Todurujo na Kadurok (empowering youth): study protocol of an HIV self-testing and edutainment comic cluster randomised trial among refugee youth in a humanitarian setting in Uganda
IntroductionRefugees experience HIV vulnerabilities due to the confluence of displacement, violence and poverty. HIV self-testing, understudied with refugees, is a promising method to increase testing uptake, yet challenges remain with linkages to confirmatory testing following a positive HIV self-t...
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| Veröffentlicht in: | BMJ open Jg. 12; H. 11; S. e065452 |
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| Sprache: | Englisch |
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British Medical Journal Publishing Group
23.11.2022
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| Abstract | IntroductionRefugees experience HIV vulnerabilities due to the confluence of displacement, violence and poverty. HIV self-testing, understudied with refugees, is a promising method to increase testing uptake, yet challenges remain with linkages to confirmatory testing following a positive HIV self-test. This study aims to evaluate the effectiveness of HIV self-testing kits and ‘edutainment’ comics in increasing HIV testing and HIV status knowledge among refugee youth aged 16–24 years in Bidi Bidi Refugee Settlement, Uganda.Methods and analysisThis study will be conducted in Bidi Bidi. We conducted a qualitative formative phase with focus groups (n=40) to generate knowledge of barriers and facilitators of HIV prevention, testing and care among refugee youth (aged 16–24) in Bidi Bidi. These findings were used to create comic scenarios aligning with edutainment approaches to health promotion and inform a four-arm cluster randomised controlled trial in Bidi Bidi using a 2×2 factorial design: (1) HIV self-testing alongside edutainment comics, (2) HIV self-testing alone, (3) edutainment comic alone and (4) standard of care. The target sample size will be 120 youth (30 per arm), who will be enrolled in the trial and followed for 3 months. Data will be collected at baseline and 3 months after enrolment. The primary outcomes (HIV testing frequency, HIV status knowledge) and secondary outcomes (linkage to confirmatory HIV testing, HIV care linkage, HIV self-test kit use, HIV-related stigma, HIV knowledge, safer sex efficacy, condom use, adolescent sexual and reproductive health (SRH) stigma, sexual relationship power, access to SRH services) will be evaluated using descriptive statistics and regression analyses.Ethics and disseminationThis study was approved by the University of Toronto Research Ethics Board, Mildmay Uganda Research Ethics Committee and the Uganda National Council for Science and Technology. Results will be shared in peer-reviewed publications and community knowledge sharing.Trial registration numberNCT05213689. |
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| AbstractList | IntroductionRefugees experience HIV vulnerabilities due to the confluence of displacement, violence and poverty. HIV self-testing, understudied with refugees, is a promising method to increase testing uptake, yet challenges remain with linkages to confirmatory testing following a positive HIV self-test. This study aims to evaluate the effectiveness of HIV self-testing kits and ‘edutainment’ comics in increasing HIV testing and HIV status knowledge among refugee youth aged 16–24 years in Bidi Bidi Refugee Settlement, Uganda.Methods and analysisThis study will be conducted in Bidi Bidi. We conducted a qualitative formative phase with focus groups (n=40) to generate knowledge of barriers and facilitators of HIV prevention, testing and care among refugee youth (aged 16–24) in Bidi Bidi. These findings were used to create comic scenarios aligning with edutainment approaches to health promotion and inform a four-arm cluster randomised controlled trial in Bidi Bidi using a 2×2 factorial design: (1) HIV self-testing alongside edutainment comics, (2) HIV self-testing alone, (3) edutainment comic alone and (4) standard of care. The target sample size will be 120 youth (30 per arm), who will be enrolled in the trial and followed for 3 months. Data will be collected at baseline and 3 months after enrolment. The primary outcomes (HIV testing frequency, HIV status knowledge) and secondary outcomes (linkage to confirmatory HIV testing, HIV care linkage, HIV self-test kit use, HIV-related stigma, HIV knowledge, safer sex efficacy, condom use, adolescent sexual and reproductive health (SRH) stigma, sexual relationship power, access to SRH services) will be evaluated using descriptive statistics and regression analyses.Ethics and disseminationThis study was approved by the University of Toronto Research Ethics Board, Mildmay Uganda Research Ethics Committee and the Uganda National Council for Science and Technology. Results will be shared in peer-reviewed publications and