Mobile Phones and HIV Testing: Multicountry Instrumental Variable Analysis From Sub-Saharan Africa.

Publisher: JMIR Publications Country of Publication: Canada NLM ID: 100959882 Publication Model: Electronic Cited Medium: Internet ISSN: 1438-8871 (Electronic) Linking ISSN: 14388871 NLM ISO Abbreviation: J Med Internet Res Subsets: MEDLINE

Publication: <2011- > : Toronto : JMIR Publications
Original Publication: [Pittsburgh, PA? : s.n., 1999-

Cell Phone*/statistics & numerical data ; HIV Infections*/diagnosis ; HIV Infections*/prevention & control; Humans ; Africa South of the Sahara ; Female ; Adult ; HIV Testing/methods ; HIV Testing/statistics & numerical data ; Young Adult ; Middle Aged

Background: Sub-Saharan Africa has been a technological hothouse when it comes to mobile phone technology adoption. However, evidence on the role played by mobile technology on infectious disease prevention has been mostly limited to experimental studies.
Objective: This observational study investigates the role of mobile phone connectivity on HIV testing in sub-Saharan Africa.
Methods: We make use of the novel and comprehensive OpenCelliD cell tower database and Demographic and Health Survey geocoded information for over 400,000 women in 29 sub-Saharan African countries. We examine, through ordinary least square and instrumental variable regressions, whether women's community distance from the closest cell tower influences knowledge about HIV testing facilities and the likelihood of ever being tested for HIV.
Results: After finding a negative and significant impact of distance to the nearest cell tower on knowledge of HIV testing facility (-0.7 percentage points per unit increase in distance) and HIV testing (-0.5 percentage points per unit increase), we investigate the mechanisms through which such effects might occur. Our analysis shows that distance to a cell tower reduces HIV-related knowledge (-0.4 percentage points per unit increase) as well as reproductive health knowledge (-0.4 percentage points per unit increase). Similar results are observed when the analysis is performed at community level.
Conclusions: Results suggest that the effect of mobile phone connectivity is channeled through increased knowledge of HIV, sexually transmittable infections, and modern contraceptive methods. Further analysis shows that cell phone ownership has an even larger impact on HIV testing and knowledge. This paper adds to the recent literature on the impact of mobile-based HIV prevention schemes by showing through large-scale analysis that better mobile network access is a powerful tool to spread reproductive health knowledge and increase HIV awareness.
(©Francesco Iacoella, Nyasha Tirivayi. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 27.09.2024.)

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Keywords: HIV; Sub-Saharan Africa; access; choices and consequences; communication; connectivity; health and economic development; information and knowledge; mobile phone; public health; technological change; testing; women’s health

Date Created: 20240927 Date Completed: 20240927 Latest Revision: 20250722

20250722

PMC11470219

10.2196/48794

39331953