JMIR Publications

ABSTRACT

Background:

Young people are disproportionately impacted by HIV infection and exhibit poor HIV care continuum outcomes. mHealth interventions have promise to meet the unique needs of young people living with HIV (YPLWH). Youth-focused interventions are needed to improve HIV care continuum outcomes.

Objective:

This study assesses the preliminary efficacy and impact of a digital HIV care navigation intervention among young people living with HIV (YPLWH) in San Francisco. Health eNavigation (or Health eNav) is a 6-month text message-based, digital HIV care navigation intervention where YPLWH were connected to their own HIV care navigator through text messaging to improve engagement in HIV primary care.

Methods:

This is a single-arm, prospective, pre-post design study. Eligibility criteria for the study included: identifying as a man who has sex with men or a trans woman; being between the ages of 18 and 34 years; and being newly diagnosed with HIV or not being engaged/retained in HIV care or having a detectable viral load. 120 young men who have sex with men or trans women living with HIV were included in this analysis. We analyzed self-reported socio-behavioral information pre- and post-intervention at baseline and 6-months collected using computer assisted self-interviewing (CASI) surveys. We characterize the sample and built generalized estimating equation (GEE) models to assess differences in HIV care continuum outcomes at baseline and 6-month.

Results:

Overall, characteristics by intervention completion status were not statistically different from the crude sample. The average age of participants was about 28 years. Most participants identified as men. The sample was racially/ethnically diverse, and about half of all participants completed some college education, yet most lived in unstable housing and made monthly incomes of $1300 or less. At baseline, a majority of participants had recently received primary HIV care, yet those who completed the intervention were more likely to do so (90.00% vs. 75.00%, χ2 = 4.68, p = 0.03). More than half of the sample reported taking ART and having an undetectable viral load. Eighty-eight (73.33%) participants completed their 6-month follow-up surveys and these participants were not characteristically different from the full sample at baseline. GEE models indicated that participants had increased odds of viral suppression at 6 months compared to baseline. No statistically significant additive or multiplicative interactions comparing outcome effects over time by intervention completion.

Conclusions:

Digital HIV care navigation fills a critical gap in the public health and HIV care systems, making these systems more responsive and accountable to the needs of those most vulnerable. Our intervention bridges the time in between primary care visits with interactive, tailored, personalized, peer-delivered social support, information, and motivational interviewing to scaffold behavior change. This study is part of the next wave of systems-informed mHealth intervention research that will offer potentially disruptive solutions to traditional, in-person delivered interventions and improve the health of the most vulnerable.