A designathon to co-create community-driven HIV self-testing services for Nigerian youth: findings from a participatory event

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We organized a designathon for Nigerian youth to develop HIV self-testing (HIVST) strategies for potential implementation in their local communities. A designathon is a problem-focused event where participants work together over a short period to create and present solutions to a judging panel. Methods: We organized a 72-hour designathon for youth (14-24 years old) in Nigeria to design strategies to increase youth HIVST uptake. Proposals included details about HIVST kit service delivery, method of distribution, promotional strategy, and youth audience. Teams pitched their proposals to a diverse seven-member judging panel who scored proposals based on desirability, feasibility, potential impact and teamwork. We examined participants’ socio-demographic characteristics and summarized themes from their HIVST proposals. Results: Forty-two youth on 13 teams participated in the designathon. The median team size was 3 participants (IQR: 2–4). The median age was 22.5 years (IQR: 21–24), 66.7% were male, 47.4% completed tertiary education, and 50% lived in Lagos State. Themes from proposals included HIVST integration with other health services, digital marketing and distribution approaches, and engaging students. Judges identified seven teams with exceptional HIVST proposals and five teams were supported for further training. Conclusions: The designathon provided a structured method for incorporating youth ideas into HIV service delivery. This approach could differentiate HIV services to be more youth-friendly in Nigeria and other settings. Infectious Diseases Designathon Crowdsourcing Youth Human Immunodeficiency Virus (HIV) Self-Test Nigeria Figures Figure 1 Background Youth (age14-24 years) account for an estimated one-third of all new HIV infections globally [1]. Although youth are disproportionately affected by HIV, their contributions to the development of interventions designed for them have often been limited and sometimes tokenistic [2-9]. Youth typically contribute to research as participants, key informants, and assistants [10, 11]. While some studies have expanded youth engagement in HIV research by creating youth advisory boards (YABs), the extent of meaningful engagement varies [12-21]. Providing youth with opportunities to create solutions to health problems that affect them can enhance program implementation and build capacity for youth as co-creators [10, 22]. One strategy to meaningfully engage youth is crowdsourcing, a practice in which solutions to a social problem are solicited from multiple individuals and then shared with the public [23]. It provides space for people with diverse backgrounds to work together and share their solutions with local communities. One form of crowdsourcing is a designathon, a problem-solving event, typically held over a few days, in which participants work together to create, design, and present their proposed solutions to a panel of judges [24]. Designathons have been previously used to solve problems in education, technology, and public health. Designathons foster multi-disciplinary collaboration and can result in innovative solutions [24-26]. Responding to the need for youth engagement in HIV intervention design, we organized a designathon in Nigeria. The purpose was to develop ideas on how to promote HIV self-testing (HIVST) services among youth. This is part of the “Innovative Tools to Expand HIV Self-Testing” (ITEST) project, locally known as “4 Youth By Youth” [27]. HIVST is a process by which individuals collect their own oral fluid or blood specimen, conduct the HIV test, and interpret their results [28]. HIVST can help expand HIV testing services among those who have never tested before, such as many youth in Nigeria [28, 29]. The objective of this paper is to describe the designathon, summarize the resulting HIVST proposals, and discuss public health implications. Methods The designathon was part of a multi-phase contest in which young people shared their ideas on how to promote HIVST among youth in Nigeria. This event was one component within the study’s broader youth participatory process and we frame its processes and outcomes within this multi-phase context. We describe the initial contest (phase I) preceding the designathon and the training program (phase III) succeeding the designathon in supplementary materials (see Additional File 1: Supplement 1). We describe the designathon (phase II) below. Between March 29 – 31, 2019, we hosted the designathon in Lagos, where 13 youth teams selected to participate designed strategies to increase youth HIVST. The expected deliverables included a prototype of teams’ HIVST kit service delivery and a presentation of their idea to a panel of judges. We instructed teams to develop a community-based, youth-friendly model that would rely on modest payments. The price point was determined by earlier discrete choice experiments [30]. Day 1: We shared the purpose, rules, and expected deliverables of the contest to the teams. We familiarized participants with HIVST and briefed them about different testing kits in the Nigerian market. We scheduled panel discussions on challenges associated with standard HIV testing services and understanding the process of innovative problem-solving. Following the panel discussions, we asked participants to spend the remainder of the day in their teams to begin developing their HIVST proposals (Figure 1). Day 2: The teams participated in a presentation on how to effectively pitch their HIVST ideas. They continued working on their proposals, receiving tailored feedback (see Additional File 2: Supplement 2). Day 3: We invited an independent panel of seven judges to listen to, review any support materials, ask questions and score teams’ HIVST proposals. The judges’ expertise included telecommunications, technology, product design, youth ambassadorship, and environmental sustainability. Each team, in turn, finalized their deliverables and presented their prototypes to the judges. The judges evaluated proposals based on desirability, feasibility, impact, and teamwork. Desirability was defined as being appealing and meeting the needs of youth. Feasibility was defined as being easy to implement Nigeria. Impact was defined as having the potential to influence young people to self-test