Vuka+ is an mHealth intervention to promote PrEP medication adherence and sustained PrEP use over time among South African adolescent girls and young women.
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HIV disproportionately impacts young women in Sub-Saharan Africa. PrEP is a powerful prevention tool but is currently underutilized, particularly by women in low-resource settings. Barriers to PrEP use for Sub-Saharan Africa AGYW include low awareness, stigma, low HIV risk perception, side effects, adherence and maintenance, limited youth friendly services and clinical support and other psychosocial factors.1,2,3,4
Adherence to PrEP as prescribed is critical for achieving adequate levels of protection5,6, however, typical approaches are not sufficiently personalized or tailored to engage AGYW 1. Mobile health (mHealth) tools – such as smartphone delivered pill alarms, appointment reminders, and health information – provide an opportunity for widespread daily PrEP support particularly in settings where women may be far from health clinics and lack family or social support for PrEP uptake and continued use.8
Apps in young populations are highly acceptable and efficacious in improving adherence.9,10,11,12 App-based support optimizes clinical visit time and engages participants outside of the clinic on their own schedule. mHealth platforms allow real-time assessment of user behavior and adaptive delivery of tailored content to fit individual PrEP management challenges.7,10,11,12
The Vuka+ app adapts and builds on the HealthMpowerment intervention platform which was created by Lisa Hightow-Weidman, MD, MPH, a public health scientist at Florida State University. Vuka+ features new health and wellness tools and information developed by a team of young people and health professionals led by CONRAD and supported with funding from The United States Agency for International Development (USAID). Vuka+ users need a code to open the app.
Track and layer behaviors with medication tracking to see patterns and
meet adherence goals. Participants can also use the calendar and
analytics to support self-monitoring and get feedback on their progress.
Forum discussions and polls foster community support and peer-to-peer
sharing within the app.
Resources & Activities
Provides educational content across range of health topics, as well as
supports app engagement and behavior change through information and
Encourage and sustain app engagement over time by “unlocking” new
accessories to personalize your avatar.
The Vuka Study Team developed the first multi feature PrEP adherence smartphone app (Vuka+) for adolescent girls and young women (AGYW) in Sub-Saharan Africa.
From 2020-21, we adapted the app for sub-Saharan African AGYW, including conducting user immersion experiences, in-depth interviews, and focus groups among current and previous PrEP users and PrEP-naïve AGYW. We added features based on AGYW’s stated needs and updated the app’s look and feel and added new engagement features. The updated app was branded as Vuka+ and beta-tested in a 2-week period among 25 AGYW in Cape Town, South Africa (results not yet published).
From 2021-22, another round of revisions was made to the app following beta-testing to integrate lessons learned and optimize app functionality for a low-bandwidth setting. A pilot RCT was conducted with approximately 30 PrEP-eligible AGYW in Cape Town, South Africa, who were provided daily Truvada as PrEP. Participants were asked to use the app for at least 5-10 minutes a day for one month at which point a follow-up visit occurred to assess women’s experience using the app, as well as their acceptability of the app and its content.
Findings and Takeaways from Beta Testing
Findings from Pilot RCT
The Vuka+ Study Team will analyze the phase 1 pilot RCT data to further inform the next iteration of the Vuka app and study.
Phase 2 is a 6-month, 2-arm effectiveness and implementation trial (standard of care [SOC] vs. intervention app) to assess acceptability, feasibility and effectiveness. In addition, we will gather information on intervention delivery and barriers and facilitators for real-world delivery to inform future implementation and scale up.
The main RCT is scheduled to begin Fall 2022.