Abstract
Background
Tanzania faces a significant burden of HIV, with challenges in reaching men and ensuring timely linkage to care. To address these issues, HIV self-testing (HIVST) has been implemented to increase HIV testing, and the National HIV Hotlines are being considered as a strategy to facilitate linkage to care. This study aimed to assess the willingness of Tanzanian men to receive support from use the National HIV Hotline via mobile phones for HIVST and linkage to care. This is the baseline cross-sectional analysis from a cluster randomized control trial (cRCT; NCT03891407), assessing men’s willingness to receive and speak with an HIV counselor via the National Hotline following HIVST.
Methods
Data from 505 men from the baseline survey of a cluster-randomized controlled trial conducted in June 2019 with 18 social networks or “camps” in Dar es Salaam, Tanzania. Participants were 18-year-old or older male camp members who were HIV-negative at the time of enrolment. Logistic regression models were used to assess factors associated with men’s comfort with talking with an HIV counselor over the phone.
Results
There were 505 heterosexual male participants enrolled in the study with an average age of 29 years. Most men reported being very comfortable talking to an HIV counselor n the National HIV Hotline (84.2%) and receiving text messages support from a hotline counselor (80.6%). Logistic regression demonstrated that comfortability texting a friend about HIV self-testing (OR = 3.37, 95% CI [1.97 – 5.76], being comfortable texting a friend about HIV (OR = 3.84, 95% CI [2.20 – 6.72], previous history of receiving HIV related text messages (aOR = 0.55, 95% CI [0.31 – 0.99] were significantly associated with men’s comfortability talking to a HIV counselor on the National HIV Hotline following HIVST. However, men with a previous history of receiving HIV-related text messages had lower odds of being very comfortable talking to a hotline counselor following HIVST (aOR = 0.59, 95% CI [0.34–1.01]. The factors such as participants’ comfortability texting friend about HIVST (OR = 2.52, 95% CI [1.49 – 4.25]) and comfortability texting friend about HIV (OR = 2.96, 95% CI [1.83 – 4.80] were significantly associated with the probability of participant’s comfortability receiving text message from HIV counselor following HIVST.
Conclusion
The findings demonstrate that most men felt comfortable engaging with HIV counselors and receiving supportive text messages from the National HIV Hotline after self-testing. Comfort with hotline use was strongly associated with prior exposure to HIV-related SMS messages and willingness to discuss HIV or HIV self-testing with peers. These results underscore the feasibility of leveraging mobile health (mHealth) interventions to enhance user comfort, foster peer engagement, and facilitate tailored support for linkage to care following HIV self-testing.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12889-026-26958-5.
Keywords: HIV self-testing, The National HIV Hotline, Linkage to care, MHealth
Introduction
Tanzania has one of the highest burdens of HIV in the world, with an estimated 1.4 million people living with HIV in 2020 [1]. The HIV prevalence among adults aged 15–64 is approximately 4.6%, and there were an estimated 36,000 new HIV infections in 2020 [2]. HIV disproportionately affects certain populations in Tanzania, including women, young people, and key populations such as men who have sex with men, sex workers, and people who inject drugs [3]. The government of Tanzania has made significant progress in its HIV response over the past decade, with increased access to HIV testing, treatment, and care services. As of 2020, approximately 82% of people living with HIV in Tanzania were aware of their status, and 82% of those who were aware of their status were receiving antiretroviral therapy (ART) [1]. Additionally, the number of AIDS-related deaths has decreased by 43% since 2010. Despite these gains, major challenges persist in the HIV response in Tanzania and across sub-Saharan Africa, particularly around ensuring timely linkage to care after HIV testing. A significant percentage of people who test positive, particularly through HIV self-testing or community-based methods, do not effectively transition into treatment options [4–6]. Stigma, fear of exposure, lack of knowledge about treatments that are available, worries about confidentiality, the distance to medical facilities, and limitations of the health system such lengthy wait periods and overworked employees are some of the major challenges to linkage to care [5]. These challenges are especially pronounced among men, who are less likely than women to undergo HIV testing, more likely to delay linkage to care, and often have poorer treatment outcomes [7]. According to the 2022–2023 Tanzania HIV Impact Survey (THIS), among adults who knew their HIV status, awareness was lower among men (78.4%) than women (84.8%). Viral load suppression among all adults living with HIV was 78.0%, again lower among men (72.2%) than women (80.9%). Gender norms discouraging health-seeking behaviors, heightened stigma, and lower engagement with health services contribute to men’s underrepresentation in HIV programs and highlight the need for interventions specifically designed to improve HIV testing uptake and linkage among men [7–9].
