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

Abstract

BACKGROUND : As more people living with HIV are identified and prescribed antiretroviral treatment in Zambia, detecting new HIV infections to complete the last mile of epidemic control is challenging. To address this, innovative targeted testing strategies are essential. Therefore, Right to Care Zambia developed and implemented a novel digital health surveillance application, Lynx, in three Zambian provinces-Northern, Luapula, and Muchinga in 2018. Lynx offers real-time HIV testing data with geo-spatial analysis for targeted testing, and has proven effective in enhancing HIV testing yield. This cross-sectional mixed methods study assessed the acceptability of Lynx among HIV testing healthcare workers in Zambia. METHODS : A quantitative Likert scale (1-5) survey was administered to 176 healthcare workers to gauge Lynx's acceptability. Additionally, six qualitative key person interviews and five focus group discussions were conducted to gain an in-depth understanding of acceptability, and identify relevant barriers and facilitators. Quantitative data were analysed by averaging survey responses and running descriptive statistics. Qualitative data were transcribed and analysed in thematic coding. Data triangulation was utilised between the data sources to verify findings. RESULTS : Overall, the average survey score of perceived ease of use was 3.926 (agree), perceived usefulness was 4.179 (strongly agree) and perceived compatibility was 3.574 (agree). Survey questions related to network requirements, resource availability, and IT support had the most "strongly disagree" responses. The qualitative data collection revealed that Lynx was perceived as useful, and easy to use. Training for staff and regular updates were identified as facilitators, while conflicting work priorities and inconsistent IT support were identified barriers. CONCLUSION : Lynx was identified as acceptable by health workers due to its perceived usefulness, staff trainings, 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.