIDS-related mortality, attrition from medical care and poor ART adherence
underscore the urgent need to address the psychosocial needs of AYLHIV.
The overall goal of this program is to increase rates of adherence to antiretroviral
therapy and promote mental and physical wellness among AYLHIV. This goal will
be achieved by the following:
• Develop an accessible technology driven intervention to address the
self-management needs of AYLHIV in Uganda.
• Aid AYLHIV in Uganda to self-manage their disease by improving their
knowledge about the disease and equipping them with skills to manage the five
identified adherence barriers.
• Provide a platform for AYLHIV to securely and comfortably pose and answer
questions regarding various facets of their disease and medication adherence to
other peer AYLHIV.
After the conclusion of pilot testing, we are optimistic that our final app will be
accessible to the targeted population and received positively in the community.
Majority of participants had access to an iPad (75%) or smartphone (56.25%), and
75% of participants said that the website would be easy to access. Many
participants owned or had used a smartphone or tablet in the past, and
participants who were unfamiliar with smart devices demonstrated remarkable
ease in navigating the website after a brief tutorial suggesting that the program
was user-friendly. Program content was regarded as relevant and educational.
Limitations of our May 2019 pilot test include technical issues with deploying the
iCARE website publically on Amazon Web-Services on-site and heavy rain season
preventing maximum attendance of adolescents at adolescent day at the HIV
pediatric clinics. Suggestions for improvement included adding more male figures
to video content and the addition of an online community platform to facilitate
user-interactions.
SURVEY DEVELOPMENT
The baseline survey used to assess self-reported adherence barriers was designed
using a combination of multiple choice, Likert scale, and table style questions
generated to assess one of five salient adherence barriers: school, psychological
distress, medication, social support, and religious misperceptions. Survey
questions were based on existing mental health and depression inventory
surveys. The survey was initially created using Qualtrics and later integrated into
the website using JavaScript and HTML. Prior to finalizing the survey for the May
2019 pilot test, we conducted focus groups with People in Need Agency (PINA)
Uganda consultants to rephrase unclear questions, remove duplicate questions,
and simplify difficult to translate answer choices. In collaboration with the PINA
consultants and following the creation of the finalized website-integrated survey
questions, we recorded Lugandan translations of each question and answer
choices to address any language barriers.
WEBSITE DEVELOPMENT
The December 2017 prototype was created using WiX, a customizable website
builder. We then coded the May 2018/2019 prototype using Python, CSS, HTML,
JavaScript and a dynamic Flask framework. The survey flow redirected patients via
link to an age/gender-specific web-page tailored according to their survey
answers. Each adolescent was presented with a personalized website designed to
address problematic areas of their self-management, specifically the
aforementioned adherence barriers, and provide resources to resolve them. The
web pages also included videos from interviews conducted with each of the PINA
consultants containing anecdotes of how they overcame HIV-specific challenges
they faced and inspirational messages and tips to uplift the spirits of the viewer.
The gender/age pairings used were male/female adolescents (13 to 15 years),
male/female young adults (16 to 19 years), and male/female adults (20 to 24
years).
PARTICIPANT RECRUITMENT
To assess feasibility, acceptability and perceived relevance of the iCARE program,
we conducted in depth interviews with 32 AYLHIV (ages 13 - 24) at three pediatric
HIV treatments centers in Kampala. We were able to identify these centers with
the help of our local consultants from PINA. Initially, we met with the director of
each clinic to introduce the project, determine patient eligibility, and finalize
logistics. Participants were interviewed by invitation during the designated
adolescent days at the respective clinics.
PILOT TESTING PROCESS
Once participants were identified, they were briefed about the program.
Participants were then instructed on how to use the iPads and navigate the
program. Initial surveys were administered via iPad and participants were able to
navigate the iCARE program on the same device. They then completed the
baseline entry survey, following which they were automatically redirected to
complete a module based on their self-reported adherence barrier. If the
participant did not report any adherence barrier, they were automatically
directed to complete a module on general wellbeing. A research associate stayed
with the participant throughout the testing, observing how they navigated the
program, answering questions, measuring duration of time spent on each module,
and assisting participants through technical difficulties. After completing the
modules, participants completed a debriefing interview, describing their
experience using the program. Interview questions included participant
challenges, likes and dislikes, and opportunities for improvement.
Female Male
13 - 15
years old
4 participants
Enjoyed the videos and found
translations useful
4 participants
Liked videos, translations, survey questions, and
resources
One participant found a question unclear and was not
sure how to proceed
16 - 19
years old
10 participants
Liked visual appeal, layout, healthy
lifestyle page
Disliked questions about alcohol/drug
use
One participant in secondary school
confused by university resources
3 participants
Liked general display/order of website, healthy lifestyle
page, relationship support, and social support
Worried uneducated people would find questions
difficult
Would like to see men share their stories in videos
20 - 24
years old
3 participants
Liked that the PINA consultants openly
talked about issues surrounding their
relationships, etc.
Wanted to customize profile
Suggested information on how children
can help each other with adherence, a
social media-like aspect for chatting
8 participants
Liked the survey questions and consultants in videos
Found support pages encouraging
Felt comfortable answering survey questions because of
anonymity
Suggested shortening the survey, removing questions
about food
Wanted complete Luganda translation of site, chat
feature, videos with HIV+ men
Was the website easy to access?
Yes 24 75%
Yes, with assistance 5 15.62%
No 3 9.38%
Access to
smartphone/tablet?
Used smartphone/tablet
before?
Yes 18 (56.25%) 24 (75%)
No 14 (43.75%) 8 (25%)
This project is working to develop an mHealth program for the self-management of
HIV among adolescents in Uganda. Few studies and interventions exist on
self-management for young people living with HIV in resource-limited areas like
Uganda. This project builds on prior research activities, from which five main
adherence barriers were identified: school, psychological distress, medication,
social support, and religious misperceptions.. We have developed an age and
gender tailored application intervention program to address these challenges. This
prototype relies on a survey to identify the adolescents’ most salient adherence
barriers. They are then directed to tailored health information or skills
development lessons addressing those specific adherence barriers. Information is
tailored to age and gender, with the goal of providing more specific, personable
support that adolescents can relate to, while overcoming challenges in accessing
healthcare provider counseling. After the conclusion of May 2019 pilot testing, we
have determined that our final app will be accessible to the population we are
targeting and received positively in the community.
Mutumba, M., et al. (2018). Perceptions of HIV Self-Management Roles and Challenges in Adolescents, Caregivers,
and Health Care Providers. Journal of the Association of Nurses in AIDS Care, 1.
Mutumba, M., et al. (2019). Perceptions of Strategies and Intervention Approaches for HIV Self-Management among
Ugandan Adolescents: A Qualitative Study, Journal of the International Association of Providers of AIDS Care
(JIAPAC), 18.