In recent years there have been efforts to scale up innovative approaches to HIV testing, such as HIV self-testing, to increase testing uptake and reach key populations [10–14]. HIV self-testing (HIVST) has been shown to increase HIV testing uptake, particularly among populations that are hard to reach through traditional testing methods [14, 15]. In Tanzania, HIVST has been shown to be acceptable and feasible and is expected to increase HIV testing uptake [14–16]. HIVST programs are especially successful in reaching men, who have historically had lower rates of testing and HIV care engagement, according to evidence from sub-Saharan Africa. Comparing HIVST to conventional facility-based methods, studies conducted in Malawi, Zambia, and Zimbabwe showed that HIVST dramatically enhanced men’s uptake of HIV testing [17–20].
HIVST was first introduced in Tanzania in 2017 and since then, the government has taken steps to promote its use as a means of increasing HIV testing uptake and improving access to testing among hard-to-reach populations [21]. As of 2021, HIVST kits were available for purchase in pharmacies and can also be distributed through community-based programs. The Ministry of Health, Community Development, Gender, Elderly, and Children (MOHCDGEC) has approved several HIVST kits for use in Tanzania, including OraQuick and Atomo, and has developed guidelines for their use. However, the use of HIVST is still relatively low in Tanzania compared to other testing methods. Also, challenges remain in ensuring that individuals who test positive through HIVST receive follow-up care and treatment, as well as addressing issues related to stigma and discrimination [22, 23]. Testing is only the first step in the HIV care continuum, and linkage to care following HIVST is crucial for achieving the UNAIDS 95–95–95 targets [3].
Studies have shown that digital health interventions, such as mobile phone text messaging or smartphone applications, have the potential to facilitate linkage to care by providing timely support, reminders, and information to individuals who have received positive HIVST results [17, 24–27]. Crucially, peer-based digital communication, such as Short Message Services (SMS) conversations between social network members or peer educators, has also been tested as a strategy to encourage HIV testing and linkage, demonstrating that men may be more receptive to linkage messages delivered by trusted peers rather than health workers [28, 29]. Several interventions have used one-way or two-way SMS platforms to send appointment reminders, deliver test results, or provide counselling support, which improved linkage outcomes [29].
In Tanzania, the efforts to improve medication adherence among people living with HIV (PLHIV) have included the implementation of various digital health interventions. One notable approach involves the use of reminder SMS texts, wherein PLHIV receive timely reminders to take their medication [30]. Importantly, lessons from these adherence-focused digital strategies can inform the design of digital support systems for linkage to care. The National HIV Hotline/Helpline, which is operated by the Tanzania Youth Alliance (TAYOA), provides counseling, information, and support services to approximately 10,000 callers daily. The Helpline represents a promising platform to adapt these digital approaches for individuals following HIV self-testing. Evidence from other sub-Saharan African settings shows that SMS reminders, interactive two-way messaging, and peer digital communication can effectively promote HIV testing uptake and linkage to services [28, 29]. By extending digital reminders, counseling, and peer support mechanisms through the Hotline, there is an opportunity to facilitate timely linkage to HIV care and strengthen continuity across the HIV care cascade [31]. However, it is not yet clear if HIVST users are willing to use the National HIV Hotline for support with linkage to care following HIV self-testing. Understanding men’s willingness to use the National HIV Hotline following HIVST and the correlate of that willingness, can inform the design of user-centered, privacy -preserving and scalable digital pathways to improve linkage. This study aimed to (i) estimate the proportion of men who report being comfortable to (a) talking with an HIV counsellor via the National HIV Hotline and (b) receiving SMS from a hotline counsellor following HIVST and (ii) identify factors associated with these comfort measure.
