JMIR Publications

ABSTRACT

Background:

Sub-Saharan Africa is most severely affected by the HIV epidemic, particularly Zambia. Young people with HIV (YPWH) are disproportionately impacted by HIV/AIDS. Emerging adulthood (ages 18-24) is characterized by increasing independence, risk-taking behaviors, identity exploration, and changing social supports, all of which may impact HIV self-management, including medication adherence, retention in care. Substance use may further undermine HIV outcomes. Innovative and scalable interventions targeting HIV self-management and substance use reduction among Zambian YPWH are urgently needed.

Objective:

We propose to develop and pilot a multicomponent mobile health (mHealth) intervention to improve HIV self-management and reduce substance use among YPWH in Zambia. We will adapt the 4-session in-person Healthy Choices intervention for mobile delivery (mHC) to increase access and delivery. We will also develop Motivational Text Messaging (MTM) to enhance intervention impact. Both components will be delivered using the Computerized Intervention Authoring System (CIAS). Using the Multiphase Optimization Strategy (MOST) framework, we will assess preliminary efficacy of the resulting intervention and identify the most effective component or combination of components.

Methods:

The study includes 3 phases. Phase I will conduct focus groups with Zambian YPWH to explore barriers and facilitators of HIV self-management and substance use to inform intervention adaptation. Phase II will involve adaptation and beta-testing of mHC and MTM for functionality and feasibility using a community advisory board. Phase III will consist of a pilot trial using the MOST framework to evaluate feasibility, acceptability, and preliminary efficacy of intervention components. A total of 100 YPWH will be randomized to one of four experimental conditions: (1) standard ART counseling (SAC), (2) mHC + SAC, (3) MTM + SAC, and (4) mHC + MTM + SAC. Feasibility and acceptability will be assessed through intervention paradata of usage patterns, and the System Usability Scale. Preliminary impact will be evaluated using ART adherence and substance use outcomes. Participants will complete assessments at baseline and at 3- and 6-month follow-up visits. Biomarkers of ART adherence and HIV/sexually transmitted infections will also be collected.

Results:

Recruitment for this study began in May 2024 for Phase 1. Focus group discussions were completed with 48 young YPWH in July 2024. Phase 3, the pilot feasibility trial began in June 2025. Upon project completion, we will have developed an innovative mobile health intervention to support HIV self-management and reduce substance use among Zambian YPWH, which will be ready for testing in a larger efficacy trial.

Conclusions:

This study addresses a critical problem—suboptimal ART adherence, substance use, and challenges with HIV self-management—among YPWH in Zambia. We are developing two potentially synergistic, technology-based, theory-driven intervention components aimed at improving HIV self-management and substance use outcomes. Our study is responsive to the need for scalable interventions to improve HIV outcomes. If successful, this study will pave the way for the scale-up of mHealth interventions to improve HIV care outcomes among YPWH in Zambia and other low-resource settings. Clinical Trial: ClinicalTrials.gov ID: NCT06415357; https://clinicaltrials.gov/study/NCT06415357?cond=hiv&aggFilters=status: