Mobile Phones and HIV Testing: Multicountry Instrumental Variable Analysis From Sub-Saharan Africa

Background: Sub-Saharan Africa has been a technological hothouse when it comes to mobile phone technology adoption.However, evidence on the role played by mobile technology on infectious disease prevention has been mostly limited to experimentalstudies. Objective: This observational study investigates the role of mobile phone connectivity on HIV testing in sub-Saharan Africa. Methods: We make use of the novel and comprehensive OpenCelliD cell tower database and Demographic and Health Surveygeocoded information for over 400,000 women in 29 sub-Saharan African countries. We examine, through ordinary least squareand instrumental variable regressions, whether women's community distance from the closest cell tower influences knowledgeabout HIV testing facilities and the likelihood of ever being tested for HIV. Results: After finding a negative and significant impact of distance to the nearest cell tower on knowledge of HIV testing facility(-0.7 percentage points per unit increase in distance) and HIV testing (-0.5 percentage points per unit increase), we investigatethe mechanisms through which such effects might occur. Our analysis shows that distance to a cell tower reduces HIV-relatedknowledge (-0.4 percentage points per unit increase) as well as reproductive health knowledge (-0.4 percentage points per unitincrease). Similar results are observed when the analysis is performed at community level.. Conclusions: Results suggest that the effect of mobile phone connectivity is channeled through increased knowledge of HIV,sexually transmittable infections, and modern contraceptive methods. Further analysis shows that cell phone ownership has aneven larger impact on HIV testing and knowledge. This paper adds to the recent literature on the impact of mobile-based HIVprevention schemes by showing through large-scale analysis that better mobile network access is a powerful tool to spreadreproductive health knowledge and increase HIV awareness