Material and methods
Study design and setting
We utilized data from the baseline survey of the STEP (Self Testing Education Promotion) project, a five-year study funded by the National Institutes of Health (K99/R00MH110343) in Tanzania. The trial is registered at Clinical Trial.gov (NCT03891407). A structured questionnaire, developed by the STEP research team, was used to collect data for this study. The parent STEP project was conducted from 2018 to 2023. Data for this study were collected in June 2019 during the baseline survey among male social networks locally referred to as “camps” in Dar es Salaam, Tanzania [31].
Participants and sampling
Eligible participants were male camp members aged ≥ 18 years who were HIV -negative at enrollment and provided written informed consent. Study staff enumerated members in each camp and invited all eligible men to complete a structured baseline survey [32]. Participants of the STEP project were recruited from 18 camps (social networks comprising mainly young men) in the Manzese and Tandale wards of Dar es Salam, Tanzania [32]. The men were members of social network “camps” in Dar es Salaam, which are informal but organized gathering places for young men [33]. Camps typically have elected leaders, constitutions, and membership dues and serve as spaces where men socialize daily, play sports, and engage in income-generating activities. At the same time, camps have been identified as high-risk environments for HIV because members frequently meet new sexual partners, sometimes engage in concurrent sexual relationships, and report alcohol and marijuana use. Camps thus represent both protective and risky social spaces and have been recognized as strategic venues for reaching young men who are often out of school, informally employed, and at elevated risk of HIV infection [33]. Participants were recruited with the following inclusion criteria: (1) male, (2) aged 18 years or older, (3) been a camp member for at least three months, and (4) self-report as HIV-negative at enrollment [34]. Recruitment was conducted by trained Tanzanian research assistants who were familiar with the camp context and had prior training in both HIV research and human subjects’ protection. Eligible men were approached in person at their camp meeting sites and, after providing informed consent, were invited to participate in the survey. The structured questionnaires were administered face-to-face by the research assistants in Kiswahili, the national language, to ensure comprehension. Data were collected using tablets with electronic forms that allowed for direct entry, reducing transcription errors. Written informed consent was obtained from all participants prior to data collection. A total of 508 participants were screened; three participants did not meet eligibility criteria, and 505 participants consented to participate into the study. The data used for analysis were accessed in April 2023.
Measures
The study examines two outcomes using 3-point Likert items (1) How comfortable would you feel talking with an HIV counselor on the National HIV hotline? And 2) How comfortable would you feel receiving text messages from an HIV counsel on your mobile phone? Response options were answered by 1) very comfortable 2) somewhat comfortable and 3) Uncomfortable. Seven prespecified explanatory variables were examined (i) participant’s role in the camp, (ii) history of receiving HIV-related text message, (iii) history of sending a text message to friend about HIV, (iv) comfortability texting close friend in camp about HIV, (v) comfortability texting close friend about HIVST, (vi) willingness to receive information via mobile phone following HIVST, and (vii) comfortability sending self-test result via text. Guided by prior literature and baseline characteristics, we considered socio-demographic and access variable such as age, education, marital status, employment, HIV testing history, mobile phone access/ownership and phone-sharing, prior exposure to HIV-related SMS, and awareness and use of National HIV Hotline, as potential cofounders. These variables were summarized at baseline and evaluated in bivariable analyses alongside the key exposures.
Statistical analysis
For each outcome (comfort talking with a counselor, comfort receiving SMS) we fit bivariable logistic regression models to estimated odds ratio (OR) with 95% confidence intervals. The main study outcomes focused on the comfortability of individuals in talking to a HIV Variables with a significance level of p < 0.10 in bivariable analysis were entered into multivariable logistic regression models and adjusted odds rations (aOR) with 95% confidence intervals. No subgroup or interaction analyses were conducted. Analysis was based on available cases, observations with missing values on model variables were excluded from the relevant analyses and the final sample sizes are reported in tables. Participants were recruited from 18 male social networks (camps), analyses treated observation as independent. Stata statistical software, version 16.1, was utilized for all analyses [35].
