Health worker acceptability of an HIV testing mobile health application within a rural Zambian HIV treatment program

Abstract

Background: As more people living with HIV (PLHIV) are being identified and prescribed antiretroviral treatment (ART) in Zambia, completing the last mile of epidemic control by detecting new HIV infections is becoming increasingly challenging. To address this, innovative targeted testing strategies are essential. Therefore, in 2018, Right to Care Zambia developed and implemented a novel digital health surveillance application, Lynx, in three Zambian provinces—Northern, Luapula, and Muchinga. Lynx is a targeted testing tool, offering real- time HIV testing data and geo-spatial analysis, and has proven effective in enhancing HIV testing yield. This study aims to assess the acceptability of Lynx among healthcare workers involved in HIV testing through qualitative and quantitative data collection methods to ensure its optimal utilisation. Methods: This study adopted a cross-sectional design with a mixed-methods data collection approach involving facility and community healthcare workers who conduct HIV testing. A quantitative Likert scale (1–5) survey was administered to 176 healthcare workers, 72 male, 101 female, 3 undisclosed, at Lynx facilities to gauge the acceptability of the intervention. The survey focused on the participants’ perceptions of the intervention’s ease of use, usefulness, and compatibility with the local context. Additionally, six qualitative key person interviews and five focus group discussions were conducted with a sample of the healthcare workers to gain an in-depth understanding of the same factors, and to identify barriers and facilitators of acceptability. Quantitative data were analysed by averaging responses to survey questions and running descriptive statistics by demographic variables. Qualitative data were transcribed and analysed in thematic coding. Data triangulation was utilised between the data sources to verify the findings. Results: Overall, the average score (1–5) of perceived ease of use was 3.926 (agree), perceived usefulness was 4.179 (strongly agree) and perceived compatibility was 3.574 (agree). The 4 frequency of the survey scores, “strongly agree/disagree”, indicates that over 10% of the respondents strongly agreed with 11/15 statements, and over 10% of the respondents strongly disagreed with 1/15 statements. Survey questions related to network requirements, resource availability, and IT support had the most “strongly disagree” responses. The qualitative data collection revealed the benefits of the Lynx programme—live digital data capture and review with the geographic information system (GIS) were perceived as useful, and the application was perceived as very easy to use. An expressed facilitator ensured that all staff received training, and Lynx received ongoing user-based updates to address changing contexts. Identified barriers included conflicting work priorities among users and inconsistent IT support. Conclusion: Lynx was identified as acceptable due to its perceived usefulness, staff training, and regular updates. For a mobile health intervention to be embraced in rural Zambian settings, key facilitators include robust IT support, comprehensive training, user feedback-based updates, and consideration of facility staff priorities.