community knowledge sharing.Trial registration numberNCT05213689. Introduction Refugees experience HIV vulnerabilities due to the confluence of displacement, violence and poverty. HIV self-testing, understudied with refugees, is a promising method to increase testing uptake, yet challenges remain with linkages to confirmatory testing following a positive HIV self-test. This study aims to evaluate the effectiveness of HIV self-testing kits and ‘edutainment’ comics in increasing HIV testing and HIV status knowledge among refugee youth aged 16–24 years in Bidi Bidi Refugee Settlement, Uganda.Methods and analysis This study will be conducted in Bidi Bidi. We conducted a qualitative formative phase with focus groups (n=40) to generate knowledge of barriers and facilitators of HIV prevention, testing and care among refugee youth (aged 16–24) in Bidi Bidi. These findings were used to create comic scenarios aligning with edutainment approaches to health promotion and inform a four-arm cluster randomised controlled trial in Bidi Bidi using a 2×2 factorial design: (1) HIV self-testing alongside edutainment comics, (2) HIV self-testing alone, (3) edutainment comic alone and (4) standard of care. The target sample size will be 120 youth (30 per arm), who will be enrolled in the trial and followed for 3 months. Data will be collected at baseline and 3 months after enrolment. The primary outcomes (HIV testing frequency, HIV status knowledge) and secondary outcomes (linkage to confirmatory HIV testing, HIV care linkage, HIV self-test kit use, HIV-related stigma, HIV knowledge, safer sex efficacy, condom use, adolescent sexual and reproductive health (SRH) stigma, sexual relationship power, access to SRH services) will be evaluated using descriptive statistics and regression analyses.Ethics and dissemination This study was approved by the University of Toronto Research Ethics Board, Mildmay Uganda Research Ethics Committee and the Uganda National Council for Science and Technology. Results will be shared in peer-reviewed publications and community knowledge sharing.Trial registration number NCT05213689. Refugees experience HIV vulnerabilities due to the confluence of displacement, violence and poverty. HIV self-testing, understudied with refugees, is a promising method to increase testing uptake, yet challenges remain with linkages to confirmatory testing following a positive HIV self-test. This study aims to evaluate the effectiveness of HIV self-testing kits and 'edutainment' comics in increasing HIV testing and HIV status knowledge among refugee youth aged 16-24 years in Bidi Bidi Refugee Settlement, Uganda.INTRODUCTIONRefugees experience HIV vulnerabilities due to the confluence of displacement, violence and poverty. HIV self-testing, understudied with refugees, is a promising method to increase testing uptake, yet challenges remain with linkages to confirmatory testing following a positive HIV self-test. This study aims to evaluate the effectiveness of HIV self-testing kits and 'edutainment' comics in increasing HIV testing and HIV status knowledge among refugee youth aged 16-24 years in Bidi Bidi Refugee Settlement, Uganda.This study will be conducted in Bidi Bidi. We conducted a qualitative formative phase with focus groups (n=40) to generate knowledge of barriers and facilitators of HIV prevention, testing and care among refugee youth (aged 16-24) in Bidi Bidi. These findings were used to create comic scenarios aligning with edutainment approaches to health promotion and inform a four-arm cluster randomised controlled trial in Bidi Bidi using a 2×2 factorial design: (1) HIV self-testing alongside edutainment comics, (2) HIV self-testing alone, (3) edutainment comic alone and (4) standard of care. The target sample size will be 120 youth (30 per arm), who will be enrolled in the trial and followed for 3 months. Data will be collected at baseline and 3 months after enrolment. The primary outcomes (HIV testing frequency, HIV status knowledge) and secondary outcomes (linkage to confirmatory HIV testing, HIV care linkage, HIV self-test kit use, HIV-related stigma, HIV knowledge, safer sex efficacy, condom use, adolescent sexual and reproductive health (SRH) stigma, sexual relationship power, access to SRH services) will be evaluated using descriptive statistics and regression analyses.METHODS AND ANALYSISThis study will be conducted in Bidi Bidi. We conducted a qualitative formative phase with focus groups (n=40) to generate knowledge of barriers and facilitators of HIV prevention, testing and care among refugee youth (aged 16-24) in Bidi Bidi. These findings were used to create comic scenarios aligning with edutainment approaches to health promotion and inform a four-arm cluster randomised controlled trial in Bidi Bidi using a 2×2 factorial design: (1) HIV self-testing alongside edutainment comics, (2) HIV self-testing alone, (3) edutainment comic alone and (4) standard of care. The target