Personal mobile platform helps prevent spread of HIV

While mobile platforms are becoming an increasingly common medical and public health tool, there are few evaluations of their effectiveness. A new joint doctoral thesis from Karolinska Institutet and Stellenbosch University, South Africa, shows that using mobile platforms for recently circumcised men can help to reduce the spread of HIV, especially amongst 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 have intercourse already after four weeks, which interferes with the healing process and increases the risk of sexually transmitted infections. 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 and regularly sent automated voice messages to mobile phones during the 42 days of the healing. Each message was tailored to the phase of the healing process patients were in.

“The information must be repeated continuously during the healing process if the men are to take it in,” says Yoesrie Toefy, who is an Imam and family advisor. “It has to take account of personal circumstances 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 in not being able to satisfy their partners sexually. A side-effect of the project was that those who received messages were more likely to practice alternatives to penetrative sex, which in itself reduces the risk of sexually transmitted infections.

The intervention proved not 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 main supervisor Associate Professor at KI Sarah Thomsen.

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.

Joint PhD programme in collaboration between KI and Stellenbosch University

The thesis was written under a joint doctoral programme between Stellenbosch University and Karolinska Institutet. The programme commenced in 2012 and currently has five active doctoral students, of whom Yoesrie Toefy is the first to graduate.

Thesis: Development and testing of an m-health platform to reduce post-operative penetrative sex in recipients of voluntary medical male circumcision, Toefy, Yoesrie, 2017-06-14.