JMIR Publications

ABSTRACT

Background:

HIV continues to be a public health challenge adversely affecting youth and young adults, as they are the fastest growing group of new HIV infections in the U.S. Among these, sexual and gender minorities primarily men who have sex with men (MSM) and trans women are disproportionately affected. Furthermore, young people living with HIV (YPLWH) have poorer outcomes across the HIV care continuum. HIV prevention science has turned to mobile health (mHealth) as a novel approach to reach and engage YPLWH experiencing barriers to HIV care.

Objective:

This study assesses feasibility and acceptability of a digital HIV care navigation intervention for YPLWH in San Francisco. Health eNavigation (or Health eNav) is a 6-month digital HIV care navigation intervention using SMS text messaging to connect YPLWH to their own digital HIV care navigator and improve engagement in HIV primary care. Digital HIV care navigation included delivery of the following: 1) HIV care navigation, 2) health promotion and education, 3) motivational interviewing, and 4) digital social support.

Methods:

We evaluated the feasibility and acceptability of a digital HIV care navigation intervention among YPLWH. We assessed feasibility using quantitative data for the overall sample (N=120) to describe participant engagement with the intervention. We collected back-end data from a third-party text messaging platform. All text messages sent during the 6-month intervention period between an individual participant and their digital HIV care navigator were captured and maintained locally in a database and included date, time and body of each text message sent. We assessed acceptability by conducting semi-structured, in-depth interviews with a sub-sample of 16 participants twelve months after enrollment. Participants were purposively sampled in order to obtain diversity in levels of engagement, race/ethnicity, and gender identity. Interviews were audio-recorded and transcribed verbatim. Transcriptions were randomly checked for quality and accuracy against original recordings. Qualitative interview data were coded and analyzed using grounded theory.

Results:

Overall, the digital HIV care navigation intervention was feasible and acceptable. The majority of participants exhibited medium or high levels of engagement (41.67% and 21.67%, respectively). Of the majority of participants who were newly diagnosed with HIV, 63% (or 24/38) had medium to high engagement. Similarly, among those who were not newly diagnosed, 63% (or 52/82) had medium to high engagement. The majority of participants found that the intervention was added value to their lives and improved their engagement in HIV care, medication adherence, and viral suppression.

Conclusions:

Digital HIV care navigation is a potentially powerful tool that may help bridge the gaps for linkage and retention and improve overall engagement in HIV care for many YMSM and young trans women living with HIV. By utilizing digital technology, Health eNav capitalizes on the familiarity and accessibility of mobile devices and social media platforms to engage with hard-to-reach YPLWH who confront unique barriers to HIV care. Our results indicate that participation in digital HIV care navigation is both feasible and acceptable, across pervasive structural barriers that would otherwise hinder intervention engagement.