DOI: 10.5061/dryad.cvdncjt8h
title: Acceptability of short message service reminders as the support tool for PrEP adherence among young women in Mukono district, Uganda

description: Adolescent girls and young women (AGYW) have a disproportionately high
 incidence of HIV compared to males of the same age in Uganda. AGYW are a
 priority sub-group for daily oral Pre-Exposure Prophylaxis (PrEP), but
 their adherence has consistently remained low. Short Message Service (SMS)
 reminders could improve adherence to PrEP in AGYW. However, there is a
 paucity of literature about the acceptability of SMS reminders among AGYW
 using PrEP. We assessed the level of acceptability of SMS reminders as a
 PrEP adherence support tool and the associated factors, among AGYW in
 Mukono district, Central Uganda. We consecutively enrolled AGYW using PrEP
 in Mukono district in a cross-sectional study. A structured pre-tested
 questionnaire was administered to participants by three trained research
 assistants. Data were analyzed in STATA 17.0; continuous variables were
 summarized using median and interquartile range (IQR) while categorical
 variables were summarized using frequencies and percentages. Acceptability
 of SMS was defined as willingness to accept SMS reminders to support PrEP
 adherence and was assessed using the seven constructs of the theoretical
 framework of acceptability. The relationship between the outcome and
 independent variables was assessed using a modified Poisson regression
 with robust standard errors. During 2022, 142 AGYW with median age 22
 years (IQR; 18, 24) of whom 80.3% owned a personal mobile phone were
 assessed. SMS reminders were highly acceptable [90.9%, 95% Confidence
 Interval (CI) [84.9, 95.0]]. Rural residence (aPR: 0.92, 95% CI (0.84,
 0.99)) and having belief that SMS cannot breach individual’s privacy (aPR:
 1.40, 95% CI (1.07, 1.84)) were significantly associated with
 acceptability of SMS reminders. Having a personal mobile phone and
 acceptability of SMS reminders were high in this sub-population. SMS
 reminder can be leveraged to support AGYW to adhere to PrEP but should be
 designed in a way that maintains confidentiality, and supports AGYW living
 in rural settings.
description: The data set was collected through a reseacher administered
 questionnaire.  The main dependent variable was
 acceptability of SMS reminders. This was measured using the seven
 constructs derived from the Theoretical Framework of Acceptability
 (TFA)(1). These include; affective attitude, burden, perceived
 effectiveness, ethicality, intervention coherence, opportunity costs, and
 self-efficacy. A 5-point Likert item question per construct was used and
 each level of a Likert scale was given a weight ranging from one to five.
 The summated scores from the weights assigned to each response were
 computed. The obtained summated acceptability score was then dichotomized
 using the 50th percentile of the possible summated scores which ranges
 from 7 to 35 (the 50th percentile is 21). Therefore “Acceptability of SMS
 reminders" was defined as a value greater than 21. 
 The independent variables were captured as described in the data
 dictionary attached Data analysis was performed in
 STATA version 17.0 (Texas, USA).  At Univariate analysis, categorical
 variables were summarized using frequencies and percentages; and continous
 variables were summarized with median and inter-quartile range
 (IQR).<br> <br> The level of acceptability was calculated as a
 proportion of total participants that accepted the use of SMS reminders
 and its exact confidence interval (CI) was calculated.
 In the evaluation of factors associated with acceptability of SMS
 reminders, the primary outcome was the acceptability of SMS reminders as a
 PrEP adherence support tool recorded as a binary outcome (“Acceptable”
 versus “Not acceptable”). The relationship between the outcome and the
 independent variables was assessed using a modified Poisson regression
 model with robust standard errors. At bivariate analysis, the crude
 prevalence ratio (cPR) was computed together with the CI and P-value for
 each independent variable. The independent variables with a P value of
 less than 0.2 were included in the multivariate model.
 At multivariate analysis, Interaction was assessed using the
 chunk test (-2loglikelihood ratio test). Confounding was assessed and an
 independent variable was considered a confounder if they changed the
 magnitude of the adjusted prevalence ratio of another independent variable
 in the multivariate model by more than 10%. The adjusted prevalence ratio
 (aPR) was computed and reported together with the CI and P-value of each
 independent variable in the final model. statistical significancy was set
 at 0.05.
description: # Acceptability of short message service reminders as the support tool for
 PrEP adherence among young women in Mukono district, Uganda Dataset DOI:
 [10.5061/dryad.cvdncjt8h](10.5061/dryad.cvdncjt8h) ## Description of the
 data and file structure In this dataset, we aimed to assess the
 acceptability of short message service (SMS) reminders among Adolescent
 Girls and Young Women (AGYW) prescribed Pre-Exposure Prophylaxis (PrEP).