for HIV. Teamwork was defined as effectively working together. Each domain was scored on a three-point scale, with one being a low score, two being a medium score and three being a high score. The maximum score allotted to a team, from each judge, was 12 points. The top three teams were announced at the end of the designathon. The judges’ scores for each team’s HIVST proposal can be found in the supplementary materials (see Additional File 3: Supplement 3). We provided cash prizes to the top three teams: NGN 250,000 ($694) for first place, NGN 150,000 ($416) for second place, and NGN 50,000 ($138) for third place. We provided food, transportation, and accommodation to all participants. Data Analysis We performed descriptive statistics to characterize demographic data of participants. We summarized teams’ HIVST ideas with respect to their HIVST service delivery, method of distribution, promotional strategies, and youth audience. Results Participant Characteristics Forty-two young Nigerians were selected to participate in 13 teams (Table 1). The median team size was three participants (interquartile range: 2 – 4). The median age was 22.5 years (interquartile range: 21 – 24), 66.7% were male, 47.4% completed tertiary education, and 50% resided in Lagos State. Twenty-one (58.3%) participants were students and four (11.1%) were self-employed or entrepreneurs. Of 11 (30.6%) employed participants, five were members of the National Youth Service Corps (NYSC), two were nurses, two were employees at a private company, one was a laboratory assistant, and one worked in human resources. Table 1. Characteristics of participants at the designathon: Nigeria 2019 ( N = 42) n % Age (Years) 18-21 14 33.3 22-24 28 66.7 Gender Female 14 33.3 Male 28 66.7 Location (State) Abuja 2 4.8 Cross River 4 9.5 Edo 1 2.4 Enugu 5 11.9 Kwara 1 2.4 Lagos 21 50 Ondo 2 4.8 Osun 1 2.4 Oyo 4 9.5 Rivers 1 2.4 Highest Level of Education Senior Secondary 15 39.5 Some Tertiary 5 13.2 Tertiary 18 47.4 Missing 4 Occupation Employed 11 30.6 Self Employed/Entrepreneur 4 11.1 Student 21 58.3 Missing 6 Designathon Pitches The primary goal of pitches by teams was to propose solutions on how to increase HIVST among youth in Nigeria (Table 2). Their ideas varied across the HIVST service delivery, method of distribution, promotional strategies, and youth audience. HIVST Service Delivery Five teams proposed delivering HIVST kits with other STI testing or health products. Three of these teams focused on creating a bundle product that combined HIVST with self-care products (e.g. condoms, lubricants, panty liners), one of which finished in third place. Of the remaining two teams, one pitched selling two HIVST kits in one set to reduce the purchasing cost for young people and another proposed complementing HIVST with nutritional supplements. Method of Distribution Six teams proposed an online platform to sell kits. These online platforms included websites, online retail stores, and mobile phone applications. Among the six teams with an online platform, three also had an offline distribution strategy, such as placing their kits at pharmacies, retail outlets, or gyms to reach young people who may not have access to phones or the internet. Six teams proposed to distribute their kits solely offline. Among these six teams, two developed creative methods to distribute their kits. One team proposed to stock vending machines with HIVST kits in areas with more youth and another team would partner with mobile phone card vendors. Promotional Strategies Seven teams planned to use social media (WhatsApp, Facebook, Instagram, and Twitter) to conduct online marketing campaigns for their kits. One team, which finished in second place, developed their own social media application where youth could report their test results and find post-test HIV services. Three teams described a peer referral system to enhance HIVST uptake, of which two incentivized youth for peer referrals. Youth Audience Five teams planned to focus on youth in school. Four teams focused on tertiary students and one team focused on both secondary and tertiary students. One team planned to engage hard-to-reach populations such as out-of-school youth, female sex workers, and men who have sex with men. One team proposed to recruit rural adolescent girls and members of the National Youth Service Corps (NYSC), a mandatory service program for Nigerian youth. This team, which finished in first place, proposed leveraging youth service networks to distribute kits and encourage HIVST. Designathon proposals shared the following characteristics: educating youth on their health status and where to obtain appropriate services; offering care relevant to the needs of youth; and providing the opportunity for youth to participate in health service delivery. Furthermore, the teams provided youth with alternatives to clinical settings to access HIV and services. Moreover, all teams underscored the importance of maintaining young peoples’ rights to privacy and confidentiality. The teams also proposed to partner with institutions (e.g. schools, local community centers) where youth frequent to advertise and distribute their kits. Discussion We organized a designathon in which we crowdsourced ideas on how to increase HIVST among Nigerian youth. This designathon provided an opportunity for young Nigerians to collaborate and develop strategies. We extend the literature by using a designathon methodology, allowing robust input from youth, and providing structured feedback and mentorship. The designathon generated proposals that were determined by a judging panel to be potentially feasible, desirable, and impactful. The participants’ diverse backgrounds and expertise may have helped in the development of promising proposals. Youth with different perspectives can draw from their experiences to develop potentially feasible interventions. This insight is consistent with a previous designathon in the United States that brought together diverse individuals [25]. The high quality of submissions may also have been related to their knowledge of local health services and youth preferences [22]. The designathon engaged local youth and allowed them to meaningfully contribute. Youth participants led the design of HIVST interventions, which is rare in health research [31, 32]. There are implications for allowing youth to design solutions to health problems. Although the designathon was open to youth age 14-24 