Ethics approval and consent to participate
This study utilized secondary data collected from the previous STEP project, which was implemented starting in 2018. The initial ethics approval for that project was obtained from the University of South Carolina, covering the period from May 2017 to May 2018, during which data collection took place. The project received approval from different institutions due to the Principal Investigator (PI) shifting institutions during the project. Specifically, the project was reviewed and approved by the institutional review boards of the University of South Carolina (approval period: 5/16/2017 to 5/15/2018), the National Institute of Medical Research of Tanzania (NIMR/HQ/R.8c/Vol.I/1170, approval period: 29th June 2017 to 28th June 2018), and George Washington University in 2021. All respondents provided written informed consent prior to participation in the original study. All study procedures were performed in accordance with the ethical standards of the institutional and/or national research committees and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For our current study, which involves secondary analysis of this already collected data, we did not seek an extension of the original ethics approval. According to the guidelines of our institutional review boards and standard ethical practices, secondary data analysis does not typically require new, or extended ethics approval provided the data was collected ethically and anonymized appropriately, with no new data collection involving human subjects being undertaken.
Results
Our study had 505 participants, of which all were male, and most were single (63.8%), had secondary level education or greater (67.7%) and were in the age group 25–34 years (39.8%). Most of the participants had previously tested for HIV (90.3%), however, a majority had no history of using HIVST kit (91.5%). Regarding mobile phone access, most of the participants reported having a mobile phone (98.0%) and about a fifth reported sharing the mobile phone with another individual (19.4%). Nearly a third of participants had a history of receiving HIV-related text message (28.5%) and about a fifth reported sending a friend in a camp text message about HIV (22.2%). Most participants indicated being comfortable texting a friend about HIVST (82.8%) while just over half reported being comfortable texting friend about HIV (52.7%). Of the 505 participants, only 3.6% were aware of the National HIV Hotline. Most participants indicated being very comfortable talking to a HIV counselor on National HIV Hotline (84.2%) and receiving text from HIV Counselor (80.6%) following HIVST. Table 1 present the distribution of various characteristics and responses obtained from the study participants.
Table 1.
Participants’ characteristics, including demographic characteristics and HIV and HIVST knowledge and use. Dar es Salaam (n = 505)
| Characteristics | Frequency (percentage) | Cumulative percent |
|---|---|---|
| Age group (years) | ||
| 18—24 | 200 (39.6) | 39.6 |
| 25—34 | 201 (39.8) | 79.4 |
| 35 + | 104 (20.6) | 100 |
| Educational level | ||
| Primary or less | 163 (32.3) | 32.3 |
| Secondary or greater | 342 (67.7) | 100 |
| Marital status | ||
| Single | 322 (63.8) | 63.8 |
| Monogamous marriage/Cohabiting | 183 (36.2) | 100 |
| Previous HIV Testing | ||
| No | 49 (9.7) | 9.7 |
| Yes | 456 (90.3) | 100 |
| Access to Mobile Phone | ||
| No | 10 (2.0) | 2.0 |
| Yes | 495 (98.0) | 100 |
| Participants sharing mobile phone with other individuals | ||
| No | 407 (80.6) | 80.6 |
| Yes | 98 (19.4) | 100 |
| History of receiving HIV-related text message | ||
| No | 361 (71.5) | 71.5 |
| Yes | 144 (28.5) | 100 |
| History of sending friend in camp text message about HIV | ||
| No | 393 (77.8) | 77.8 |
| Yes | 112 (22.2) | 100 |
