Zambia Ureport:
Revolutionizing HIV Response
Among Adolescents and Young
People through SMS
The Promotional Links
• http://www.youtube.com/watch?v=A7o40dx
W7xU
• http://www.youtube.com/watch?v=VkSciE_Vj
g8
The Storyline (April 2012 – March 2014)
Gvt/NAC –
Urgency to
refocus on
young people
and HIV
Prevention
Apr
2012
Impact
Evaluation
Grant
Awarded to
Zambia
Ureport by
3iE
Design
Workshop for
Zambia
Ureport
Jul
2012
Concept :
Accelerating
Adolescent-Led
HIV Response in
Zambia through
SMS.
Oct
2012
Dec
2012
Official
Launch of
Zambia
Ureport in
Kitwe (World
AIDS Day)
Aug
2013
Film-UNICEF
Innocenti
Nov
2013
Innovation
Award at 3rd
HIV
prevention
convention
Mar
2014
The IssueThe urgency for greater refocus on HIV prevention in Zambia.
• New infections continued to outpace HIV
treatment enrolment (100 vs 85 among >15
years)#
• Every hour 3 adolescents and youths (15-24
yrs) get infected with HIV
• Slow progress in utilization of HIV services
among young people (15-24 yrs)
• HIV testing,
• Male Circumcision,
• Condom Use,
• ART initiation and retention
#Zambia
UNGASS Report (2006-2011).
27,000
# of new infection per
year among A&Y 1524 yrs – 60% female
72
# of new infection per
day among A&Y in
Zambia
3 HIV
infection per
hour - Zambia
The Issue-
Percentage (%)
Slow progress in utilization of HIV services among young people (15-24 yrs) –
need to accelerate trends.
100
90
80
70
60
50
40
30
20
10
0
Male 15-24
Female 15-24
70
Target 2015
70
50
41 38
41
42
35
30
21
11.5
0
% With Comprehensive
Knowledge about HIV.
# (Most
% With multiple partners who % who have had an HIV test
reported condom use at last sex and received results in the past
12 months
recent data points: BSS 2009, DHS 2007)
% boys who are circumcised
The IssueLimited transfer of comprehensive HIV knowledge from teachers to
adolescents (12-15 yrs) – SACMEQ III 2009 (ZAMBIA)
120%
100%
80%
Teachers
Learners
Bottleneck analysis –?
Alternative solutions to catchup on transfer knowledge?
99%
82%
60%
34%
40%
20%
4%
0%
% Respondant Scoring >75% HIV
Competency (Desired SACMEQ
level)
% Respondant Scoring at least 50%
HIV competency (Minimum
SACMEQ level)
The OpportunityExploring alternative solutions to transfer knowledge and create
demand for HIV services among adolescents and youths
Peer
education/
In/out of
school
Radio/
TV/
News Paper
Internet/
Mobile phone
Zambia-Ureport
Strategic Objectives
1. Promote adolescents and youths participation in National HIV
response.
2. Increase HIV comprehensive knowledge among adolescents
and youth.
3. Increase demand for HIV high impact prevention services
(HTC, MC, ART, condoms use) among adolescents and youths
4. Monitor availability, utilization and quality of adolescents and
youths sensitive HIV services.
Participatory/User-Centered Approach to Design
• Design workshop involving UNICEF
Child Ambassadors
• Government leadership and
Lusaka Launch, Youth Day 2013
coordination
• Official launch during key national
event (WAD 2012 and National Youth
Day 2013)
Design Workshop- Zambia U-Report, Oct 17-19th
2012
Copperbelt Launch by NAC Chairperson, Bishop Banda
Lusaka Launch, by Minister of Youth and Sport
Permanent Secretary, March 7th 2013
Zambia-Ureport
Strategic Results
NASF strategic results: Incidence of HIV is reduced
by 50% by 2015 among young people
UNDAF Intermediary Outcome 1.1
Government and partners scale up prevention services
to enable the reduction of new infections by 50% by
2015
Zambia-Ureport Outcome:
Adolescents and Youths (girls and boys) adopt HIV preventive
behaviors and double uptake of high impact HIV prevention
services.