years, individuals selected to participate were all 18-24 years. Thus, older adolescents were more successful in presenting promising HIVST ideas. Moreover, participants were aware selected finalists would be allowed to not only design an HIVST strategy but implement it in their local areas. It is possible that this designathon encouraged a sense of community ownership among participants, which has been observed in a previous HIV-related designathon [24]. Several proposals integrated HIVST with sexual/reproductive health services. This finding is consistent with larger literature underlining the importance of integrating HIV testing services and sexual/reproductive health services [33-37]. In these other contexts, HIV testing service had been embedded within family planning, STI testing, and sexual health counseling. These studies demonstrate the integration of HIV services with other health services increases testing acceptability and health service use, improving the quality of care [33-37]. Given that many youth at risk for HIV also need other services, integrated HIV care may be an effective approach to reach young people. Our study has several limitations. First, the judges selected HIVST proposals that had the potential to be feasible, desirable, and impactful. Judges did not have outcome data on these domains when judging, but pilots are now underway. Second, designathons are typically held over a few days, much shorter than would allow them to develop a comprehensive HIVST plan. However, following our designathon, selected finalists were then invited to a four-week training program to build research and entrepreneurial skills and implement and manage their programs. Finally, the designathon is resource-intensive, which can be challenging in resource-limited settings. To minimize costs, we leveraged local resources, such as staffing from the Nigerian implementing team and passionate volunteers to serve as mentors. The designathon contained novel features, which has implications for public health research and policy. First, this event allowed youth to lead in the development of interventions that could benefit them, which is rare in many HIV programs for youth in low and middle-income countries. Designathons may provide an opportunity for youth to take health ownership and lead health research. Furthermore, results from these teams’ proposals can help HIV testing services be more responsive to the unique needs of youth. Further implementation science is needed to evaluate the effectiveness of the proposed ideas. Conclusions We described the processes and outcomes of the first health-related designathon in Nigeria that focused on improving HIVST among youth. Youth-led development of HIVST strategies offers promising solutions to expand HIVST among young people in Nigeria. Abbreviations AIDS: Acquired Immunodeficiency Syndrome; HIV: Human Immunodeficiency Virus; HIVST: HIV Self-testing; ITEST: Innovative Tools to Expand HIV Self-Testing; NGN: Nigerian Naira NYSC: National Youth Service Corps; STI: Sexually Transmitted Infection; YAB: Youth Advisory Board Declarations Ethics approval and consent to participate We obtained ethical approval from the institutional review boards of Saint Louis University (St. Louis, MO), University of North Carolina at Chapel Hill (Chapel Hill, NC), and the Nigerian Institute of Medical Research (Lagos, Nigeria). All participants provided consent to participate. The age of research consent in Nigeria is 14 years old. Consent for publication We obtained verbal consent from designathon participants to publish photographs of their participation in the event. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This work was made possible by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Grant number: UG3HD096929 and NIAID K24AI143471. The funders played no role in the design of the study and collection, analysis, interpretation of data and in writing the manuscript. Authors’ contributions KMT: data analysis, writing the manuscript. CO, TG: project administration, data collection and analysis, writing the manuscript. UN: project administration, data collection, reviewing and editing the manuscript. 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An innovation bootcamp model to develop HIV self-testing social enterprise among young people in Nigeria: a youth participatory design approach. The Lancet Global Health. 2020; 8(Suppl 1):S12. Tables Due to technical limitations, Table 2 is only available as a download in the supplemental files section Additional Files Additional File 1. File name: Additional File 1 File format: .doc Title: Supplement 1. Timeline of study events: Nigeria 2019 Additional File 2. File name: Additional File 2 File format: .pdf Title: Supplement 2. Photographs from the designathon: Nigeria 2019 Additional File 3. File name: Additional File 3 File format: .xls Title: Supplement 3. Judges' scores for all teams at the designathon: Nigeria 2019* Supplementary Files AdditionalFile1.docx AdditionalFile2.pdf AdditionalFile3.xls Table2.xls Cite Share Download PDF Status: Published Journal Publication published 31 May, 2021 Read the published version in BMC Infectious Diseases → Version 2 posted Reviewer # 1 agreed at journal 18 Nov, 2020 Reviewers invited by journal 17 Nov, 2020 Editor assigned by journal 30 Oct, 2020 Submission checks completed at journal 30 Oct, 2020 Editor invited by journal 30 Oct, 2020 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-32099","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":4296697,"identity":"51fec1db-b0fb-409c-ab5e-d21f7a499661","order_by":0,"name":"Kadija M Tahlil","email":"","orcid":"https://orcid.org/0000-0001-5792-451X","institution":"University of North Carolina at Chapel Hill","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kadija","middleName":"M","lastName":"Tahlil","suffix":""},{"id":4296698,"identity":"c21326b3-b3bf-4d4a-9852-0d3cd253145f","order_by":1,"name":"Chisom 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05:37:24","currentVersionCode":2,"declarations":"","doi":"10.21203/rs.3.rs-32099/v2","doiUrl":"https://doi.org/10.21203/rs.3.rs-32099/v2","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-021-06212-6","type":"published","date":"2021-05-31T20:51:29+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":3461569,"identity":"ecb2f368-18de-4751-a6bf-3152b2d59ad7","added_by":"auto","created_at":"2020-11-09 