Zambia U-report, Revolutionizing HIV Response among Adolescents and Young People through SMS
Zambia: U-Report for HIV prevention
Zambia’s U-report platform, designed to improve HIV knowledge among the country’s young people, uses the most popular tool among this demographic: mobile devices. The programme provides confidential, individual and interactive HIV and STI counselling free of charge via SMS. The service enables demand creation tailored to specific HIV services and referral to a location nearest the user; and it tracks and reports on knowledge gaps and emerging issues related to HIV and STI that inform other programmes.
Through this innovative approach to HIV outreach, U-Report has increased demand for HIV services including testing and counselling, and has used reported information to shape Zambia’s 2014-2016 National HIV Strategy. U-Report is the first large-scale mobile health programme using SMS messaging to increase young people’s participation in the national HIV and AIDS response.
U-Report grew dramatically between December 2012 and February 2014 with 41,000 U-Reporters joining the Zambia programme. Of these, 27 per cent are 10-19 years old and nearly half (45 per cent) are 20-24 years old. All of Zambia’s 10 provinces have registered U-Reporters with 52 per cent in Lusaka, and 28 per cent in Copperbelt. About 27,000 (66 per cent) of these U-reporters engaged counsellors through SMS, generating about 126,000 text messages (an average of four SMS requests per active U-Reporter). On average, each of the three U-Report counsellors fields 80 SMS requests every day.
How does it work?
Two programmatic modules (Knowledge Bank, and Poll/Campaign) are the backbone of Zambia U-Report.
The Knowledge Bank module is designed to enable two-way interaction between SMS Counsellors and the U-Reporter who sends in spontaneous SMS requests.
The poll/campaign module is uniquely designed to generate tailored demand creation among U-Reporters and to refer them to the closest HIV services during specific campaigns (e.g., HIV testing and counselling, voluntary medical male circumcision and condom use) in their community. It also allows young people to take a more central role in shaping the national HIV response in their community and at the national level through regular opinion polls on HIV programme bottlenecks and innovative approaches to address them. For instance, according to U-Reporters, the main barrier to HTC was a fear of a positive test result. Lack of awareness of the importance of HTC was highest among younger adolescents. Older adolescents and youth recommended increasing targeted campaigns, while younger adolescents prioritized incentive-based demand creation and campaigns targeting parents.
Increasing HIV Testing and Counselling uptake among adolescents and youth via SMS
In June 2013, U-Report delivered an HTC campaign over 10 days through SMS messages. This effort triggered a two-way interactive SMS counselling session between U-Reporters and trained SMS counsellors. SMS counsellors addressed questions and referred U-Reporters to the nearest HTC site in their location. Of the 5,702 U-Reporters (10-24 years) reached in this 10-day period, 1,139 (about 20 per cent) reported they had not received HTC in the past 12 months. Of those 1,139 who had not accessed HTC, 18 per cent went for HTC during the campaign. The majority of those accessing HTC for the first time in 12 months during the campaign, 62 per cent were adolescents, 15-19 years. Most of those who accessed services (93 per cent) reported that they were happy with the treatment they received at the health facility. Among those who did not go for testing, the main reason reported was that they were busy at school or at work (58 per cent).
Potential impact at scale
Zambia U-Report has the potential to provide a sustainable and cost-effective way to ensure meaningful participation of adolescents and youth in the formulation of policy, as well as the design and implementation of programming that addresses their health and lifestyle needs. This investment could significantly impact the incidence of HIV among adolescents and youths.
By harnessing the popularity of text messages, Zambia U-Report aims to engage and continuously counsel young people on HIV and STI prevention via SMS, turning Zambia’s youth into agents of change towards achieving an HIV and AIDS-free generation in Zambia.
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