The Next T

Optimising HIV testing linked care through user-centred design and creative communication
Year: 2016-2019
Where: Tanzania
Project Status:

The Next T project in Tanzania develops new HIV testing services and care models for adolescents using human-centred design.

The Next T project uses human centred design and creative problem-solving approaches to:

– Understand the barriers to testing for HIV, subsequent linkage to care and adherence to treatment for adolescents girls and young women (AGYW) in Tanzania.
– Develop innovative solutions that support stakeholders along the HIV cascade.

Next T identified adolescents’ health-seeking behaviour, HIV testing preferences, attitudes towards HIV services, and social networks and influencers as key research themes for the project. In the design research phase, participatory and qualitative methods were utilised to capture the opinions, preferences, and attitudes of adolescents, male partners, and health providers. During the course of this project, Scope (formerly known as M4ID) used design tools and methods to engage with 366 adolescents, male partners, family members and healthcare providers.

Identifying barriers and enablers of health-seeking behaviour

Findings from the research revealed that, for adolescents, the process of testing for HIV and subsequently linking to care involves overcoming a complex set of barriers at multiple levels (Barrier Ecosystem). Adolescents face barriers to accessing care at individual, interpersonal, community, and health system levels. The perception of these barriers in the minds of adolescents and young people becomes overwhelming and prevents them from considering or accessing testing and care.

Research findings also indicate that clients follow an adoption curve when overcoming the barriers leading up to testing for HIV, linkage to care and adherence to medication. Based on what are the most critical barriers a client faces at any point in time, it is possible to segregate clients into distinct stages (Mindshape model). This can have implications towards enabling the stakeholders in the health system to understand what are the most critical barriers a client faces when he/she comes in contact with the system and tailor testing and care services accordingly.

Development of two solutions

Mindshape Model

Mindshape Screening Tool, uses a hybrid behavioural-psychographic approach to segment populations based on their barriers to testing, linkage and adherence. The segmentation will allow programmes to target people with differentiated information, services, and programmes based on their ‘mindshape’ and may lead to better outcomes along the HIV cascade. The Mindshape Model itself categorises clients based on the different barriers they face in their journey towards testing, getting linked to care and adhering to medication. Through quantitative research with 2067 adolescent girls and young women (AGYW) in two regions in Tanzania, we sought to understand if AGYWs fall into the distinct stages, what is the distribution of the population across these stages and how these groups differ from each other on psychographic characteristics. Validation of model has been successful. The sample was distributed into the various Mindshape groups which are mutually exclusive and statistically significantly different from each other. Two of the Mindshape groups are found to significantly predict HIV positivity.

Improving HIV counselling

The second solution, also based on the Mindshape Model, aims to improve HIV counselling, which is meant to improve linkage to care and adherence to medication. The solution will enable the counsellor to understand and address individual client fears, and empower each individual by providing them with accessible information about their prospective testing journey. The project team created a pair of innovative training modules that seek to instill a cognitive framework in counsellors that helps them to assess client barriers and respond with appropriate messages and referrals that are responsive to the priorities of the client. The curriculum was tested with 10 HIV counsellors and regional trainers in Dodoma, Tanzania. The participants indicated that there is a clear need for counsellors to understand and respond to the needs of clients. The participants appreciated the participatory format of training and found it very relevant to their work.