13:36:32","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1976007,"visible":true,"origin":"","legend":"Designathon team discussing their project and receiving mentorship from member of the contest advisory panel","description":"","filename":"Figure1Revised.jpg","url":"https://assets-eu.researchsquare.com/files/rs-32099/v2/b46821f9222efa6d7f91f23a.jpg"},{"id":13611609,"identity":"7f268ec8-6f31-4aed-90e9-f65fe107e473","added_by":"auto","created_at":"2021-09-17 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13:36:33","extension":"xls","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":34304,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.xls","url":"https://assets-eu.researchsquare.com/files/rs-32099/v2/06d2447018575e247048b5a9.xls"}],"financialInterests":"","formattedTitle":"A designathon to co-create community-driven HIV self-testing services for Nigerian youth: findings from a participatory event","fulltext":[{"header":"Background","content":"\u003cp\u003eYouth (age14-24 years) account for an estimated one-third of all new HIV infections globally [1]. Although youth are disproportionately affected by HIV, their contributions to the development of interventions designed for them have often been limited and sometimes tokenistic [2-9]. Youth typically contribute to research as participants, key informants, and assistants [10, 11]. While some studies have expanded youth engagement in HIV research by creating youth advisory boards (YABs), the extent of meaningful engagement varies [12-21]. Providing youth with opportunities to create solutions to health problems that affect them can enhance program implementation and build capacity for youth as co-creators [10, 22].\u003c/p\u003e\n\u003cp\u003eOne strategy to meaningfully engage youth is crowdsourcing, a practice in which solutions to a social problem are solicited from multiple individuals and then shared with the public [23]. It provides space for people with diverse backgrounds to work together and share their solutions with local communities. One form of crowdsourcing is a designathon, a problem-solving event, typically held over a few days, in which participants work together to create, design, and present their proposed solutions to a panel of judges [24]. Designathons have been previously used to solve problems in education, technology, and public health. Designathons foster multi-disciplinary collaboration and can result in innovative solutions [24-26].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResponding to the need for youth engagement in HIV intervention design, we organized a designathon in Nigeria. The purpose was to develop ideas on how to promote HIV self-testing (HIVST) services among youth. This is part of the \u0026ldquo;Innovative Tools to Expand HIV Self-Testing\u0026rdquo; (ITEST) project, locally known as \u0026ldquo;4 Youth By Youth\u0026rdquo; [27]. HIVST is a process by which individuals collect their own oral fluid or blood specimen, conduct the HIV test, and interpret their results [28]. HIVST can help \u0026nbsp;expand HIV testing services among those who have never tested before, such as many youth in Nigeria [28, 29]. The objective of this paper is to describe the designathon, summarize the resulting HIVST proposals, and discuss public health implications.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe designathon was part of a multi-phase contest in which young people shared their ideas on how to promote HIVST among youth in Nigeria. This event was one component within the study\u0026rsquo;s broader youth participatory process and we frame its processes and outcomes within this multi-phase context. We describe the initial contest (phase I) preceding the designathon and the training program (phase III) succeeding the designathon in supplementary materials (see Additional File 1: Supplement 1). We describe the designathon (phase II) below.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"text-align: inherit;\"\u003eBetween March 29 \u0026ndash; 31, 2019, we hosted the designathon in Lagos, where 13 youth teams selected to participate designed strategies to increase youth HIVST. The expected deliverables included a prototype of teams\u0026rsquo; HIVST kit service delivery and a presentation of their idea to a panel of judges. We instructed teams to develop a community-based, youth-friendly model that would rely on modest payments. The price point was determined by earlier discrete choice experiments [30].\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eDay 1: We shared the purpose, rules, and expected deliverables of the contest to the teams. We familiarized participants with HIVST and briefed them about different testing kits in the Nigerian market. We scheduled panel discussions on challenges associated with standard HIV testing services and understanding the process of innovative problem-solving. Following the panel discussions, we asked participants to spend the remainder of the day in their teams to begin developing their HIVST proposals (Figure 1).\u003c/p\u003e\n\u003cp\u003eDay 2: The teams participated in a presentation on how to effectively pitch their HIVST ideas. They continued working on their proposals, receiving tailored feedback (see Additional File 2: Supplement 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDay 3: We invited an independent panel of seven judges to listen to, review any support materials, ask questions and score teams\u0026rsquo; HIVST proposals. The judges\u0026rsquo; expertise included telecommunications, technology, product design, youth ambassadorship, and environmental sustainability. Each team, in turn, finalized their deliverables and presented their prototypes to the judges.\u003c/p\u003e\n\u003cp\u003eThe judges evaluated proposals based on desirability, feasibility, impact, and teamwork. \u0026nbsp;Desirability was defined as being appealing and meeting the needs of youth. Feasibility was defined as being easy to implement Nigeria. Impact was defined as having the potential to influence young people to self-test for HIV. Teamwork was defined as effectively working together. Each domain was scored on a three-point scale, with one being a low score, two being a medium score and three being a high score. The maximum score allotted to a team, from each judge, was 12 points. The top three teams were announced at the end of the designathon. The judges\u0026rsquo; scores for each team\u0026rsquo;s HIVST proposal can be found in the supplementary materials (see Additional File 3: Supplement 3). We provided cash prizes to the top three teams: NGN 250,000 ($694) for first place, NGN 150,000 ($416) for second place, and NGN 50,000 ($138) for third place. We provided food, transportation, and accommodation to all participants.