Output 1:
An effective sms-based
mechanism to increase A&Y
participation in National HIV
prevention response is
available.
Output 2:
Adolescents and Youths have
increased comprehensive
knowledge of high impact HIV
prevention measures and
services
Output 3:
Adolescents and Youths
demand for and are
referred to HIV high impact
prevention services
Zambia Ureport
Strategic features
1.
2.
3.
4.
5.
6.
7.
8.
Innovative, free-of-charge and youth friendly SMS platform
Opt-in/Voluntary registration on all mobile networks
Real-time, individualized, two-way communication with trained counselors
FREE to the U-reporter
Age and gender sensitive confidential counseling
Tailored SMS interventions/referrals
Continuous multichannel engagement (SMS, radio, TV, IPC)
Robust quality assurance of SMS counseling
Module 1: Knowledge Bank
Ask, Learn and Share
B- Share/peers
1
SMS
6
2
5
Requests for HIV and
STIs information
SMS
A- Ask, Learn
(Spontaneous SMS requests)
3
4
SMS counselors
Personalized
education/counseling
(age& sex sensitive
geography specific)
Module 2: Poll and Campaign
Participate, Influence, Demand and Share
D- Share/peers
6
SMS
3
2
A- Participate
Policy
4
(System Generated SMS,
automated, semi-automated)
B- Influence
Campaign
Design
1
5
Service
uptake
SMS counselors
SMS
Participate in
Campaigns/opinion polls
Zambia U-Report
High Level Work-Plan (2012-2017)
2015-2017
Phase 2: Scale-up
- Scale-up (2015-2016).
- Final Evaluation (2017)
2013-2014
Phase 1: Pilot and Evaluation
2012
• Piloting in 2 provinces Copperbelt and
Lusaka
• Review and Impact Evaluation
(June-Nov)
Phase 0: Planning/Launch
- Design Workshop/IT platform/HR
- Partnership (Counseling, Mobiles Providers)
Zambia U-Report
Direct and indirect beneficiaries (2013-2017)
800,000
Direct beneficiaries (U-Reporters)
682,422
700,000
600,000
Indirect beneficiaries (50% of non ureporters
reached with radio/Tv programme)
481,572
500,000
378,105
400,000
325,156
263,978
300,000
206,856
200,000
100,000
583,011
153,790
100,000
50,000
0
2013
2014
2015
2016
2017
KEY RESULTS – METRICS
Module 1: Knowledge Bank
Confidential SMS Counseling virtual interface
Counseling
Session
between a
Ureporter and
the SMS
counselor.
U-reporter
Details
Quality Control
Notes
In 15 months of implementation, about 44,000 Ureporters mostly
from all the 10 provinces, engaging about 29,000 conversation on
various HIV/AIDS and SRH themes.
Module 1- Knowledge Bank
Insights into key knowledge needs among Ureporters
Analysis of 13,000 SMS from Ureporters (Dec 2012-May 2013),
Difference between
HIV and AIDS, 0.50%
Pregnancy, 2%
HTC (Why, where,
cost), 0.50%
HPV, 3%
HIV Cure, 4%
Symptoms of HIV and
AIDS, 19%
ARVs, 4%
Random query about
health, 6%
Symptoms of Syphilis,
Gonorrhea and other
STI, 6%
Condoms, 8%
Modes of transmision
of HIV, 18%
Masturbation, 8%
PMTCT, 9%
Male circumcision,
12%
Module 2: Zambia Ureport impact on HIV Testing Uptake–
Results: 30%-43% increase in HTC uptake among adolescents
Increase (%) in HTC uptake (post vs. baseline) among Ureporter by Age-Sex, Lusaka
and Chongwe districts (June-July 2013)
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
40%
43%
Male
31% 30%
Female
31%
27%
22%
"10-14"
"15-19"
Age category
"20-24"
21%
">=25"
Ureporters advocating for change in HIV policy for
adolescents and youths at 3rd HIV Prevention convention
• HIV among adolescents and
youths prioritized in 3rd HIV
Prevention convention
recommendations
• Speech by Ureporters on
(HTC, VMMC, Condoms) –
November 2013.