sample size will be 120 youth (30 per arm), who will be enrolled in the trial and followed for 3 months. Data will be collected at baseline and 3 months after enrolment. The primary outcomes (HIV testing frequency, HIV status knowledge) and secondary outcomes (linkage to confirmatory HIV testing, HIV care linkage, HIV self-test kit use, HIV-related stigma, HIV knowledge, safer sex efficacy, condom use, adolescent sexual and reproductive health (SRH) stigma, sexual relationship power, access to SRH services) will be evaluated using descriptive statistics and regression analyses.This study was approved by the University of Toronto Research Ethics Board, Mildmay Uganda Research Ethics Committee and the Uganda National Council for Science and Technology. Results will be shared in peer-reviewed publications and community knowledge sharing.ETHICS AND DISSEMINATIONThis study was approved by the University of Toronto Research Ethics Board, Mildmay Uganda Research Ethics Committee and the Uganda National Council for Science and Technology. Results will be shared in peer-reviewed publications and community knowledge sharing.NCT05213689.TRIAL REGISTRATION NUMBERNCT05213689. |
| Author | Berry, Isha Logie, Carmen H Gittings, Lesley Odong Lukone, Simon Kisubi, Nelson Loutet, Miranda G Coelho, Madelaine Atama, Malon Okumu, Moses Kyambadde, Peter |
| AuthorAffiliation | 4 Centre for Gender & Sexual Health Equity , Vancouver , British Columbia , Canada 11 Uganda Refugee and Disaster Management Council , Yumbe , Uganda 13 Most at Risk Population Initiative , Mulago Hospital , Kampala , Uganda 2 Women's College Research Institute , University of Toronto , Toronto , Ontario , Canada 7 Dalla Lana School of Public Health , University of Toronto , Toronto , Ontario , Canada 8 Department of Sociology , University of Toronto , Toronto , Ontario , Canada 3 United Nations University Institute for Water, Environment and Health (UNU-INWEH) , Hamilton , Ontario , Canada 5 School of Social Work , University of Illinois-Champaign , Urbana , Illinois , USA 6 School of Social Sciences , Uganda Christian University , Mukono , Uganda 9 University of Cape Town , Rondebosch , South Africa 10 School of Health Studies, Faculty of Health Sciences , Western University , London , ON , Canada 12 Yumbe Regional Referral Hospital , Yumbe , Uganda 1 Factor-Inwentash Faculty of Social Work , Un |
| AuthorAffiliation_xml | – name: 2 Women's College Research Institute , University of Toronto , Toronto , Ontario , Canada – name: 13 Most at Risk Population Initiative , Mulago Hospital , Kampala , Uganda – name: 1 Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Ontario , Canada – name: 6 School of Social Sciences , Uganda Christian University , Mukono , Uganda – name: 5 School of Social Work , University of Illinois-Champaign , Urbana , Illinois , USA – name: 9 University of Cape Town , Rondebosch , South Africa – name: 8 Department of Sociology , University of Toronto , Toronto , Ontario , Canada – name: 4 Centre for Gender & Sexual Health Equity , Vancouver , British Columbia , Canada – name: 11 Uganda Refugee and Disaster Management Council , Yumbe , Uganda – name: 3 United Nations University Institute for Water, Environment and Health (UNU-INWEH) , Hamilton , Ontario , Canada – name: 7 Dalla Lana School of Public Health , University of Toronto , Toronto , Ontario , Canada – name: 10 School of Health Studies, Faculty of Health Sciences , Western University , London , ON , Canada – name: 12 Yumbe Regional Referral Hospital , Yumbe , Uganda |
| Author_xml | – sequence: 1 givenname: Carmen H orcidid: 0000-0002-8035-433X surname: Logie fullname: Logie, Carmen H email: carmen.logie@utoronto.ca organization: Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada – sequence: 2 givenname: Moses surname: Okumu fullname: Okumu, Moses organization: School of Social Sciences, Uganda Christian University, Mukono, Uganda – sequence: 3 givenname: Miranda G surname: Loutet fullname: Loutet, Miranda G organization: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada – sequence: 4 givenname: Madelaine surname: Coelho fullname: Coelho, Madelaine organization: Department of Sociology, University of Toronto, Toronto, Ontario, Canada – sequence: 5 givenname: Isha surname: Berry fullname: Berry, Isha organization: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada – sequence: 6 givenname: Lesley surname: Gittings fullname: Gittings, Lesley organization: School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada – sequence: 7 givenname: Simon surname: Odong Lukone fullname: Odong Lukone, Simon organization: Uganda Refugee and Disaster Management Council, Yumbe, Uganda – sequence: 8 givenname: Nelson surname: Kisubi fullname: Kisubi, Nelson organization: Uganda Refugee and Disaster Management Council, Yumbe, Uganda – sequence: 9 givenname: Malon surname: Atama fullname: Atama, Malon organization: Yumbe Regional Referral Hospital, Yumbe, Uganda – sequence: 10 givenname: Peter surname: Kyambadde fullname: Kyambadde, Peter organization: Most at Risk Population Initiative, Mulago Hospital, Kampala, Uganda |
