University students in Zimbabwe will co-design a mobile phone tool that helps them decide whether to use HIV prevention or contraception services, then test whether it boosts uptake across 16 colleges. Young people in sub-Saharan Africa often avoid HIV testing, PrEP, and contraception—not because services are unavailable, but because navigating the options feels confusing or stigmatising. Existing self-care programmes let students pick up supplies without a clinic visit, but they lack decision aids that help someone weigh, say, daily pills versus a long-acting injectable. This project fills that gap by building those aids directly into an mHealth platform students already use. If the trial shows the tool works, it could shift how sexual health services reach young people across the region. Instead of requiring a clinic appointment for every decision, students could privately assess their needs, order supplies, and track follow-up care through their phone. That would free nurses and community health workers to focus on complex cases rather than routine dispensing. The team is also planning to adapt the model for young people who are not in university, so the impact could extend beyond campus.
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Background There is suboptimal uptake of HIV and contraception services among young people. Self-care, where an individual manages their own health or illness with/without a health provider, can improve uptake of these services. There is limited evidence of how self-care can be optimally implemented. mHealth is recommended as necessary support for self-care. mHealth support can be enhanced by decision aids that guide informed choices between available options. With college/university students we will co-develop and evaluate a self-care intervention, mHealth supported self-care among tertiary education students in Zimbabwe (MASCOT), to improve uptake of HIV and contraception services. The study builds on a pilot of a self-care intervention that is supported by an mHealth tool but without decision aids. Study aim To determine how self-care can address poor service engagement among young people, with the ultimate goal of reducing HIV incidence and unintended pregnancies. Specific objectives 1. Explore preferences for decision aids and how they can be incorporated into the existing self-care intervention 2. Develop/adapt blueprints for HIV prevention and contraception decision aids according to student values/preferences 3. Integrate existing mHealth tool with decision aids for HIV prevention and contraception 4. Determine feasibility and acceptability of MASCOT in two colleges/universities 5. Determine effectiveness of MASCOT in improving uptake of HIV and contraception services and its societal costs in a cluster randomised trial in 16 colleges/universities 6. Explore how to adapt MASCOT for other settings Methods The study has five work packages: 1. Work Package 1 - Focus group discussions and discrete choice experiments to explore preferences for HIV prevention and contraception decision aids and how they can be integrated with the existing self-care intervention. 2. Work Package 2 - Develop/adapt blueprints for HIV prevention and contraception decision aids. 3. Work Package 3 - Hackathon to integrate HIV prevention and contraception decision aids with the existing mHealth tool that facilitates distribution of self-care commodities and tracks use of services 4. Work Package 4 - Pilot of peer-led self-care supported by the integrated mHealth tool in two colleges. 5. Work Package 5 - Cluster randomised trial to determine the effectiveness of mHealth supported self-care in terms of uptake of HIV and contraception services. During detailed process evaluation we will explore how MASCOT can be adapted for young people outside colleges/universities. Timelines for delivery Work package 1: Year1 Quarter 1 to Year 1 Quarter 3 Work package 2: Year 1 Quarter 3 to Year 2 Quarter 1 Work package 3: Year 2 Quarter 2 to Year 3 Quarter 1 Work package 4: Year 3 Quarter 1 to Year 3 Quarter 4 Work package 5: Year 3 Quarter 4 to end of Year 5 Anticipated impact and dissemination The project will develop a self-care intervention that can increase uptake of HIV and contraception services among young people, ultimately reducing HIV incidence and negative effects of unintended pregnancy. The intervention can free health workers to concentrate on other priorities. Results will be disseminated to students and other young people, Ministries of Health and other key stakeholders.
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