Child Ambassadors (Natasha Zulu , 14 and on her left Solomon Nkonde
18) delivering the resolutions from a Pre-Convention Consultation for
Adolescents and youths- Picture by UNICEF Zambia — in Lusaka
Zambia Ureporters Barriers to HTC uptake by
Age (n=814; November 2013).
•
90%
84%
83%
•
•
80%
70%
Afraid of outcome because they indulge in sexual
activities
Fear of Stigma if found positive.
They are afraid of breaking reletionships when
they find out they are positive.
65%
Because of their ignorance
60%
Scared
50%
Ignorance
40%
Confident
30%
Other
20%
14%15%
8%
10%
4%
6%
3%
5%
7%
4%
0%
10-14'
15-19'
20-24'
Bar-Chart by Age group
•
•
•
Some say they haven’t had sex so they are confident.
Because they know that they are too young.
They think because they don’t get sick they are ok.
Zambia Ureporter Proposed solutions to accelerate
HTC uptake by Age (n=681, Nov 2013)
•
80%
•
70%
69%
67%
•
•
Sensitising
•
Incentives
•
Give them money or gifts when they test.
Invite them to a braii with artists and make testing
the fee for getting in.
By going into different schools and testing them
class by class.
Parents should advise on testing.
•
•
•
Government should make a law on Testing.
Make testing compulsory.
Test anyone who goes to the hospital for anything.
60%
50%
49%
38%
40%
There should be sensitization campaigns in our
communities.
Counselling and educating them on the
importance of knowing the status.
Policy
30%
Other
20%
14%
12%
10%9%
10%
13%
11%
7%
0%
0%
10-14'
15-19'
Bar-Chart by Age group
20-24'
Zambia Ureporters Barriers to VMMC uptake by Age
(n=1518, Nov 2013)
70%
61%
60%
Pain
56%
54%
Reduced Feeling
Lack of knowledge
Other
40%
30%
23%
18%
15%
20%
12%11%
10%
They fear that it is painful.
Because of the scary comments passed by friends.
•
•
•
Most men are afraid of losing sensitivity.
Some say sex becomes boring.
They are afraid of reduced performance in bed.
•
•
Because of the time it takes to heal.
Some are in school and others work so waiting to
heal would be hard.
•
•
Lack of knowledge about the process
Lack of knowledge about benefits
•
Some are afraid of finding female nurses, they
should be given right to choose.
They feel shy being touched there.
Men have too much pride.
It is against some traditions.
Recovery Time
50%
20%
•
•
8%
9%
5%
0%
10-14'
15-19'
20-24'
•
•
•
Zambia Ureporters proposed solutions to accelerate VMMC
uptake by Age (n=632, Nov 2013)
80%
71%
68%
70%
•
•
70%
Educate young people on all the advantages of MC.
Educate them on the advantages and partial
protection against STIs.
Educate on Benefits
60%
Educate on Cancer
advantages
50%
Educate on Dangers
of NO MC
40%
Other
28%
30%
25%
20%
17%
13%
10%
11%
5%
6%
15-19'
20-24'
0% 0%
0%
10-14'
• Educate them on the benefits for their partners in terms of
Cervical Cancer.
• I would tell him that if he truly loves me, he will protect me
from Cervical Cancer.
• Educate young people on the dangers of not doing MC.
Zambia Ureporters Barriers to Condoms uptake by
Age (n=1544, Nov 2013)
•
•
100%
90%
•
•
87%
83%
80%
Sex more Enjoyable
70%
Prove love
61%
60%
Shy to buy
•
Other
•
50%
40%
33%
30%
20%
10%
5%
5% 5%
0%
7%
2%
5% 4%
0%
10-14'
15-19'
•
20-24'
They think sex is more enjoyable without condoms.
