Our crowdsourcing open call consisted of a 5-step process including digital crowdsourcing open call, web-based submissions, judging, analysis of themes, and common themes identified (Figure 1) throughout the design and implementation, data collection, and data analysis phases.

For this study, we used crowdsourcing, which involves a group of individuals working together to solve a problem and then publicly share the solutions [13,14]. The 4 Youth By Youth (4YBY) team announced a crowdsourcing open call to promote HIVST among young people in Nigeria from November 2 to 22, 2020. 4YBY is a team of young people, health professionals, activists, and entrepreneurs from diverse backgrounds, who are united by the shared passion to advance Nigerian youth participation in creating innovative, sustainable HIV prevention services. The “World’s AIDS Day HIV Self-Testing Contest” was held on December 1, 2020, to commemorate the annual WAD celebration. Due to the COVID-19 pandemic, we only used web-based engagement to recruit Nigerian young people between the ages of 14 and 24 years to take part in the crowdsourcing open call. To guarantee that a varied range of Nigerian young people from various backgrounds were involved, purposive sampling procedures were used [15]. The 4YBY team sent the crowdsourcing open call information to youth listservs and advertised on all social media platforms, including Instagram, Facebook, WhatsApp, and a website. The goal of the digital crowdsourcing open call was to provide open and safe areas for Nigerian young people to express their thoughts and ideas about how to promote HIVST during the pandemic. Individual demographic and contact information such as name, number, age, gender identity, education, and location were collected for each entrant.

Participants responded to the prompt “How might you promote HIV self-testing among young people during COVID-19 measures?” using either Google Forms or email. Each submission had a word limit of 150 words to succinctly capture their unique ideas for HIV promotion throughout the pandemic. Consent to participate and demographic information were also obtained from each participant. The requested demographic information included contact information, age, gender, relationship status, current location, highest level of completed education, and occupation. Individuals had the option of not reporting sociodemographic characteristics.

Two research members (CO-U and UN) checked for the eligibility of each submission. Four independent reviewers (AE, SM, AZM, and TG) rated participant entries based on defined judging criteria, which included desirability, feasibility, and impact (Textbox 1). Each submission received either a 1 (low), 2 (moderate), or 3 (high) for each of the 3 defined judging criteria, with the highest overall combined score being 9. This process was adapted from the human-centered, design thinking framework [15,16]. The first, second, and third place contestants each earned a monetary prize for their outstanding submission: 50,000 Naira (approximately US $139) for third place, 150,000 Naira (approximately US $417) for second place, and 250,000 Naira (approximately US $694) for third place.

Following the crowdsourcing open call’s conclusion, staff deidentified each entry and used summary statistics to compile the participants’ demographic data. A thematic analysis was conducted using open coding that assigns themes to capture specific ideas and axial coding, which explores linkages between concepts and categories and determines common themes [17,18]. The coding exercises were completed in a Google Spreadsheet by trained staff who were not part of the study team, and then a thematic codebook was constructed and used to assess qualitative data. Each of the 2 staff members (OA and AE) coded the crowdsourcing open call entries separately before meeting to resolve any discrepancies in coding judgments. The codebook was then created by consensus between the 2 researchers (CO-U and UN) [18]. Throughout the coding process, recurring themes were identified, and codes were created to meet the HIVST promotion themes. The staff members reread each submission a final time after developing the initial codebook to fine-tune the final codebook. Snapshots of entries that fit in each code were included in the final codebook. This was then forwarded to a third party for final examination and approval.

Regulatory approval to conduct the research was received from the Nigerian Institute of Medical Research Institutional Review Board (Project #: IRB 18/028). Informed consent was obtained from all participants involved in the study. Following the conclusion of the crowdsourcing open call, each entry was deidentified to ensure anonymity. These measures were implemented to uphold ethical standards, ensuring participant protection and transparency throughout the research process. Additionally, monetary compensation was awarded to first-, second-, and third-place submissions.

The 2020 digital WAD crowdsourcing open call received a total of 153 entries from Nigerians aged 14 to 24 years, of which 83.7% (n=128) were through Google Forms, and 16.3% (n=25) were by email. Of the 153 entries, there were 125 unique submissions identified after duplicates (n=24), and those submissions that could not be scored based on our inclusion criteria (n=4) were removed. Characteristics and demographics were collected for the 125 eligible, unique submissions.

The majority of the entrants were male (n=65, 52%). There were 44 (35.2%) female individuals, 1 (0.8%) individual preferred not to say their gender, and 15 (12%) gender responses were left missing. The average age of the entrants was 19.96 (SD 2.73) years, and the median age was also 20 (IQR 24-20) years. The breakdown of the number of individuals per age group is as follows: 48 (38.4%) individuals aged 14-19 years and 64 (51.2%) individuals aged 20-24 years. The highest level of education obtained by participants was mostly senior secondary school (n=61, 48.8%), followed by some tertiary school (n=22, 17.6%), bachelor’s degree (n=17, 13.6%), junior secondary school (n=4, 3.2%), primary school (n=2, 1.6%), and master’s degree (n=2, 1.6%). In total, 15 (12%) individuals did not report their highest level of education. The majority of entrants lived in Lagos state (n=36, 28.8%) and in the South-West region (n=61, 48.8%). Table 1 includes the characteristics of the eligible submissions.

Of the 125 eligible submissions, the mean score of the submissions was 5.42 (1.65). In total, 20 participants were selected as finalists with their submissions scoring as 7.5 or above. Three submissions were selected as the top submissions and were given a prize (Multimedia Appendix 1).