 We also measured demographic and other individual factors  ### Files and
 variables File: Manuscript_dataset.dta **Description:** This section
 describes the variables included in the dataset (data dictionary) |
 Variable Name | Variable type | Variable Label | Value Labels | |
 :------------------- | :------------ |
 :------------------------------------------------------------------------------------------------------------------- | :--------------------------------------------------------------------------------------------------------------------- | | id | Numeric | Identification number of the study participant | ### | | residence | categorical  | Area/setting of residence (urban was defined as Town councils, municiparity, city) | 1-Urban                              2-Rural | | agecat | Categorical | Categorized age of participants | 0-15-19 years                    1-20-24 years | | schooling | Categorical | Schooling status/ whether a participant is currently attending school at any level | 1-Yes                            2-No | | PrEP\_Initiation | Categorical | Number of months since initiation of PrEP | 1-Past 1 Month           2-Past 2 Months       3-Past 3 or more Months | | PrEP\_Visits | Categorical | Visits made by the participant to a health facility for PrEP related services | 0-None                       1-One                         2-Twice                        3-3 or more times | | disclosure | Categorical | If the participant disclosed PrEP use to any other person | 1-Yes                             2-No | | disclose\_use | Categorical | Individual the participant disclosed to (only for those who self-reprted to have disclosed PrEP use) | 1-Parent                      2-Spouse/primary partner                         3-Peer-Friend | | disclose\_support | Categorical | If the individual that the participant disclose PrEP use to provided support to continue using prEP | 1-Yes                                2-No | | missed\_dose | categorical | Missing a PrEP dose in the past 4 weeks | 1-Yes                                2-No | | reason | categorical | Resons for missing a PrEP dose | 1-Forgot                          2-Had no pills                 3-Side effects                 4-Others | | moved | categorical | Moving from the usual home for more than 2 consective days in the past 4 weeks | 1-Yes                                2-No | | had\_phone | categorical | Have ever owned a personal mobile phone | 1-Yes                                2-No | | have\_phone | categorical | Currently own a personal mobile phone | 1-Yes                                2-No | | share\_phone | categorical | Share a personal mobile phone with any other person | 1-Yes                                2-No | | phone\_alarm | categorical | Ever used a phone alarm in the last 4 weeks | 1-Yes                                2-No | | use\_sms | categorical | Ever used a phone SMS features in the last 4 weeks | 1-Yes                                2-No | | willing\_use\_sms | Categorical | Willingness to use SMS reminders to support adherence to PrEP | 0-No                                    1-Yes | | delivery\_method | Categorical | Delivery method of SMS reminders | 1-One-way option             2-Two-way option | | sms\_freq | categorical | Frequency of SMS reminders | 1-Daily                                 2-Once a week                   3-Twice a week                  4-Once a month | | privacy | categorical | Belive that use of SMS reminders can breach individuals privacy | 1-Yes                                2-No | | literacy | categorical | Knowledge and Ability ability to use a phone SMS feature unaided | 1-Yes                                2-No | | adherence | Numeric | Percentage of pills prescribed that were actually taken by the participant in the past 4 weeks (self-report) | ### | | affective\_attitude | Numeric | Willingness to use SMS reminders to support adherence to PrEP | # | | burden | Numeric | level of agreement that the use of SMS reminders as a PrEP adherence support tool would be burdensome to participant | # | | ethicality | Numeric | Extent to which use of SMS reminders aligns with participant's values and beliefs | # | | coherence | Numeric | level of agreement that SMS reminders can be used to support oral PrEP adherence | # | | opportunity\_cost | Numeric | level of agreement that participant would give up some of her time to use SMS reminder | # | | effectiveness | Numeric | Level of agreement that SMS reminders would help you in adhering to oral PrEP? | # | | self\_efficacy | Numeric | Level of agreement that you would confidently utilize SMS reminders  | # | | Note: Missing values | empty | Missing values appear empty | 
 
 | 
 
 ## Code/software * STATA version 17.0 (Texas, USA) * All codes are within
 the software ## Access information Other publicly accessible locations of
 the data: * N/A Data was derived from the following sources: * n/a ##
 Human subjects data The participants gave written informed consent to
 publish de-identified data in accordance with Uganda National Cuncil for
 Science and Technology (UNCST), a local human participant research
 regulator. The identifying characteristics like numerical age, physical
 address were reducted.