| Comfortability texting friend about HIVST | ||
| No | 87 (17.2) | 17.2 |
| Yes | 418 (82.8) | 100 |
| Comfortability texting friend about HIV | ||
| No | 266 (52.7) | 52.7 |
| Yes | 239 (47.3) | 100 |
| Aware of National HIV Hotline | ||
| No | 487 (96.5) | 96.5 |
| Yes | 18 (3.6) | 100 |
| Previous HIV Testing | ||
| No | 49 (9.7) | 9.7 |
| Yes | 456 (90.3) | 100 |
| Access to Mobile Phone | ||
| No | 10 (2.0) | 2.0 |
| Yes | 495 (98.0) | 100 |
| Participants sharing mobile phone with other individuals | ||
| No | 407 (80.6) | 80.6 |
| Yes | 98 (19.4) | 100 |
| History of receiving HIV-related text message | ||
| No | 361 (71.5) | 71.5 |
| Yes | 144 (28.5) | 100 |
| History of sending friend in camp text message about HIV | ||
| No | 393 (77.8) | 77.8 |
| Yes | 112 (22.2) | 100 |
| Comfortability texting friend about HIVST | ||
| No | 87 (17.2) | 17.2 |
| Yes | 418 (82.8) | 100 |
| Comfortability texting friend about HIV | ||
| No | 266 (52.7) | 52.7 |
| Yes | 239 (47.3) | 100 |
| Comfortability talking to a HIV Counselor on National HIV Hotline following HIVST | ||
| Uncomfortable | 26 (5.1) | 5.1 |
| Somewhat Comfortable | 54 (10.7) | 15.8 |
| Very Comfortable | 425 (84.2) | 100 |
| Comfortability receiving text from HIV Counselor following HIVST | ||
| Uncomfortable | 27 (5.3) | 5.3 |
| Somewhat Comfortable | 71 (14.1) | 19.4 |
| Very Comfortable | 407 (80.6) | 100 |
Comfortability talking to a HIV Counselor on National HIV Hotline following HIVST
In both bivariable and multivariable analyses, history of receiving HIV-related text messages, comfort texting a friend about HIVST, and comfort texting a friend about HIV were significantly associated with being comfortable talking to a counselor on the National HIV Hotline (Table 2).
Table 2.
Logistic regression of the association between participants’ comfortability talking to a HIV Counselor on National HIV Hotline following HIVST and predictor variables showing unadjusted and adjusted odds ratio
| Characteristics | n (%) | Unadjusted OR (95% CI) | P -Value | Adjusted OR (95% CI) | P -Value |
|---|---|---|---|---|---|
| Previous HIV Testing | |||||
| No | 49 (9.7) | Reference | Reference | ||
| Yes | 456 (90.3) | 1.02 (0.46–2.27) | 0.954 | 1.01 (0.43–2.38) | 0.979 |
| Access to Mobile Phone | |||||
| No | 10 (2.0) | Reference | Reference | ||
| Yes | 495 (98.0) | 0.56 (0.71–4.49) | 0.590 | 0.85 (0.09–7.82) | 0.887 |
| Participants sharing mobile phone with other individuals | |||||
| No | 407 (80.6) | Reference | Reference | ||
| Yes | 98 (19.4) | 1.49 (0.78–2.88) | 0.228 | 1.35 (0.67–2.73) | 0.407 |
| History of receiving HIV-related text message | |||||
| No | 361 (71.5) | Reference | 0.102 | Reference | 0.048 |
| Yes | 144 (28.5) | 0.66 (0.40–1.09) | 0.55 (0.31–0.99) | ||
| History of sending friend in camp text message about HIV | |||||
| No | 393 (77.8) | Reference | Reference | ||
| Yes | 112 (22.2) | 0.65 (0.40–1.10) | 0.104 | 0.70 (0.38–1.29) | 0.249 |
| Comfortability texting friend about HIVST | |||||
| No | 87 (17.2) | Reference | < 0.001 | Reference | < 0.001 |
| Yes | 418 (82.8) | 3.37 (1.97–5.76) | 3.08 (1.73–5.48) | ||
| Comfortability texting friend about HIV | |||||
| No | 266 (52.7) | Reference | < 0.001 | Reference | < 0.001 |
| Yes | 239 (47.3) | 3.84 (2.20–6.72) | 3.39 (1.89–6.07) | ||
| Aware of National HIV Hotline | |||||
| No | 487 (96.5) | Reference | 0.600 | Reference | 0.713 |
| Yes | 18 (3.6) | 1.49 (0.33–6.60) | 1.34 (0.28–6.29) | ||
In the bivariate analysis, we found that comfortability texting a friend about HIVST (OR = 3.37, 95% CI [1.97–5.76]) and comfortability texting friend about HIV (OR = 3.84, 95% CI [2.20–6.72]) were significantly associated with the probability of participant’s comfortability talking to a HIV counselor on National HIV Hotline following HIVST (Table 2).
