Abstract
BackgroundYouth living with HIV (YLHIV) enrolled in HIV treatment experience higher loss to follow-up, suboptimal treatment adherence, and greater HIV-related mortality compared with younger children or adults. Despite poorer health outcomes, few interventions target youth specifically. Expanding access to mobile phone technology, in low- and middle-income countries (LMICs) in particular, has increased interest in using this technology to improve health outcomes. mHealth interventions may present innovative opportunities to improve adherence and retention among YLHIV in LMICs.ObjectiveThis study aimed to test the effectiveness of a structured support group intervention, Social Media to promote Adherence and Retention in Treatment (SMART) Connections, delivered through a social media platform, on HIV treatment retention among YLHIV aged 15 to 24 years and on secondary outcomes of antiretroviral therapy (ART) adherence, HIV knowledge, and social support.MethodsWe conducted a parallel, unblinded randomized controlled trial. YLHIV enrolled in HIV treatment for less than 12 months were randomized in a 1:1 ratio to receive SMART Connections (intervention) or standard of care alone (control). We collected data at baseline and endline through structured interviews and medical record extraction. We also conducted in-depth interviews with subsets of intervention group participants. The primary outcome was retention in HIV treatment. We conducted a time-to-event analysis examining time retained in treatment from study enrollment to the date the participant was no longer classified as active-on-treatment.ResultsA total of 349 YLHIV enrolled in the study and were randomly allocated to the intervention group (n=177) or control group (n=172). Our primary analysis included data from 324 participants at endline. The probability of being retained in treatment did not differ significantly between the 2 study arms during the study. Retention was high at endline, with 75.7% (112/163) of intervention group participants and 83.4% (126/161) of control group participants active on treatment. HIV-related knowledge was significantly better in the intervention group at endline, but no statistically significant differences were found for ART adherence or social support. Intervention group participants overwhelmingly reported that the intervention was useful, that they enjoyed taking part, and that they would recommend it to other YLHIV.ConclusionsOur findings of improved HIV knowledge and high acceptability are encouraging, despite a lack of measurable effect on retention. Retention was greater than anticipated in both groups, likely a result of external efforts that began partway through the study. Qualitative data indicate that the SMART Connections intervention may have contributed to retention, adherence, and social support in ways that were not captured quantitatively. Web-based delivery of support group interventions can permit people to access information and other group members privately, when convenient, and without travel. Such digital health interventions may help fill critical gaps in services available for YLHIV.Trial RegistrationClinicalTrials.gov NCT03516318; https://clinicaltrials.gov/ct2/show/NCT03516318
Highlights
Young people aged 15 to 24 years account for more than 30% of new HIV infections, over 80% of whom live in sub-Saharan Africa (SSA); AIDS remains the leading cause of death among youth in SSA [1,2,3,4,5,6]
HIV-related knowledge was significantly better in the intervention group at endline, but no statistically significant differences were found for antiretroviral therapy (ART) adherence or social support
Intervention group participants overwhelmingly reported that the intervention was useful, that they enjoyed taking part, and that they would recommend it to other Youth living with HIV (YLHIV)
Summary
Young people aged 15 to 24 years account for more than 30% of new HIV infections, over 80% of whom live in sub-Saharan Africa (SSA); AIDS remains the leading cause of death among youth in SSA [1,2,3,4,5,6]. Despite a lack of age-disaggregated data on antiretroviral therapy (ART) coverage for youth, available data show that youth living with HIV (YLHIV) enrolled in HIV care experience higher loss to follow-up and suboptimal treatment adherence compared with younger children or adults [7,8,9,10]. Interventions to improve HIV-related outcomes implemented in low- and middle-income countries (LMICs) largely target adults and aim to improve ART adherence; fewer interventions target retention in care [12,13,14]. Youth living with HIV (YLHIV) enrolled in HIV treatment experience higher loss to follow-up, suboptimal treatment adherence, and greater HIV-related mortality compared with younger children or adults. Most participants reported having access to a mobile phone in their household (303/349, 86.8%), with 67.1% (234/349) reporting that they owned their own mobile phone.
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