15. Positively Connected For Health (PC4H): Acceptability And Feasibility of A Digital Health Adherence And Engagement In Care Intervention For Adolescents And Young Adults Living With HIV

Abstract

SBHC staff, and use of performance improvement tools led by an Implementation Coach) and staff-level initiatives (trainings, technical assistance and incentives). Three matched-pairs of SBHCs were assigned to two cohorts to receive the same intervention: Cohort 1 initiated in Fall 2016, Cohort 2 in Fall 2017. All patients seen at least once in baseline and intervention years were included for analysis. Outcomes were the offer of an annual HIV test by the clinical staff and the acceptance of testing by the adolescents. Predictors examined included the intervention year, age > 16 years, gender, and ever having been sexually active. For each outcome, we fitted a logistic mixed effects model separately for each cohort. Odds ratios for each variable were calculated, p values set at < .01. Results: Combining both cohorts, there were 5504 unique patients in the baseline year and 5925 in the intervention year, of which the mean age was 15.9 (SD ¼ 1.43), 58.3% were female, 49.1% Hispanic, 26.5% Black and 36.3% had ever been sexually active. The odds of an HIV test offer for Cohort 1 increased by 14% (p ¼ 0.0043) from baseline (14.1%) to intervention (16.8%), and for Cohort 2 by 40% (p < 0.0001) from baseline (8.8%) to intervention (11.6%). Among those offered HIV testing, the odds of test acceptance increased in Cohort 1 by 81% (p < 0.0001) from baseline (34.6%) to intervention (47.8%) and in Cohort 2 by 59% (p < 0.0001) from baseline (59.0%) to intervention (67.7%). Both analyses were adjusted for age, gender, and sexual activity. Females tended to have lower odds of being offered testing within both Cohort 1 (OR ¼ 0.75) and Cohort 2 (OR ¼ 0.67), (p < 0.0001). Ever having been sexually active was associated with increased odds of an HIV test offer (Cohort 1 OR ¼ 1.56, p < 0.0001; Cohort 2 OR ¼ 1.99, p < 0.0001), as well as HIV test acceptance (Cohort 1 OR¼4.45, p<0.0001; Cohort 2 OR¼3.78, p<0.0001). Conclusions: To date, the implementation intervention increased both the offer and acceptance of HIV testing, with males more likely to be offered testing and with sexually active students more likely to be offered and to accept testing. Implementation activities will continue for one more year for each Cohort as we explore further innovations to increase universal testing and efforts to sustain these improvements.

PEERNaija: A Gamified mHealth Behavioral Intervention to Improve Adherence to Antiretroviral Treatment Among Adolescents and Young Adults in Nigeria

“…Below, we report details of the PEERNaija development process, as well as the resulting product based on the IDEAS phases, with each phase used to inform the next step of the development process. (32)(33)(34) for AYA-HIV in the US, and data from systematic reviews highlighting barriers to medication adherence guided the Empathize phase of the development process (4-6, 8). Dr. Ahonkhai's preliminary quantitative data demonstrated that 40% of Nigerian AYA-HIV who remained in care 1 year after starting ART had virologic failure (HIV RNA > 1,000 copies/mL) (4).…”

“…Qualitative insights into the needs and thought processes of AYA-HIV were gathered from formative, in-depth interviews from Nigerian AYA-HIV, as well as by Dowshen et al through the development of the TreatYourSelf mHealth application (32)(33)(34). Ahonkhai conducted semi-structured in-depth interviews with 20 AYA-HIV at the study site, NIMR.…”

“…They had not been exposed to adherence apps themselves but thought app-based reminders and peer social support would be important features of such an intervention. Further, through the conduct of formative participatory design workshops, the TreatYourSelf team identified five themes that were important to users: (1) positive and non-judgmental tone, (2) minimal, avatar-based gamification, (3) motivational messages, (4) nondisclosure through neutral signifiers, and (5) social support through camaraderie (32)(33)(34). All but one (theme 2) of these themes were supported by growing literature on SMS-based reminder interventions (26,29,30) and was consistent with the overall sentiments of Nigerian youth; thus, were incorporated into the PEERNaija prototype (32)(33)(34).…”

“…The process is more deliberative than a focus group, and the participants are compensated as stakeholder "experts" (82). The first studio session included Children's Hospital of Philadelphia researchers who developed the TreatYourSelf mobile application for use among AYA-HIV in the US (32)(33)(34). For the second studio session, we invited key stakeholders who work with AYA-HIV in Nigeria including: (a) public health officials active in the oversight and administration of a network of HIV care and treatment centers, (b) pediatric and adolescent providers, and (c) adolescent HIV counselors.…”

“…In this paper, we describe the design and development of the PEERNaija smartphone application. Informed by TreatYourSelf, a smart phone-based application designed with input from AYA-HIV in Philadelphia, was created using an EMA for AYA-HIV in the United States (US), and has demonstrated feasibility and short-term (3 month) improvement in selfreported adherence (32)(33)(34). Key features of the guiding application include medication reminders and adherence tracking, refill and appointment reminders, leaderboard and adherence points, internal community supports through discussion forums, peer-to-peer kudos, and community-based resources list.…”