In the multivariate analysis, after controlling for the other predictor variables, we found that history of receiving HIV-related text message, comfortability texting friend about HIVST, and comfortability texting friend about HIV remained significantly associated with the probability of participant’s comfortability talking to a HIV counselor on National HIV Hotline following HIVST (Table 2). Participants with a previous history of receiving HIV related text message had significantly lower odds of being very comfortable talking to a HIV counselor on National HIV Hotline following HIVST (aOR = 0.55, 95% CI [0.31–0.99]). Participants who reported being comfortable texting a friend about HIVST had 3.08 higher odds of being very comfortable talking to a HIV counselor on National HIV Hotline following HIVST (aOR = 3.08, 95% CI [1.73–5.48]). Finally, participants who reported being comfortable texting friend about HIV had 3.39 higher odds of being very comfortable talking to a HIV counselor on National HIV Hotline following HIVST (aOR = 3.39, 95% CI [1.89–6.07]).
Comfortability receiving text message from HIV Counselor following HIVST
In both bivariable and multivariable analyses, history of receiving HIV-related text messages, comfort texting a friend about HIVST, and comfort texting a friend about HIV were significantly associated with being comfortable receiving text messages from a counselor on the National HIV Hotline (Table 3).
Table 3.
Logistic regression of the association between participants’ comfortability receiving text from HIV Counselor following HIVST and predictor variables showing unadjusted and adjusted odds ratio
| Characteristics | n (%) | Unadjusted OR (95% CI) | P -Value | Adjusted OR (95% CI) | P -Value |
|---|---|---|---|---|---|
| Previous HIV Testing | |||||
| No | 49 (9.7) | Reference | Reference | ||
| Yes | 456 (90.3) | 0.77 (0.35–1.69) | 0.515 | 0.73 (0.32–1.68) | 0.464 |
| Access to Mobile Phone | |||||
| No | 10 (2.0) | Reference | Reference | ||
| Yes | 495 (98.0) | 0.44 (0.05–3.52) | 0.590 | 0.58 (0.07–5.13) | 0.624 |
| Participants sharing mobile phone with other individuals | |||||
| No | 407 (80.6) | Reference | Reference | ||
| Yes | 98 (19.4) | 1.25 (0.70–2.22) | 0.446 | 1.14 (0.61–2.10) | 0.683 |
| History of receiving HIV-related text message | |||||
| No | 361 (71.5) | Reference | 0.195 | Reference | 0.054 |
| Yes | 144 (28.5) | 0.73 (0.46–1.17) | 0.59 (0.34–1.01) | ||
| History of sending friend in camp text message about HIV | |||||
| No | 393 (77.8) | Reference | Reference | ||
| Yes | 112 (22.2) | 0.88 (0.52–1.48) | 0.638 | 1.04 (0.58–1.88) | 0.888 |
| Comfortability texting friend about HIVST | |||||
| No | 87 (17.2) | Reference | 0.001 | Reference | 0.003 |
| Yes | 418 (82.8) | 2.52 (1.49–4.25) | 2.28 (1.31–3.95) | ||
| Comfortability texting friend about HIV | |||||
| No | 266 (52.7) | Reference | < 0.001 | Reference | < 0.001 |
| Yes | 239 (47.3) | 2.96 (1.83–4.80) | 2.74 (1.66–4.53) | ||
| Aware of National HIV Hotline | |||||
| No | 487 (96.5) | Reference | 0.396 | Reference | 0.254 |
| Yes | 18 (3.6) | 0.64 (0.23–1.80) | 0.53 (0.18–1.57) | ||
In the bivariate analysis, we found that comfortability texting friend about HIVST (OR = 2.52, 95% CI [1.49–4.25]) and comfortability texting friend about HIV (OR = 2.96, 95% CI [1.83–4.80]) were significantly associated with the probability of participant’s comfortability receiving text message from HIV counselor following HIVST (Table 3).
