JMIR Publications

ABSTRACT

Background:

Youth living with HIV (YLHIV) enrolled in HIV treatment experience higher loss to follow up, sub-optimal treatment adherence, and greater HIV-related mortality compared to 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 (LMIC) in particular, has increased interest in using this technology to improve health outcomes. Digital health interventions may present innovative opportunities to improve adherence and retention among YLHIV in LMIC.

Objective:

To test the effectiveness of a structured support group intervention, SMART Connections delivered through a social-media platform, on HIV treatment retention among YLHIV ages 15 to 24 years, as well as on secondary outcomes of ART adherence, HIV knowledge, and social support.

Methods:

We conducted a parallel, randomized-controlled, unblinded 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). Health providers referred potentially eligible patients to study staff who recruited them to participate in the health facility. We collected data at baseline and endline through structured interviews and medical record extraction. We also conducted in-depth interviews (IDI) 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.

Results:

353 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 two study arms during of the study. Retention was high at endline 75.7% of intervention groups participants, and 83.4% of control group participants active on treatment. HIV-related knowledge was significantly better in the intervention group at endline, but no statistically significance 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.

Conclusions:

Our findings of improved HIV knowledge and high acceptability are encouraging, despite a lack of measurable effect on retention. Greater than anticipated retention in both groups was likely a result of external efforts that began part-way through the study. Qualitative data indicate that the SMART Connections intervention may have contributed to retention, adherence and social support in ways that we were not able to capture quantitatively. Online 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. Clinical Trial: ClinicalTrials.gov NCT03516318