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData Analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe performed descriptive statistics to characterize demographic data of participants. We summarized teams\u0026rsquo; HIVST ideas with respect to their HIVST service delivery, method of distribution, promotional strategies, and youth audience.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eParticipant Characteristics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eForty-two young Nigerians were selected to participate in 13 teams (Table 1). The median team size was three participants (interquartile range: 2 \u0026ndash; 4). The median age was 22.5 years (interquartile range: 21 \u0026ndash; 24), 66.7% were male, 47.4% completed tertiary education, and 50% resided in Lagos State. Twenty-one (58.3%) participants were students and four (11.1%) were self-employed or entrepreneurs. Of 11 (30.6%) employed participants, five were members of the National Youth Service Corps (NYSC), two were nurses, two were employees at a private company, one was a laboratory assistant, and one worked in human resources. \u0026nbsp;\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\n \u003ctable style=\"border: none;width:293.0pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 293pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 32pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"color:black;\"\u003eTable 1. Characteristics of participants at the designathon: Nigeria 2019 (\u003cem\u003eN\u003c/em\u003e = 42)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 4pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;padding: 0in 5.4pt;height: 4pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 4pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;padding: 0in 5.4pt;height: 4pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 4pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cstrong\u003e\u003cu\u003e\u003cspan style=\"color:black;\"\u003en\u003c/span\u003e\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cstrong\u003e\u003cu\u003e\u003cspan style=\"color:black;\"\u003e%\u003c/span\u003e\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"color:black;\"\u003eAge (Years)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp 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233.35pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"color:black;\"\u003eGender\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New 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style=\"color:black;\"\u003e66.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 12pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;padding: 0in 5.4pt;height: 12pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 12pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;padding: 0in 5.4pt;height: 12pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 12pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 16pt;vertical-align: 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style=\"color:black;\"\u003e9.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:24.0pt;'\u003e\u003cspan style=\"color:black;\"\u003eEdo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;padding: 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5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:24.0pt;'\u003e\u003cspan style=\"color:black;\"\u003eOsun\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e2.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:24.0pt;'\u003e\u003cspan style=\"color:black;\"\u003eOyo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e9.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:24.0pt;'\u003e\u003cspan style=\"color:black;\"\u003eRivers\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e2.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 14pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;padding: 0in 5.4pt;height: 14pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 14pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;padding: 0in 5.4pt;height: 14pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 14pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"color:black;\"\u003eHighest Level of Education\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:24.0pt;'\u003e\u003cspan style=\"color:black;\"\u003eSenior Secondary\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e15\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e39.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:24.0pt;'\u003e\u003cspan style=\"color:black;\"\u003eSome Tertiary\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e13.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:24.0pt;'\u003e\u003cspan style=\"color:black;\"\u003eTertiary\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e18\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e47.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:24.0pt;'\u003e\u003cspan style=\"color:black;\"\u003eMissing\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 14pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;padding: 0in 5.4pt;height: 14pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 14pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;padding: 0in 5.4pt;height: 14pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 14pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"color:black;\"\u003eOccupation\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:24.0pt;'\u003e\u003cspan style=\"color:black;\"\u003eEmployed\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e30.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:24.0pt;'\u003e\u003cspan style=\"color:black;\"\u003eSelf Employed/Entrepreneur\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e11.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:24.0pt;'\u003e\u003cspan style=\"color:black;\"\u003eStudent\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e21\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e58.