While mobile platforms are becoming an increasingly common medical and public health tool, few evaluations of their effectiveness exist. A new joint doctoral thesis from the Karolinska Institute (KI) in Sweden and Stellenbosch University (SU) shows that using mobile platforms for recently circumcised men can reduce the spread of HIV, especially among men engaging in high-risk sexual activities.
Voluntary circumcision is common in many countries in eastern and southern Africa, since it reduces the risk of HIV infection. The World Health Organisation advises men to abstain from penetrative sex for six weeks after the operation. However, studies show that most men already engage in intercourse after four weeks, which interferes with the healing process and increases the risk of the transmission of sexually transmitted diseases (STDs). The thesis examines why men do not follow the six-week recommendation and how information can be supplied to them in a way that encourages abstinence for the entire healing period.
The mobile health platform was designed in consultation with former patients. Automated voice messages were regularly sent to mobile phones during the 42 days of healing. Each message was tailored to the specific healing phase of every patient.
“The information must be repeated continuously during the healing process if the men are to take it in," says imam Yoesrie Toefy, one of the researchers. “It has to take personal circumstances into account and be a dialogue with the patient, rather than clinical finger-pointing from the doctor."
One reason why married men in particular ignored the recommendation and had sex before the end of the six-week rehabilitation period, was that they experienced a loss of self-esteem due to not being able to satisfy their partners sexually. However, those who received messages were more likely to practise alternatives to penetrative sex, which in itself reduces the risk of STD infection.
The intervention didn't prove to be significantly effective for the whole patient group, but had a fourfold greater effect on patients with high-risk sexual behaviours.
“This emphasises the need to tailor HIV interventions to different patient groups and to different phases of the treatment," says the main supervisor, Associate Professor Sarah Thomsen of the KI.
Yoesrie Toefy believes that the m-health platform has the potential to be adapted to other kinds of treatment: “We've created a rehabilitation method based on health behaviour change that can be used as a complement to the information patients receive from their doctors," he says. “We believe that it will be most effective in combination with personal appointments."
The thesis was written in terms of a joint doctoral programme between SU and the KI. The programme commenced in 2012 and currently has five active doctoral students, of whom Yoesrie Toefy will be the first to graduate.