Some of the youths think that using a condom is like
masturbating
People say you can’t eat a sweet with a wrapper.
They think using condoms is old school and doesn’t
feel good.
Some boys say you have to prove your love by having
sex without the condom.
My boyfriend said I had to show that I love him by not
using a condom.
Some say if you insist on condoms then you don’t
trust them.
Zambia Ureporters Barriers to Condoms uptake by Sex
(n=1544, Nov 2013)
•
•
90%
83%
81%
•
•
80%
70%
Sex more Enjoyable
60%
Prove love
50%
Shy to buy
•
Other
40%
30%
•
20%
10%
•
8%
7% 7%
6%
3%
0%
male
Female
4%
They think sex is more enjoyable without condoms.
Some of the youths think that using a condom is like
masturbating
People say you can’t eat a sweet with a wrapper.
They think using condoms is old school and doesn’t feel good.
Some boys say you have to prove your love by having
sex without the condom.
My boyfriend said I had to show that I love him by not
using a condom.
Some say if you insist on condoms then you don’t
trust them.
Zambia Ureporters proposed solutions to accelerate Condom
uptake by Age (n=644, Nov 2013)
•
•
Give out free condoms everywhere.
Give out condoms for free where
youths are found.
Give free
•
•
35%
Educate about
importance
Educate young people about the
importance of using condoms.
Sensitisations campaigns about the
benefits of using condoms.
30%
Create Distribution
Centers
50%
45%
45%
42%
40%
36% 36%
27%
25%
Give in Schools
25%
22%
•
21%
Other
20%
•
15%
Create centers where young people
can get condoms from other young
people.
Condoms should be given door to
door.
15%
12%
12%
•
10%
•
5%
3%
3%
0%0%
0%
10-14'
15-19'
20-24'
Start distributing condoms in
school.
Introduce condoms in schools and
communities.
Zambia Ureporters proposed solutions to accelerate Condom
uptake by Sex (n=644, Nov 2013)
40%
36%
35%
35%
Give free
30%
30%
Educate about
importance
26%
25%
Create Distribution
Centers
Give in Schools
20%
16%
15%
Give out free condoms everywhere.
Give out condoms for free where
youths are found.
•
Educate young people about the
importance of using condoms.
Sensitisations campaigns about the
benefits of using condoms.
•
•
Other
16%
14%
•
•
14%
•
Create centers where young people
can get condoms from other young
people.
Condoms should be given door to
door.
10%
7%
7%
5%
•
•
0%
Male
Female
Start distributing condoms in
school.
Introduce condoms in schools and
communities.
Key Lessons Learned
• Involving adolescents as designers (Human centered-design)
• Building local capacity for Adolescent Counseling on HIV and STI through
SMS
• Leveraging South-South cooperation to adapt existing open source solution
and building local software development capabilities
• Securing government buy-in and ensuring Government remains on the
driving seat from the design phase
• Branding the initiative using adolescent-friendly solutions, including social
media promotional video
• Linking with national programme for polls/campaigns and documenting
results.
Next steps/future developments (2014-2015)
1. Expand the Knowledge Bank to broader SRH issues
2. Develop SMS-based counselling curriculum.
3. Build capacity in analytics (Big data analysis).
4. Design a public web-interface to provide real-time feeds about key
results to stakeholders (programme implementers, young people).
5. Conduct Impact evaluation study on VMMC.
6. Conduct an independent review and documentation.
7. Develop a scale-up plan with sustainability strategy.
8. Secure a free status for Short code 878 in collaboration with line
Ministries.
Acknowledgements
o
o
o
o
o
o
o
o
Government of the Republic of Zambia
CHAMP
ZICTA
Three mobile phone providers (Airtel, MTN, Zamtel)
Child Ambassadors
Brother for Life Ambassadors
HIV Implementing partners
UN Zambia