A Pilot RCT Evaluating InThistoGether, an mHealth HIV Prevention Program for Ugandan Youth
Outcomes: Human Immunodeficiency Virus, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Although not explicitly designed to address social norms, the InThistoGether (ITG) intervention engages with implicit normative beliefs around condom use, sexual behavior, and HIV testing among Ugandan youth. By promoting sex-positive messaging and normalizing discussions of condom use and HIV prevention through daily texts, the intervention subtly challenges stigma and harmful silence around adolescent sexual health. Youth responses suggested mixed comfort with this open dialogue, indicating both potential and resistance in shifting entrenched taboos.
Objectives The primary objective was to evaluate the feasibility, acceptability, and preliminary behavioral effects of InThistoGether, a text messaging-based HIV prevention program for Ugandan youth aged 18–22. The study also sought to assess whether ITG could influence HIV preventive behaviors, particularly condom use and testing.
Methods This was a two-arm randomized controlled trial involving 202 youth, recruited via Facebook and Instagram, who were randomly assigned to either the ITG intervention or an attention-matched general health control group. Participants received daily messages for seven weeks, followed by a one-week booster. Baseline and follow-up surveys measured behavior and program perceptions five months post-randomization. Analyses included logistic and Poisson regressions, adjusting for relevant covariates.
Intervention Details InThistoGether is a theory-driven, comprehensive mHealth intervention grounded in the Information-Motivation-Behavior Model. It delivers tailored, age-appropriate HIV prevention messages via SMS. Topics included HIV transmission, testing, condom negotiation, healthy relationships, and gender norms around sexual behavior. Interactive features like weekly quizzes, digital “badges” for reaching HIV prevention goals, and an on-demand Q&A function were included to promote engagement. Content was adapted based on focus group and youth advisory team input.
Results The intervention achieved high feasibility with an 83% retention rate and exceeded recruitment targets. Participants read over 80% of messages on average. ITG significantly increased condom-protected sex acts (aIRR = 1.82, p < 0.001) and HIV testing (aOR = 2.41, p = 0.03) compared to controls. However, abstinence rates remained unchanged. Some youth expressed message fatigue, particularly regarding condom-related content, though most found the program useful. Conclusions: ITG demonstrates strong feasibility and acceptability, and shows promising short-term impacts on key HIV prevention behaviors among older adolescents. The program’s normalization of sex-positive, health-focused dialogue may contribute to incremental shifts in social norms. Future research should examine long-term impacts, explore scalability, and assess how mHealth platforms can more directly address and reshape youth sexual health norms in Uganda.
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