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233.35pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:24.0pt;'\u003e\u003cspan style=\"color:black;\"\u003eMissing\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.9pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:right;'\u003e\u003cspan style=\"color:black;\"\u003e6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.95pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\u003cp\u003e\n\u003cp\u003e\u003cem\u003eDesignathon Pitches\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe primary goal of pitches by teams was to propose solutions on how to increase HIVST among youth in Nigeria (Table 2). Their ideas varied across the HIVST service delivery, method of distribution, promotional strategies, and youth audience.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHIVST Service Delivery\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFive teams proposed delivering HIVST kits with other STI testing or health products. Three of these teams focused on creating a bundle product that combined HIVST with self-care products (e.g. condoms, lubricants, panty liners), one of which finished in third place. Of the remaining two teams, one pitched selling two HIVST kits in one set to reduce the purchasing cost for young people and another proposed complementing HIVST with nutritional supplements.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMethod of Distribution\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSix teams proposed an online platform to sell kits. These online platforms included websites, online retail stores, and mobile phone applications. Among the six teams with an online platform, three also had an offline distribution strategy, such as placing their kits at pharmacies, retail outlets, or gyms to reach young people who may not have access to phones or the internet. Six teams proposed to distribute their kits solely offline. Among these six teams, two developed creative methods to distribute their kits. One team proposed to stock vending machines with HIVST kits in areas with more youth and another team would partner with mobile phone card vendors.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePromotional Strategies\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSeven teams planned to use social media (WhatsApp, Facebook, Instagram, and Twitter) to conduct online marketing campaigns for their kits. One team, which finished in second place, developed their own social media application where youth could report their test results and find post-test HIV services. Three teams described a peer referral system to enhance HIVST uptake, of which two incentivized youth for peer referrals.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eYouth Audience\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFive teams planned to focus on youth in school. Four teams focused on tertiary students and one team focused on both secondary and tertiary students. One team planned to engage hard-to-reach populations such as out-of-school youth, female sex workers, and men who have sex with men. One team proposed to recruit rural adolescent girls and members of the National Youth Service Corps (NYSC), a mandatory service program for Nigerian youth. This team, which finished in first place, proposed leveraging youth service networks to distribute kits and encourage HIVST.\u003c/p\u003e\n\u003cp\u003eDesignathon proposals shared the following characteristics: educating youth on their health status and where to obtain appropriate services; offering care relevant to the needs of youth; and providing the opportunity for youth to participate in health service delivery. Furthermore, the teams provided youth with alternatives to clinical settings to access HIV and services. Moreover, all teams underscored the importance of maintaining young peoples\u0026rsquo; rights to privacy and confidentiality. The teams also proposed to partner with institutions (e.g. schools, local community centers) where youth frequent to advertise and distribute their kits.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe organized a designathon in which we crowdsourced ideas on how to increase HIVST among Nigerian youth. This designathon provided an opportunity for young Nigerians to collaborate and develop strategies. We extend the literature by using a designathon methodology, allowing robust input from youth, and providing structured feedback and mentorship.\u003c/p\u003e\n\n\u003cp\u003eThe designathon generated proposals that were determined by a judging panel to be potentially feasible, desirable, and impactful. The participants\u0026rsquo; diverse backgrounds and expertise may have helped in the development of promising proposals. Youth with different perspectives can draw from their experiences to develop potentially feasible interventions. This insight is consistent with a previous designathon in the United States that brought together diverse individuals [25]. The high quality of submissions may also have been related to their knowledge of local health services and youth preferences [22].\u003c/p\u003e\n\n\u003cp\u003eThe designathon engaged local youth and allowed them to meaningfully contribute. Youth participants led the design of HIVST interventions, which is rare in health research [31, 32]. There are implications for allowing youth to design solutions to health problems. Although the designathon was open to youth age 14-24 years, individuals selected to participate were all 18-24 years. Thus, older adolescents were more successful in presenting promising HIVST ideas. Moreover, participants were aware selected finalists would be allowed to not only design an HIVST strategy but implement it in their local areas. It is possible that this designathon encouraged a sense of community ownership among participants, which has been observed in a previous HIV-related designathon [24].\u003c/p\u003e\n\n\u003cp\u003eSeveral proposals integrated HIVST with sexual/reproductive health services. This finding is consistent with larger literature underlining the importance of integrating HIV testing services and sexual/reproductive health services [33-37]. In these other contexts, HIV testing service had been embedded within family planning, STI testing, and sexual health counseling. These studies demonstrate the integration of HIV services with other health services increases testing acceptability and health service use, improving the quality of care [33-37]. Given that many youth at risk for HIV also need other services, integrated HIV care may be an effective approach to reach young people.