In the multivariate analysis, after controlling for the other predictor variables, we found that history of receiving HIV-related text message, comfortability texting friend about HIVST, and comfortability texting friend about HIV remained significantly associated with the probability of participant’s comfortability receiving text message from an HIV counselor on National HIV Hotline following HIVST (Table 2). Participants with a previous history of receiving HIV related text message had 0.59 lower odds of being very comfortable talking to a HIV counselor on National HIV Hotline following HIVST (aOR = 0.59, 95% CI [0.34–1.01]). Participants who reported being comfortable texting a friend about HIVST had 2.28 higher odds of being very comfortable talking to a HIV counselor on National HIV Hotline following HIVST (aOR = 2.28, 95% CI [1.31–3.95]). Finally, participants who reported being comfortable texting friend about HIV had 2.74 higher odds of being very comfortable talking to a HIV counselor on National HIV Hotline following HIVST (aOR = 2.74, 95% CI [1.66–4.53]).
Discussion
The overall goal of this study was to assess men’s willingness to use the National HIV Hotline for support with linkage to care following HIV self-testing (HIVST). We discovered that following HIVST, most participants said they felt extremely comfortable chatting to a counsellor on the National HIV Hotline (84.2%) and receiving SMS from a hotline counsellor (80.6%). Prior exposure to text messages on HIV and readiness to discuss HIV/HIVST with peers were both highly correlated with hotline communication comfort. These results demonstrate that the hotline is a viable digital support channel for connecting to care. Previous research conducted in sub-Saharan Africa has demonstrated that exposure to digital messaging connected to HIV might enhance service engagement and health-seeking behaviors. This suggests that being familiar with SMS-based treatments may lower barriers to using hotlines [17].
Interestingly, participants with a prior history of receiving HIV-related text messages were significantly less likely to report being very comfortable talking to or receiving texts from a counselor on the National HIV Hotline. One possible explanation is that prior experiences with HIV-related messages may have raised concerns about confidentiality, privacy, or unwanted disclosure, which in turn reduced comfort with formal counseling interactions. Previous studies in sub-Saharan Africa have documented that individuals sometimes perceive HIV-related digital communication as stigmatizing or intrusive, particularly when messages are received on shared or monitored devices [36, 37]. These findings suggest that while digital interventions have promise, attention must be paid to tailoring content and ensuring privacy safeguards to build trust and comfort among men.
High mobile phone ownership among participants (98%) further strengthens the potential of digital interventions to enhance HIVST linkage. Similar findings in other low-resource settings have shown that widespread phone access can be leveraged to scale up HIV-related health interventions, even in areas with limited healthcare infrastructure [38–41]. The near-universal access to mobile phones in this cohort highlights a promising opportunity for integrating hotline support with SMS reminders, two-way messaging, and interactive peer communication to improve linkage outcomes.
Taken together, these findings suggest that the National HIV Hotline could serve as a user-centered, privacy-preserving, and scalable intervention to support linkage after HIVST. By combining professional counseling with peer and digital communication strategies, the Hotline could address stigma, provide tailored follow-up support, and facilitate timely entry into care. Future studies should explore how hotline interventions could be adapted to engage not only men, but also their sexual partners, to strengthen couple-based testing and linkage strategies. Additionally, research is needed to assess the effectiveness of hotline use in rural and underserved populations where social networks, stigma, and digital access may differ significantly from urban contexts like Dar es Salaam.
