TTC was founded with the goal of improving health education through the use of text messaging, which holds the advantages of anonymity and strong uptake among the population. Partnering with the mobile carrier Celtel and the local NGO AIDS Information Centre (AIC), TTC conducted a pilot program from February through April 2008 in the Mbarra region of Uganda, with the objective of increasing public knowledge of and changing behavior around AIDS. The program aimed to encourage citizens to seek voluntary testing and counseling for HIV/AIDS.
An SMS-based multiple choice quiz was administered to 15,000 Celtel mobile phone subscribers in the rural region of Mbarra. Free airtime was offered to users to encourage participation in the program; this was determined to be a powerful incentive since users can exchange the airtime with other subscribers as a type of currency.
The quiz was interactive. When participants gave a wrong answer they received an SMS with the correct answer from the cell phone provider. The uptake rate of the survey was 17.4% and focused on two specific public health areas: (1) General knowledge about HIV transmission, and (2) the benefits of voluntary testing and counseling.
At the end of the quiz, a final SMS was sent to motivate participants to go for voluntary testing and counseling at the local health center. Those who went to the center were asked a final question: Was this was the first time they had an HIV test? After testing, participants were requested to leave their mobile phone number so that post-test counseling could be arranged. For the people who came to the health centers through TTC, HIV testing and counseling was free of charge.
The quiz had two goals:
- Collect information. In particular, the program was able to assess the rate of correct or incorrect answers within certain socio-economic sectors, and pass this information along to UNICEF.
- Promote testing and counseling. The quiz notified participants of the location of the nearest testing center. If they stated that they were referred from the quiz, testing was free (there was normally a small charge for testing).
The response level of the pilot quiz was on average 8% per question. In terms of information gathering, a key finding of the survey was that although people were quite knowledgeable about issues such as condom use, they did not think that AIDS testing was accurate or anonymous. This was a major finding, in that the population of Uganda had not been surveyed on this question before. TTC was able to pass this along to larger health agencies operating in the region, thereby contributing to the efficacy of existing health programs.
TTC planned a follow-up program in Uganda in January 2009. One of the goals of the next campaign was to promote the safety and effectiveness of the testing center, and therefore specifically encourage testing.