\u003c/p\u003e\n\n\u003cp\u003eOur study has several limitations. First, the judges selected HIVST proposals that had the potential to be feasible, desirable, and impactful. Judges did not have outcome data on these domains when judging, but pilots are now underway. Second, designathons are typically held over a few days, much shorter than would allow them to develop a comprehensive HIVST plan. However, following our designathon, selected finalists were then invited to a four-week training program to build research and entrepreneurial skills and implement and manage their programs. Finally, the designathon is resource-intensive, which can be challenging in resource-limited settings. To minimize costs, we leveraged local resources, such as staffing from the Nigerian implementing team and passionate volunteers to serve as mentors.\u003c/p\u003e\n\n\u003cp\u003eThe designathon contained novel features, which has implications for public health research and policy. First, this event allowed youth to lead in the development of interventions that could benefit them, which is rare in many HIV programs for youth in low and middle-income countries. Designathons may provide an opportunity for youth to take health ownership and lead health research. Furthermore, results from these teams\u0026rsquo; proposals can help HIV testing services be more responsive to the unique needs of youth. Further implementation science is needed to evaluate the effectiveness of the proposed ideas.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eWe described the processes and outcomes of the first health-related designathon in Nigeria that focused on improving HIVST among youth. Youth-led development of HIVST strategies offers promising solutions to expand HIVST among young people in Nigeria.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAIDS: Acquired Immunodeficiency Syndrome; HIV: Human Immunodeficiency Virus; HIVST: HIV Self-testing; ITEST: Innovative Tools to Expand HIV Self-Testing; NGN: Nigerian Naira NYSC: National Youth Service Corps; STI: Sexually Transmitted Infection; YAB: Youth Advisory Board\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe obtained ethical approval from the institutional review boards of Saint Louis University (St. Louis, MO), University of North Carolina at Chapel Hill (Chapel Hill, NC), and the Nigerian Institute of Medical Research (Lagos, Nigeria). All participants provided consent to participate. The age of research consent in Nigeria is 14 years old.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe obtained verbal consent from designathon participants to publish photographs of their participation in the event.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis work was made possible by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Grant number: UG3HD096929 and NIAID K24AI143471. The funders played no role in the design of the study and collection, analysis, interpretation of data and in writing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026rsquo; contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eKMT: data analysis, writing the manuscript.\u003c/p\u003e\n\u003cp\u003eCO, TG: project administration, data collection and analysis, writing the manuscript.\u003c/p\u003e\n\u003cp\u003eUN: project administration, data collection, reviewing and editing the manuscript.\u003c/p\u003e\n\u003cp\u003eDO, AZM, II, JO, AND, TAB: project administration, reviewing and editing the manuscript.\u003c/p\u003e\n\u003cp\u003eCOA, NER, WT, JJO, DFC: reviewing and editing the manuscript.\u003c/p\u003e\n\u003cp\u003eJI, OE, JDT: project conceptualization and administration, reviewing and editing the manuscript, overall oversight.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the Nigerian Institute of Medical Research, Lagos State AIDS Control Agency, Lagos State Ministry of Education, Steering Committee of Social Entrepreneurship to Spur Health, PinPoint Media, 4 Youth By Youth ambassadors, the program officers and members of the Prevention and Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings Consortium, and designathon judges for their help in planning and implementing the designathon.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eUnited Nations Children's Fund.\u0026nbsp;Towards an AIDS-free Generation-Children and AIDS: Sixth Stocktaking Report. 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Integrating Routine HIV Testing into Family Planning Clinics That Treat Adolescents and Young Adults.\u0026nbsp;Public Health Rep. 2016;131 Suppl 1(Suppl 1):130\u0026ndash;138. doi:10.1177/00333549161310S115\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"35\"\u003e\n\u003cli\u003eCampos-Outcalt D, Mickey T, Weisbuch J, Jones R. Integrating routine HIV testing into a public health STD clinic.\u0026nbsp;Public Health Rep. 2006;121(2):175\u0026ndash;180. doi:10.1177/003335490612100212\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"36\"\u003e\n\u003cli\u003eDukers-Muijrers NH, Somers C, Hoebe CJ, Lowe SH, Niekamp AM, Oude Lashof A, et al. Improving sexual health for HIV patients by providing a combination of integrated public health and hospital care services; a one-group pre- and post test intervention comparison.\u0026nbsp;BMC Public Health. 2012;12:1118. Published 2012 Dec 27. doi:10.1186/1471-2458-12-1118\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"37\"\u003e\n\u003cli\u003eCoyne KM,\u0026nbsp;Hawkins F,\u0026nbsp;Desmond N. Sexual and reproductive health in HIV‐positive women: a dedicated clinic improves service.\u0026nbsp;Int J STD AIDS\u0026nbsp;2007,\u0026nbsp;18(6):\u0026nbsp;420‐\u0026nbsp;421.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"38\"\u003e\n\u003cli\u003eNwaozuru U, Gbajabiamila T, Obiezu-Umeh C, Uzoaru F, Mason S, \u003cstrong\u003eTahlil K\u003c/strong\u003e, et al. An innovation bootcamp model to develop HIV self-testing social enterprise among young people in Nigeria: a youth participatory design approach. The Lancet Global Health. 2020; 8(Suppl 1):S12.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cspan style=\"font-weight: 400;\"\u003eDue to technical limitations, Table 2 is only available as a download in the supplemental files section\u003c/span\u003e\u003c/p\u003e"},{"header":"Additional Files","content":"\u003cp\u003e\u003cem\u003eAdditional File 1.