Dulli Lisa, Ridgeway Kathleen, Packer Catherine, Murray Kate R, Mumuni Tolulope, Plourde Kate F, Chen Mario, Olumide Adesola, Ojengbede Oladosu, McCarraher Donna R
FHI 360, Durham, NC, United States.
Center for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
J Med Internet Res. 2020 Jun 2;22(6):e18343. doi: 10.2196/18343.
Youth living with HIV (YLHIV) enrolled in HIV treatment experience higher loss to follow-up, suboptimal treatment adherence, and greater HIV-related mortality compared with 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 (LMICs) in particular, has increased interest in using this technology to improve health outcomes. mHealth interventions may present innovative opportunities to improve adherence and retention among YLHIV in LMICs.
This study aimed to test the effectiveness of a structured support group intervention, Social Media to promote Adherence and Retention in Treatment (SMART) Connections, delivered through a social media platform, on HIV treatment retention among YLHIV aged 15 to 24 years and on secondary outcomes of antiretroviral therapy (ART) adherence, HIV knowledge, and social support.
We conducted a parallel, unblinded randomized controlled 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). We collected data at baseline and endline through structured interviews and medical record extraction. We also conducted in-depth interviews 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.
A total of 349 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 2 study arms during the study. Retention was high at endline, with 75.7% (112/163) of intervention group participants and 83.4% (126/161) of control group participants active on treatment. HIV-related knowledge was significantly better in the intervention group at endline, but no statistically significant 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.
Our findings of improved HIV knowledge and high acceptability are encouraging, despite a lack of measurable effect on retention. Retention was greater than anticipated in both groups, likely a result of external efforts that began partway through the study. Qualitative data indicate that the SMART Connections intervention may have contributed to retention, adherence, and social support in ways that were not captured quantitatively. Web-based 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.
ClinicalTrials.gov NCT03516318; https://clinicaltrials.gov/ct2/show/NCT03516318.
与年幼儿童或成年人相比，接受艾滋病治疗的感染艾滋病毒青年（YLHIV）失访率更高、治疗依从性欠佳且与艾滋病相关的死亡率更高。尽管健康结局较差，但专门针对青年的干预措施却很少。特别是在低收入和中等收入国家（LMICs），移动电话技术的普及使人们对利用该技术改善健康结局的兴趣日益浓厚。移动医疗干预措施可能为改善LMICs中YLHIV的依从性和治疗留存率带来创新机遇。
本研究旨在测试通过社交媒体平台提供的结构化支持小组干预措施“社交媒体促进治疗依从性和留存率（SMART）连接”对15至24岁YLHIV的艾滋病治疗留存率以及抗逆转录病毒疗法（ART）依从性、艾滋病知识和社会支持等次要结局的有效性。
我们开展了一项平行、非盲随机对照试验。将接受艾滋病治疗少于12个月的YLHIV按1:1比例随机分组，分别接受SMART连接（干预组）或仅接受标准治疗（对照组）。我们通过结构化访谈和病历提取在基线和终线时收集数据。我们还对干预组部分参与者进行了深入访谈。主要结局是艾滋病治疗的留存率。我们进行了一项事件发生时间分析，考察从研究入组到参与者不再被归类为正在接受治疗之日的治疗留存时间。
共有349名YLHIV参与了本研究并被随机分配至干预组（n = 177）或对照组（n = 172）。我们的主要分析纳入了终线时324名参与者的数据。在研究期间，两个研究组的治疗留存概率无显著差异。终线时留存率较高，干预组75.7%（112/163）的参与者和对照组83.4%（126/161）的参与者正在接受治疗。干预组终线时与艾滋病相关的知识明显更好，但在ART依从性或社会支持方面未发现统计学显著差异。干预组参与者压倒性地报告称该干预措施有用，他们乐于参与，并且会向其他YLHIV推荐。
尽管对留存率缺乏可衡量的效果，但我们关于艾滋病知识改善和高可接受性的研究结果令人鼓舞。两组的留存率均高于预期，这可能是研究进行到一半时开始的外部努力所致。定性数据表明，SMART连接干预措施可能以未被定量捕捉的方式对留存率、依从性和社会支持有所贡献。基于网络提供支持小组干预措施可以让人们在方便时私下获取信息和其他小组成员，且无需出行。此类数字健康干预措施可能有助于填补YLHIV可用服务中的关键空白。
ClinicalTrials.gov NCT03516318；https://clinicaltrials.gov/ct2/show/NCT03516318
