A Multi-Component Text-Based Behaviour Change Communication Intervention to Enhance HIV/AIDS Risk Reduction among Long-Distance Truckers in Kenya

Abstract

Chronic neglect from mainstream HIV risk reduction services and risky sexual networks often expose Long-distance truckers (LDTs) to a high risk of HIV. As such, LDTs are routinely eligible for behaviour change communication (BCC) interventions on HIV/AIDS risk reduction. However, LDTs’ access to such interventions is mostly constrained by their constantly disruptive schedules. Thus, the study aimed to develop, validate, implement, and evaluate a multi-component text-based BCC intervention on HIV/AIDS risk reduction for LDTs. This was a concurrent triangulation mixed-methods study with a quantitative arm entailing a non-equivalent quasi-experimental design and a qualitative arm. The study was organized into baseline, intervention, and post-intervention phases. Initially, the LDTs were systematically sampled and then recruited into either the control (Namanga site) or the intervention arm (Busia site). Each study arm comprised 189 LDTs. At baseline, a pre-test was done to assess the baseline HIV/AIDS risk levels. Eighteen in-depth interviews and nine key informant interviews were used to collect qualitative data. Qualitative data were analyzed using a hybrid deductive-inductive approach with the QDA Miner software. Descriptive statistics and ordinal logistic regression were generated in R for the quantitative data. In phase two, an intervention informed by baseline findings was designed and validated by a team of 24 experts through an e-Delphi exercise. A two-proportion Z-test and a Cochran-Armitage test were used to compare the proportions of HIV/AIDS risk levels in both study arms. A Cramer’s V test was also used to calculate the intervention's effect size. Overall, above 80% of the LDTs were at moderate (30-39%) to high-risk (≥40%) of HIV at baseline. The predictors of the HIV/AIDS risk levels were age (aPOR=0.96; p=0.01), college/university level of education (aPOR=0.09; p=0.02), days spent away from a spouse/regular partner (aPOR=1.06; p<0.0001), monthly salaries of 15,000-30000 KSH (aPOR=0.26; p=0.007) and >30,000 KSH (aPOR=0.25; p=0.004). The barriers to HIV/AIDS risk reduction were mainly health system-related factors. Existing BCC strategies on HIV/AIDS risk reduction were media-based, healthcare worker-driven, peer-educator-driven, outreach-based, and NGO-driven. A total of 57 multi-component BCC items were rated by 24 experts in two rounds of an e-Delphi exercise. Subsequently, the BCC items were shared with participants in the intervention arm through a cloud-based text messaging platform (TD_Educator) for six months. Post-intervention, statistically significant (ꭓ2=72.25, df =1, p<0.001) higher proportions (50.62%) of low HIV/AIDS risk levels were observed in the intervention arm (Busia), an indication of a shift from high to lower risk levels following the BCC intervention, unlike the control arm (ꭓ2=0.84, d.f=2, p=0.657). Overall, the BCC intervention had a moderate effect (Cramér’s V = 0.3, χ² = 28.214, d.f. = 2, p < 0.001) on HIV/AIDS risk reduction. In conclusion, the multi-component text-based BCC intervention is considered an effective tool for enhancing HIV/AIDS risk reduction among LDTs. Thus, regular updates will be needed in the future, as the evidence for the intervention is expected to grow and evolve further.