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFile name: Additional File 1\u003c/p\u003e\n\u003cp\u003eFile format: .doc\u003c/p\u003e\n\u003cp\u003eTitle: Supplement 1. Timeline of study events: Nigeria 2019\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAdditional File 2.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFile name: Additional File 2\u003c/p\u003e\n\u003cp\u003eFile format: .pdf\u003c/p\u003e\n\u003cp\u003eTitle: Supplement 2. Photographs from the designathon: Nigeria 2019\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAdditional File 3.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFile name: Additional File 3\u003c/p\u003e\n\u003cp\u003eFile format: .xls\u003c/p\u003e\n\u003cp\u003eTitle: Supplement 3. Judges' scores for all teams at the designathon: Nigeria 2019*\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Designathon, Crowdsourcing, Youth, Human Immunodeficiency Virus (HIV), Self-Test, Nigeria","lastPublishedDoi":"10.21203/rs.3.rs-32099/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-32099/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eYouth are at high risk for HIV, but are often left out of designing interventions, including those focused on adolescents. We organized a designathon for Nigerian youth to develop HIV self-testing (HIVST) strategies for potential implementation in their local communities. A designathon is a problem-focused event where participants work together over a short period to create and present solutions to a judging panel.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe organized a 72-hour designathon for youth (14-24 years old) in Nigeria to design strategies to increase youth HIVST uptake. Proposals included details about HIVST kit service delivery, method of distribution, promotional strategy, and youth audience. Teams pitched their proposals to a diverse seven-member judging panel who scored proposals based on desirability, feasibility, potential impact and teamwork. We examined participants’ socio-demographic characteristics and summarized themes from their HIVST proposals.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eForty-two youth on 13 teams participated in the designathon. The median team size was 3 participants (IQR: 2–4). The median age was 22.5 years (IQR: 21–24), 66.7% were male, 47.4% completed tertiary education, and 50% lived in Lagos State. Themes from proposals included HIVST integration with other health services, digital marketing and distribution approaches, and engaging students. Judges identified seven teams with exceptional HIVST proposals and five teams were supported for further training.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe designathon provided a structured method for incorporating youth ideas into HIV service delivery. This approach could differentiate HIV services to be more youth-friendly in Nigeria and other settings.\u003c/p\u003e","manuscriptTitle":"A designathon to co-create community-driven HIV self-testing services for Nigerian youth: findings from a participatory event","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2020-11-09 13:36:30","doi":"10.21203/rs.3.rs-32099/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2020-11-19T00:00:00+00:00","index":1,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-11-18T00:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-10-31T00:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-10-30T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-10-30T23:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2020-06-19 13:55:02","doi":"10.21203/rs.3.rs-32099/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-10-20T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-10-12T12:00:00+00:00","index":2,"fulltext":"Recommendation: Reject\nForm responses:\n---\n\nComments to Author:\n---\nThank you for the opportunity to review this manuscript, which is about co-creation of HIV-self testing services with the youth in Nigeria. I accept that the topic presented here is important, and participation of the target population is crucial. However, this manuscript was reviewed as research, but I find that it misses basic features of a research study, particularly methodological. Therefore, I am not able to accept this paper as research. I may suggest that you could have submitted this as best practice or public health action, given the presented innovative entrepreneurial aspects of the project. However, two aspects are important, an ethical approved research process should have been presented, and it was not, and the designathon as presented should have been part of broader intervention development package, not standalone, so that evidence can be embedded into the design, with a clear evaluation research component, for both process and outcome. This is to say, I am familiar with the importance of implementation science, and the role of participatory approaches with these approaches, but request that the basic principles of systematic ethical research not be overlooked even with co-design strategies.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **No**\n* Are the methods sufficiently described to allow the study to be repeated?: **No**\n* Is the use of statistics and treatment of uncertainties appropriate?: **No**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewerAgreed","content":"","date":"2020-09-11T12:00:00+00:00","index":2,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-07-22T12:00:00+00:00","index":1,"fulltext":"Recommendation: Major revisions required\nForm responses:\n---\n\nComments to Author:\n---\nThis seems to be a novel methodology which is effective in engaging young people. As the assessment was based on four items, ie. desirability, feasibility, potential impact and team work, as a reader, I would have expected to see the summary of how the responses were measured and to see the outcomes in the results. That is, although it was stated that these were used, it was no clear how these were summarised to reach the conclusion. were the four assessment responses measured using any scale such as five point likert (1) Strongly disagree; (2) Disagree; (3) Neither agree nor disagree; (4) Agree; (5) Strongly agree.\n\nYou have included the information about who won in the additional files. As per above, it would be good to include outcomes including the winning team strategies in the manuscripts as opposed to the additional files.\n\n\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. 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