15. Positively Connected For Health (PC4H): Acceptability And Feasibility of A Digital Health Adherence And Engagement In Care Intervention For Adolescents And Young Adults Living With HIV

Abstract

Adolescents and young adults (AYA) are disproportionately affected by HIV and fewer than half of AYA who are prescribed antiretroviral therapy (ART) achieve viral suppression. Digital interventions can be uniquely designed to provide support and feedback in real time as youth go about their daily lives in order to improve health literacy and ART adherence. The purpose of this study was to determine acceptability, feasibility, and preliminary efficacy of a digital health literacy workshop coupled with a medication adherence application (app) for AYA living with HIV over a 3-month period. Demonstration project (June 2017-July 2018) of AYA 14-34 years old in Philadelphia, PA linked to care at one of five health clinics who are HIV-positive, have an unsuppressed viral load (≥200 copies/ml), and/or have been out of care for ≥6 months last 24 months, and/or newly diagnosed with HIV in last 12 months. The eHealth Literacy Scale (eHEALS) was administered prior to the workshop and at the 3-month follow-up to compare confidence in navigating digital health information. Participant satisfaction was measured via electronic surveys immediately following the workshop and after 3 months of app usage. Self-reported adherence to antiretroviral therapy (ART), by visual analog scale (VAS) for past month adherence, and viral load from electronic health records were measured at baseline and 3-month follow-up. Descriptive analyses were performed and t tests for paired samples were used to compare baseline and 3-month outcomes. Analyses performed using SPSS 24. Participants (N = 41) at workshop/baseline were mean age 25.49 years (SD 4.65, range 17–34), and majority were male (73.17%), Black (73.17%), non-Hispanic/Latino (85.37%), and on ART (97.6%). Most participants (31; 75.61%) were retained at the 3-month study visit where all were still on ART and refilled ART at least once. Among 31 participants who completed eHEALs pre-workshop and 3-months post-workshop, confidence in navigating digital health information to make health decisions among respondents increased from 48.39% (15 agreed) to 70.97% (22 agreed). Of 41 participants at baseline, 92.68% (38) said the workshop helped them navigate and more likely use the app, and 85.37% (35) said the instructor knew the subject matter well. After 3 months of app usage (n=31), 61.29% (19) reported that the app helped them miss fewer doses of ART and 80.65% (25) thought the app made them more likely to call their healthcare provider with questions. Medication and appointment reminders with progress calendar were listed as the most useful app features. Self-report adherence improved (mean VAS baseline=75.19 and 3-month=89.27, p=0.02), but there was no significant difference in viral load (n=28; mean baseline=9473.36 and 3-months=7298.43, p=0.44). Study showed high satisfaction with a digital health literacy workshop and medication adherence app, high retention rates, improved confidence in digital health literacy, and self-reported adherence, but did not show significant viral load improvement over a 3-month period. PC4H is a feasible and acceptable digital health intervention for AYA living with HIV, but requires further study.