Tushirikiane-4-Uthabiti (Supporting Each Other For Resilience): A mixed-methods mobile health study to understand and address the social and health impacts of COVID‑19 among urban refugee youth in Kampala, Uganda
THE ISSUE: The COVID‑19 pandemic has exacerbated refugee health disparities. Our team documented high food insecurity, depression, alcohol use, and unmet HIV prevention needs with urban refugee youth in Kampala, Uganda, a low-income country and the largest refugee host in Sub-Saharan Africa with 1.5 million refugees. There is an urgent need to understand, and identify effective interventions to address, the indirect and wider health consequences of COVID‑19 among youth in low-income humanitarian contexts. We focus on urban refugee youth in Kampala, Uganda, where there are 93,000 refugees largely living in slums. OUR IDEA: We will develop and evaluate the effectiveness of an mHealth (WhatsApp, SMS) intervention in reducing economic insecurity (food insecurity, poverty), increasing HIV prevention (HIV testing uptake, condom use, PrEP uptake), and improving mental health (reducing depression and problematic substance use) outcomes among an existing cohort of urban refugee youth aged 16-24 in Kampala. Our project involves: 1) qualitative phone interviews with refugee youth and key informants to understand refugee youth priorities and aspirations for reducing COVID‑19 impacts; 2) tailoring evidence-based interventions for livelihood strengthening, reducing psychological distress, and HIV prevention (HIV self-testing, PrEP linkages) for refugee youth in a 16-week mHealth (SMS, WhatsApp) intervention; 3) conducting a single arm, pre-test/post-test trial to test the intervention effectiveness in reducing poverty, improving mental health, and increasing HIV prevention cascade engagement; 4) knowledge mobilization, including a toolkit, comic book manual and radio drama, as well as policy analysis and refugee youth working paper. Findings will advance new knowledge of indirect and wider health impacts of COVID‑19 among refugee youth, and provide effectiveness data for mHealth strategies to address the syndemic of poverty, HIV and poor mental health with urban refugee youth.