# ITEST: Innovative Tools to Expand Youth-Friendly HIV Self-Testing

> **NIH NIH UH3** · SAINT LOUIS UNIVERSITY · 2020 · $1,401,975

## Abstract

ABSTRACT
HIV incidence remains high among youth aged 14-24 in Sub-Saharan Africa, thus underscoring the
importance of interventions to prevent HIV in this age group. Nigerian youth are at the epicenter of an
expanding HIV crisis, with the second largest number of new youth HIV infections of any country. Yet fewer
than one in five Nigerian youth have ever been HIV tested. Young people are often framed as the fraught
victims of new HIV infections, instead of recognizing their resilience and power in advancing effective
response to the epidemic. Conventional expert-driven, top-down interventions have largely failed. Innovative
solutions that leverage the resourcefulness and resilience of youth are sorely needed. In this proposal, we will
develop innovative youth-friendly HIV self-testing services based on open challenges and apprenticeships
that are informed by a youth participatory action research framework. Open challenges solicit solutions from
the community and then implement the best solutions, while apprenticeship builds local capacity for youth-led
projects to increase the likelihood of success and ensure comprehensive evaluation. Three randomized
controlled trials based on open challenges have led to improved rates of HIV testing and condom use among
at-risk youth, but none of these approaches have been in Africa. These participatory approaches will be used
to identify innovative HIV self-testing strategies that meet the specific needs of Nigerian youth. Each strategy
will have a comprehensive plan for enhancing HIV prevention (including HIV pre- exposure prophylaxis and
behavioral approaches) among at-risk youth. Two HIV self-testing strategies will be selected by judges as
semi-finalists and evaluated in separate local government area pilots (UG3 phase). Once the project meets
stringent requirements demonstrating trial readiness and pilot effectiveness, a single strategy will be
evaluated in a pragmatic, cluster randomized controlled trial in 24 local government areas of Nigeria (UH3
phase). The intervention development process will build capacity for decentralized HIV self- testing, drawing
on the strengths, creativity, and engagement of Nigerian youth. Leveraging our extensive experience
organizing HIV research in Nigeria, we propose the following specific aims: (1) To use open challenges and
apprenticeship to develop new HIV self-testing services; (2) To evaluate the effectiveness of two semi-finalist
participatory interventions on HIV testing and other key prevention services among at-risk, HIV-negative
youth (14-24years old); (3) To determine the effectiveness of a finalist participatory intervention on HIV
testing and other key HIV prevention outcomes in 24 areas using a stepped wedge, pragmatic randomized
controlled trial. The overarching goal is not to create a monolithic “one-size fits all” HIV self-testing strategy,
but rather to demonstrate that open challenges can engage and inspire youth to develop innovative and
effective HIV...

## Key facts

- **NIH application ID:** 10228136
- **Project number:** 4UH3HD096929-03
- **Recipient organization:** SAINT LOUIS UNIVERSITY
- **Principal Investigator:** Juliet Iwelunmor
- **Activity code:** UH3 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $1,401,975
- **Award type:** 4N
- **Project period:** 2018-09-01 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10228136

## Citation

> US National Institutes of Health, RePORTER application 10228136, ITEST: Innovative Tools to Expand Youth-Friendly HIV Self-Testing (4UH3HD096929-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10228136. Licensed CC0.

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