The 4 youth by youth (4YBY) crowdsourced HIV prevention intervention: A stepped-wedge longitudinal trial on HIV self-testing uptake among adolescents and young people in Nigeria

Juliet Iwelunmor, Division of Infectious Diseases, Washington University School of Medicine in St. Louis, USA. Electronic address: ijuliet@wustl.edu.
Chisom Obiezu-Umeh, Implementation Science Department, Feinburg School of Medicine, Northwestern University, Chicago, USA.
Titilola Gbaja-Biamila, Division of Infectious Diseases, Washington University School of Medicine in St. Louis, USA; Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria.
David Oladele, Division of Infectious Diseases, Washington University School of Medicine in St. Louis, USA; Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria.
Ucheoma Nwaozuru, Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Adesola Z. Musa, Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria; Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.
Olunike R. Abodunrin, Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria; Department of Biostatistics and Epidemiology, Nanjing Medical University, Jiangsu, China.
Folahanmi T. Akinsolu, Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria; Department of Public Health, Lead City University, Oyo, Nigeria.
Temitope Ojo, Division of Infectious Diseases, Washington University School of Medicine in St. Louis, USA.
Olufunto Olusanya, Division of Infectious Diseases, Washington University School of Medicine in St. Louis, USA.
Tajudeen Bamidele, Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria.
Nkiru Ezeama, Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria.
Chinyere Okeke, Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria.
Ifiok Johnny, Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria.
Moses Ekene, Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria.
Nurudeen Rahman, Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria.
Tomilola Musari-Martins, Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria.
Sola Ajibaye, Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria.
Akeem Lateef, Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria.
Victor Ojo, Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria.
Yusuf Babatunde, Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria.
Collins O. Airhihenbuwa, Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.
Kathryn Muessig, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Nora Rosenberg, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Rhonda BeLue, Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University School of Medicine, NY, New York, USA.
Hong Xian, College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, USA.
Donaldson F. Conserve, Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
Zhuoru Zou, Xi'an Jiaotong University XJTU · Health Science Centre, School of Public Health, Xi'an, Shaanxi, China.
Jason J. Ong, Implementation Science Department, Feinburg School of Medicine, Northwestern University, Chicago, USA; Central Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
Lei Zhang, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
Jamie Curley, College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, USA.
Susan Nkengasong, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.

Document Type

Journal Article

Publication Date

4-20-2025

Journal

Contemporary clinical trials

Volume

154

DOI

10.1016/j.cct.2025.107919

Keywords

Adolescents and young adults; Crowdsourced intervention; HIV self-testing; Implementation science; Nigeria; Stepped-wedge trial

Abstract

UNLABELLED: Adolescents and young adults (AYAs) participatory approaches for HIV control have increased across LMICs, but there are few trials to evaluate effectiveness. We assessed a crowdsourced HIV self-testing (HIVST) intervention among a cohort of AYA in Nigeria. METHODS: We conducted a pragmatic stepped-wedge cluster randomized control trial recruiting participants (aged 14-24 years) from 32 local government areas across four geo-political zones in Nigeria. Eligible AYA were HIV negative or unknown HIV status, residing in study sites, spoke English, and consented. Areas were randomly assigned to one of four steps and AYA were followed for 24 months. AYA research facilitators implemented a 4YBY crowdsourced HIV prevention bundle. The primary outcome was self-reported HIVST uptake. We compared the probability of HIVST between the control and intervention periods using a generalized linear mixed model. We examined the fixed cost and per capita cost of the intervention. The protocol was registered with Clinical Trials.gov on January 15, 2021, under registration NCT04710784. RESULTS: 2652 AYA were screened, and 1500 were enrolled in the study (March 10, 2021- August 31, 2023). 1333/1500 (89 %) were followed up at 24 months. The mean age of AYA was 20 ± 2.65 years old, most were students (1155/1500, 77 %), and unemployed (915/1500, 61 %). The intervention led to a 9.96-fold increase in HIV self-testing uptake compared to the control period (95 % CI: 8.36-11.85, p < 0.0001). The annual fixed cost of the intervention was estimated at US$42,237, with a per capita testing cost of US$14.8. No significant adverse events were reported. CONCLUSION: A crowdsourced HIV prevention intervention increased HIVST uptake among Nigerian AYA. Greater participation of AYA in the design and implementation of clinical trials is needed to achieve UNAIDS targets.

Department

Prevention and Community Health

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