Hanne Ochieng Lichtwarck

• Lichtwarck, Hanne Ochieng; Mbotwa, Christopher Hariri; Kazaura, Method Rwelengera; Moen, Kåre & Mmbaga, Elia (2023). Early disengagement from HIV pre-exposure prophylaxis services and associated factors among female sex workers in Dar es Salaam, Tanzania: A socioecological approach. BMJ Global Health. ISSN 2059-7908. 8(12). doi: 10.1136/bmjgh-2023-013662.
• Mbotwa, Christopher H; Kazaura, Method Rwelengera; Moen, Kåre; Lichtwarck, Hanne Ochieng; Leshabari, Melkizedeck T & Metta, Emmy [Show all 7 contributors for this article] (2023). Effect of an mHealth intervention on retention in HIV pre-exposure prophylaxis services among female sex workers: Preliminary evidence of the use of the Jichunge app in Dar es Salaam, Tanzania. Digital Health. 9. doi: 10.1177/20552076231170507. Show summary

  Background Mobile health (mHealth) applications have been reported to be effective in promoting access and adherence to health services. However, knowledge about their effect on retention in HIV preventive services among at-risk populations in sub-Saharan Africa is limited. Objective We aimed to evaluate the effect of the Jichunge mHealth application on retention in HIV pre-exposure prophylaxis (PrEP) services among female sex workers in Dar es Salaam, Tanzania. Methods We used respondent-driven sampling to recruit female sex workers eligible for PrEP and who owned a smartphone. All study participants were provided with a smartphone application (Jichunge app) aiming to promote PrEP use through medication reminders, easy access to PrEP information, online consultations with a doctor and/or peer educator, and online discussions between PrEP users. The effect of optimal use of the Jichunge app on retention in PrEP services at 1-month was modelled using log-binomial regression. Results A total of 470 female sex workers with a median age of 26 (interquartile range: 22–30) years were recruited. Overall, 27.7% of female sex workers were retained in PrEP services at 1 month. Retention was twice as high among optimal users of the app than among sub-optimal users (adjusted risk ratios = 2.00, 95% confidence interval (CI): 1.41–2.83, p < 0.001). Conclusion The optimal use of the Jichunge mHealth application was significantly associated with higher retention in PrEP services among female sex workers in Dar es Salaam.

• Lichtwarck, Hanne Ochieng; Kazaura, Method; Moen, Kåre & Mmbaga, Elia (2022). Harmful Alcohol Use and Associated Socio-Structural Factors among Female Sex Workers Initiating HIV Pre-Exposure Prophylaxis in Dar es Salaam, Tanzania. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. doi: 10.3390/ijerph20010698. Show summary

  Harmful alcohol use is an important risk factor for premature mortality and morbidity and associated with increased HIV risk and lower uptake of and adherence to HIV interventions. This study aimed to assess the extent of harmful alcohol use and associated socio-structural vulnerability factors among female sex workers in Dar es Salaam, Tanzania, a key population in the HIV epidemic. Data from a study of female sex workers initiating pre-exposure prophylaxis (PrEP) recruited through respondent driven sampling were used. We assessed harmful alcohol use with the Alcohol Use Disorders Identification Test (AUDIT) defined as having an AUDIT score ≥ 16. Associations between harmful alcohol use and socio-structural factors were assessed using logistic regression with marginal standardization. Of the 470 women recruited, more than one third (37.3%) had a drinking pattern suggestive of harmful alcohol use. Such use was independently associated with sex work-related mobility (aPR: 1.36, 95% CI: 1.11-1.61), arrest/incarceration (aPR: 1.55, 95% CI: 1.27-1.84) and gender-based violence (aPR: 1.31, 95% CI: 1.06-1.56). The high prevalence of harmful alcohol use and the interconnectedness with socio-structural factors indicate a need for a holistic programmatic approach to health for female sex workers. Programming should not solely direct attention to individual behavior but also include strategies aiming to address socio-structural vulnerabilities.

• Mauka, Wilhellmuss; Mbotwa, Christopher; Moen, Kåre; Lichtwarck, Hanne Ochieng; Haaland, Inga & Kazaura, Method Rwelengera [Show all 9 contributors for this article] (2021). Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach. Journal of Medical Internet Research. ISSN 1438-8871. doi: 10.2196/23204. Show summary

  Background: There is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed. Objective: We present the results of the development of a mobile app (Jichunge) intended to promote adherence to PrEP among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania. Methods: A participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW. Results: The relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app’s design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs. Conclusions: The participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion. Trial Registration: The trial registration number is PACTR202003823226570

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• Spjeldnæs, Amanda Hylland; Patel, Davina Kaur; Lichtwarck, Hanne Ochieng; Givan, Kathleen Alexandra; Gravdahl, Oline Friestad & Lengle, Emma Joanna (2023). Legeopprop for sivilbefolkningen på Gaza. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 143(17). doi: 10.4045/tidsskr.23.0713.
• Keynejad, Roxanne C; Deraz, Omar; Ingenhoff, Rebecca; Eick, Frode; Njie, Hassan & Graff, Selina [Show all 17 contributors for this article] (2023). Decoloniality in global health research: ten tasks for early career researchers. BMJ Global Health. ISSN 2059-7908. doi: 10.1136/bmjgh-2023-014298.
• Lichtwarck, Hanne Ochieng; Kazaura, Method Rwelengera; Mmbaga, Elia & Moen, Kåre (2021). Sex worker stigma among female sex workers initiating PrEP in Dar es Salaam Preliminary analysis from baseline data collection in the PREPTA study . Show summary

  Introduction: Female sex worker stigma is an understudied social determinant of health. In the context of HIV/AIDS studies have found that FSW stigma can pose a barrier both to access prevention and treatment services. Methods: We did a baseline survey of 471 FSW in Dar es Salaam initiating pre-exposure prophylaxis (PrEP). The participants were recruited using respondent driven sampling. Interviews covered several topics of relevance to PrEP, including a 13 point item 4 item validated FSW stigma scale where statements reflected perceptions and experiences of being a FSW. Additionally we did qualitative interviews with 25 FSW. Results: Median stigma scale score was 30 (IQR 27-35), a lower score compared to another study conducted in a different region of Tanzania. A majority of respondents expressed agreement with four of the five positively phrased statements such as “You like your job as a sex worker” (73.4% either agreed or completely agreed). Additionally a majority indicated disagreement with seven of eight negative phrased statements such as “Working as a sex worker makes you feel like a bad person” (66.6% either disagreed or completely disagreed). Qualitative data indicated that several of the women had experienced or felt stigma related to their profession and one participant explained that this could for instance impede participation in research. However, several expressed that they saw sex work as any other work and had become self-assured as people able to sustain themselves and in many cases their family members. Discussion: These preliminary findings shows a nuanced picture of these sex workers own perspectives related to their work, stigma and themselves, and opposes a view of FSW as victims devoid of agency and self-assurance.

• Lie, Anne Helene Kveim; Jensen, Terje; Lichtwarck, Hanne; Storaas, Jon; Torjussen, Erik & Havnes, Ingrid Amalia (2015). Å sette brukeren i sentrum – allerede som student :. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 135(14), p. 1236–1237. doi: 10.4045/tidsskr.15.0702.

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