The average word count of Google Forms submissions was 425.27 (SD 392.91) words. Two videos were submitted with lengths of 4.3 and 6.4 minutes. A total of 5 submissions included images, 1 submission consisted of a video and images, 1 entrant submitted a PowerPoint (Microsoft Corp) presentation file, and 4 submissions included a combination of images and text. All other entries were text submissions.

Following the conclusion of the digital crowdsourcing event, the top-scored ideas generated informed the refinement of a youth-friendly HIVST intervention delivery, particularly focusing on enhancing linkage to care. This refined intervention is to be evaluated in a randomized controlled trial (ClinicalTrials.gov NCT04710784).

This digital WAD crowdsourcing open call administered during the COVID-19 pandemic generated ideas on how HIVST uptake can be increased among Nigerians in the course of the COVID-19 pandemic. The study illustrated efforts to reach young people creatively to facilitate HIVST while being compliant with the COVID-19 pandemic. Our findings also highlight accessible, affordable, and feasible ways to create awareness of HIVST throughout the COVID-19 pandemic and after the pandemic.

Our data suggest that HIVST can be effectively used to meet the demands of young people’s HIV testing during the pandemic. The COVID-19 pandemic created countless barriers that required the public to rethink a way around the norm and develop new strategies to overcome the obstacles, specifically reconsidering how to promote and fulfill HIVST services [19]. For example, across Nigeria, there were many disruptions to health care services [20], including those of HIV and sexually transmitted infections [9,21]. Yet, there was a need for innovative public health and social measures to reduce the disruptions caused by the pandemic [22]. Our crowdsourcing open call illustrated how a digital program can be used as a strategy to promote HIVST services that are compliant with the COVID-19 guidelines carried out in Nigeria [23]. Digital activities such as our crowdsourcing open call allowed for COVID-19 mitigation measures to continue to occur successfully while being compliant with government guidance [24,25].

Participants generated ideas on how HIVST distribution can be modified to adhere to the ongoing restrictions caused by the pandemic through channels that are digital as well as existing infrastructures and partnerships with key players. The ideas proposed can help form future campaigns, specifically during a time of limited physical interaction, and can pave the way toward more innovative and cost-saving techniques.

This study was held completely digitally due to the COVID-19 pandemic. It was a safe way to connect with individuals across Nigeria and administer new ideas that followed COVID-19 regulations. Although a large number of individuals participated in our crowdsourcing open call, it was significantly less than our crowdsourcing open calls in previous years 2018 and 2019 [15]. This could be related to competing COVID-19 demands. Though we gave the options of both web-based or offline submissions, all submissions were received via email or Google Forms. We recognize that technological advancements are continually occurring globally, and many young people have access to a mobile device, laptop, or computer [26]. In Nigeria, 63.8% of the population had internet access in 2020 [27]. However, internet connections are not always reliable and lead to issues during web-based learning or streaming [26]. Because our digital crowdsourcing open call was held via Zoom (Zoom Video Communications), this may have averted individuals from the crowdsourcing open call, knowing that they may have a possibility of internet connection issues.

However, as in previous years, the crowdsourcing open call engaged a wide range of young people and allowed them to voice their ideas on how to promote HIVST through various innovative strategies [15]. Crowdsourcing is not only a strategic way to receive solutions [9,10] but also very unique in the way that it includes individuals with different perspectives and creates meaningful participation among young people [13,14,28]. Our crowdsourcing open call accentuated this with youth participation and the development of ideas to prospectively scale up HIVST among young people and in communities throughout Nigeria. Harnessing young people’s concepts through crowdsourcing open calls captivates young people’s perspectives and potentially enhances mobilization efforts. Young people generated adapted, effective, and original strategies relating to the design, distribution, and education of HIVST kits during the COVID-19 era. We showed how young people can engage, produce innovative approaches, and create in-person or web-based connections.

This study has several limitations. First, most ineligible entries were those submitted via Google Forms, with 24 as duplicates and 2 as submissions that could not be scored. Second, many submissions included text that did not specifically answer the crowdsourcing open-call question, such as those that defined HIV and those that described the burden of HIV in Nigeria. These limitations highlight a need for better communication and marketing of the crowdsourcing event so individuals fully understand the objective of the crowdsourcing open call and prompt being asked. Third, this study inevitably had selection bias, in which some individuals may have been more likely selected than others, and the group of participants may not have been equally representative of all ages of young people in Nigeria (14 to 24 years). In addition, the crowdsourcing open call was completely web-based, and submissions were submitted through Google Forms and email, which may have excluded individuals who wanted to participate but had limited or no access to the internet. Fourth, analytical bias may have been introduced during the evaluation or scoring process. Finally, demographic information was more frequently missing in email submissions (ie, age and gender), whereas participants who submitted via Google Forms filled in the age and gender question.

Findings from this study will help inform and improve strategies of HIVST to increase HIVST uptake in Nigeria during the COVID-19 pandemic and for years to come in the postpandemic era. This study implies that crowdsourcing and involvement of young people are valuable in identifying current and unconventional HIVST uptake strategies, particularly during an ongoing pandemic, and should also be considered in other aspects of research.

Though the study has many limitations, the crowdsourcing open call engaged a large, diverse number of young people through digital connections. The entrants suggested a diverse range of innovative techniques to increase the uptake of HIVST for vulnerable young people in Nigeria. Their tailored strategies to promote HIVST during the COVID-19 pandemic indicate that HIVST is a feasible method of testing despite barriers relating to physical interactions and in-person testing facilities. Findings from our crowdsourcing open call will inform future research on promoting HIVST and can contribute to the sustainability of HIVST even in times of unprecedented crises.