We undertook several steps to mitigate common biases. To reduce confounding, we used a DAG-informed, a priori adjustment set (age, education, marital status, employment, prior HIV testing, phone ownership/phone-sharing, and hotline awareness) and additionally retained prior HIV-related SMS exposure given its conceptual proximity to the outcomes. However, this study has some limitations. Our findings are most generalizable to urban, young to mid-adult men in Dar es Salaam who participate in organized male social networks (“camps”) and report high mobile-phone access (98%). The high prevalence of comfort with hotline-based support after HIVST (very comfortable talking to a counselor: 84.2%; very comfortable receiving SMS: 80.6%) likely reflects this digitally connected, peer-networked context. Caution is therefore warranted in extrapolating these absolute proportions to men in rural settings, to older age groups, or to women and gender-diverse individuals, among whom phone access, phone-sharing, literacy, stigma, and norms around discussing HIV may differ. Taken together, the results are most applicable to urban Tanzanian contexts with strong peer networks and high mobile penetration, and they offer plausible insights for comparable urban settings in the region. External validation in rural areas, other regions of Tanzania, and among women/partners ideally using probability sampling and behavioral endpoints (actual hotline use) would strengthen inferences about broader generalizability.
Conclusion
Our study sheds light on men’s willingness to utilize the National HIV Hotline for support with linkage to care following HIV self-testing in Tanzania. A key finding was the high comfort level expressed by men in communicating with a counselor at the hotline about HIVST and HIV. The high level of acceptance and openness towards discussing HIV-related topics among peers also points to an important avenue for HIV prevention and care. Overall, this study adds to the growing body of evidence on the promising potential of mobile health (mHealth) interventions to promote HIV testing and facilitate timely linkage to care in resource-limited settings.
Supplementary Information
Acknowledgements
This study was supported by grants from the National Institute of Mental Health (Grant #R00MH110343: PI: DFC) and Minority Health International Research Training (MHIRT) (Grant T37-MD001448) from the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD, USA.
CONSORTIUM
Bridge Africa team.
Ivan Teri7.
Sylvia Shirima7.
Gasper Mbita7.
Affiliation: BRIDGE Africa Board Members.
Abbreviations
- AIDS
Acquired Immune Deficiency Syndrome
- HIV
Human Immunodeficiency Virus
- HIVST
HIV self-testing
- STEP
Self-Testing Education and Promotion
- mHealth
Mobile Health
Authors’ contributions
FM designed and drafted the manuscript. KO, GM performed data analysis. NM, JSN, IT, BRIDGE Africa team and DFC review, provided substantial comments and edits the draft.
Funding
This study was supported by grants from the National Institute of Mental Health (Grant #R00MH110343: PI: DFC) and Minority Health International Research Training (MHIRT) (Grant T37-MD001448) from the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD, USA.
Data availability
The datasets generated and/or analyzed in the current study are not publicly available due to sensitive information about the participants. However, data are available from the PI or corresponding author (dxc341@gmail.com) upon reasonable request.
Declarations
Ethics approval and consent to participate
This study utilized secondary data collected from the previous STEP project, which was implemented starting in 2018. The initial ethics approval for that project was obtained from the University of South Carolina, covering the period from May 2017 to May 2018, during which data collection took place. The project received approval from different institutions due to the Principal Investigator (PI) shifting institutions during the project. Specifically, the project was reviewed and approved by the institutional review boards of the University of South Carolina (approval period: 5/16/2017 to 5/15/2018), the National Institute of Medical Research of Tanzania (NIMR/HQ/R.8c/Vol.I/1170, approval period: 29th June 2017 to 28th June 2018), and George Washington University in 2021. All respondents provided written informed consent prior to participation in the original study. All study procedures were performed in accordance with the ethical standards of the institutional and/or national research committees and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For our current study, which involves secondary analysis of this already collected data, we did not seek an extension of the original ethics approval. According to the guidelines of our institutional review boards and standard ethical practices, secondary data analysis does not typically require new, or extended ethics approval provided the data was collected ethically and anonymized appropriately, with no new data collection involving human subjects being undertaken.
Consent for publication
All authors provided consent to publish this paper.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Frank Mhando, Email: frank.mhando@gmail.com.
BRIDGE Africa Team:
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets generated and/or analyzed in the current study are not publicly available due to sensitive information about the participants. However, data are available from the PI or corresponding author (dxc341@gmail.com) upon reasonable request.