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global qualitative systematic review publication-title: AIDS doi: 10.1097/QAD.0000000000001705 – ident: 2025092501401420000_12.11.e065452.10 doi: 10.1136/bmjgh-2017-000682 – ident: 2025092501401420000_12.11.e065452.16 doi: 10.2989/16085906.2020.1725071 – volume: 22 year: 2021 ident: 2025092501401420000_12.11.e065452.66 article-title: Ethical considerations for involving adolescents in biomedical HIV prevention research publication-title: BMC Med Ethics doi: 10.1186/s12910-021-00695-3 – volume: 7 start-page: 1 year: 2013 ident: 2025092501401420000_12.11.e065452.7 article-title: Testing experiences of HIV positive refugees in Nakivale refugee settlement in Uganda: informing interventions to encourage priority shifting publication-title: Conflict and Health doi: 10.1186/1752-1505-7-2 – ident: 2025092501401420000_12.11.e065452.4 – ident: 2025092501401420000_12.11.e065452.50 – ident: 2025092501401420000_12.11.e065452.63 doi: 10.1136/bmj.e7586 – volume: 22 start-page: 783 year: 2017 ident: 2025092501401420000_12.11.e065452.31 article-title: Comics as a medium for providing information on adult immunizations publication-title: J Health Commun doi: 10.1080/10810730.2017.1355418 – ident: 2025092501401420000_12.11.e065452.56 doi: 10.1521/aeap.14.2.172.23902 – volume: 24 year: 2021 ident: 2025092501401420000_12.11.e065452.13 article-title: Intersecting stigma and HIV testing practices among urban refugee adolescents and youth in Kampala, Uganda: qualitative findings publication-title: J Int AIDS Soc doi: 10.1002/jia2.25674 – volume: 32 start-page: 371 year: 2018 ident: 2025092501401420000_12.11.e065452.47 article-title: Experiences using and organizing HIV self-testing publication-title: AIDS doi: 10.1097/QAD.0000000000001705 – ident: 2025092501401420000_12.11.e065452.45 doi: 10.1186/1471-2288-3-1 – ident: 2025092501401420000_12.11.e065452.54 doi: 10.1080/09540120802032627 – volume: 73 start-page: 45 year: 2017 ident: 2025092501401420000_12.11.e065452.40 article-title: Strengths-based narrative storytelling as therapeutic intervention for refugees in Greece publication-title: World Federation of Occupational Therapists Bulletin doi: 10.1080/14473828.2017.1298557 – ident: 2025092501401420000_12.11.e065452.44 – ident: 2025092501401420000_12.11.e065452.25 doi: 10.1136/bmj.l1083 – ident: 2025092501401420000_12.11.e065452.6 doi: 10.11604/pamj.2020.37.265.25038 – volume: 15 start-page: 927 year: 2014 ident: 2025092501401420000_12.11.e065452.34 article-title: Comics and medicine publication-title: Lancet Oncol doi: 10.1016/S1470-2045(14)70352-3 – ident: 2025092501401420000_12.11.e065452.60 doi: 10.1023/A:1007051506972 – volume: 13 year: 2018 ident: 2025092501401420000_12.11.e065452.22 article-title: A pilot trial of the peer-based distribution of HIV Self-Test kits among fishermen in Bulisa, Uganda publication-title: PLoS One doi: 10.1371/journal.pone.0208191 – ident: 2025092501401420000_12.11.e065452.36 doi: 10.1080/10810730050019573 – volume: 14 year: 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reducing depression and stress in Latino dementia family caregivers publication-title: Alzheimer Dis Assoc Disord doi: 10.1097/WAD.0000000000000077 – volume: 14 year: 2019 ident: 2025092501401420000_12.11.e065452.35 article-title: The effectiveness of using entertainment education narratives to promote safer sexual behaviors of youth: a meta-analysis, 1985-2017 publication-title: PLoS One doi: 10.1371/journal.pone.0209969 |
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| Snippet | IntroductionRefugees experience HIV vulnerabilities due to the confluence of displacement, violence and poverty. HIV self-testing, understudied with refugees,... Refugees experience HIV vulnerabilities due to the confluence of displacement, violence and poverty. HIV self-testing, understudied with refugees, is a... Introduction Refugees experience HIV vulnerabilities due to the confluence of displacement, violence and poverty. HIV self-testing, understudied with refugees,... |
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| SubjectTerms | Confidentiality Disease prevention Displaced persons Empowerment Health facilities HIV HIV & AIDS Human immunodeficiency virus Humanitarianism Infections Intervention Knowledge Medical tests PREVENTIVE MEDICINE Public health Refugees Reproductive health Settlements & damages Sexually transmitted diseases STD Stigma Teenagers Young adults |
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| Title | Todurujo na Kadurok (empowering youth): study protocol of an HIV self-testing and edutainment comic cluster randomised trial among refugee youth in a humanitarian setting in Uganda |
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