BACKGROUND: There are approximately 200,000 persons living with HIV (PLWH) in government-controlled territories of Ukraine, of whom only three in four know their HIV status. HIV index testing (HIT) can increase HIV case finding, but barriers include stigma in naming partners and health worker (HW) lack of time to deliver HIT services. CASI-Plus is a mHealth tool with a standardized, non-judgmental questionnaire through which PLWH clients can learn about HIT and identify partners for partner notification and testing.
METHODS: This formative mHealth study took place in 2023 in two regions of wartime Ukraine. It included virtual workshops with health workers (HW) and in-person in-depth interviews with clients from vulnerable key population groups. Qualitative human-centered design methods included HIT workflow mapping, discussion of barriers to HIV testing, brainstorming CASI-Plus design features, a features prioritization game, and feedback on the design of the questionnaire and script.
RESULTS: Participants included 22 HW in 3 workshops and 10 clients (6 persons who inject drugs and 4 men who have sex with men). Both HW and clients had a favorable perception of CASI-Plus, feeling it would help clients to discuss their partnerships with reduced shame: “Patients are sometimes embarrassed to admit to the doctor how many partners they have… when it's on the tablet, we won't look them in the eye, and maybe they will open up” (HW).
Clients expressed willingness to use CASI-Plus on a tablet within the clinic, and all but one expressed a preference for using CASI-Plus rather than naming partners to a HW. Clients were comfortable with encrypted SMS messaging for on-going communication with HW about partner notification and testing.
HW prioritized features centered on partner elicitation. They expressed concern about using the tool for SMS messaging with clients, additional data entry burden, and physical security of tablet devices. They favored summary displays of information about partners as reported by index clients, and expressed interest in using the summaries for their required data entry into the national HIV data system.
CONCLUSIONS: Our formative study yielded valuable recommendations from clients and health workers to ensure CASI-Plus is acceptable and feasible to implement in wartime Ukraine.