A Social Media–Based Support Group for Youth Living With HIV in Nigeria (SMART Connections): Randomized Controlled Trial

Abstract

Background 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. Objective 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. Methods 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. Results 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. Conclusions 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. Trial Registration ClinicalTrials.gov NCT03516318; https://clinicaltrials.gov/ct2/show/NCT03516318

Psychosocial interventions for improving engagement in care and health and behavioural outcomes for adolescents and young people living with HIV: a systematic review and meta‐analysis

“…The majority of studies were conducted in the United States (n = 18, 60%), with the remainder of studies done in Uganda (n = 4) [63][64][65][66][67], Thailand (n = 3) [68][69][70][71], Zimbabwe (n = 2) [72,73], Nigeria (n = 1) [74], South Africa (n = 1) [75] and Zambia (n = 1) [76]. Most studies (n = 26, 86.7%) used an individually randomized controlled trial design to evaluate the intervention, whereas fewer (n = 4, 13.3%) used cluster randomization with families or clinic sites as the unit of randomization (Table 1) [63,67,71,72,77].…”

“…Four studies involved peer implementers, in some cases relying on professional support to implement interventions [72,73,76,93]. Five interventions were delivered by lay counsellors or facilitators [74,79,86,87,94,95]. Additionally, five interventions had no delivery personnel involved and were delivered by digital means only (one of these was delivered in a hybrid clinicaldigital setting as described above) [65,66,82,84,85].…”

“…The first consideration relates to the adaptation of interventions developed for adult populations. A substantial number of the studies detailed consultative processes with adolescents and young people, such as youth advisory groups [82], preliminary interviews with AYPLHIV [107,117,118], focus groups and workshops [74,[119][120][121], youth-designed personalized content [122] and involvement of peer mentors [72,73,78,81,123]. These processes are vital to ensure that interventions are implemented with full consideration of what works best for younger HIV-affected populations [124].…”

“…Our review also elicits a set of implications for policy and practice related to HIV programming. Lay health counsellors with specific HIV-focused training have been leveraged to positive effect among adult populations in resource-constrained settings [74], and may be a feasible cadre to deliver support to younger populations living with HIV [72,73]. Where lay workers have been deployed with adult populations, they are often trained in counselling skills [50], and may be employed as part of government health systems.…”

eHealth Communication With Clients at Community-Based HIV/AIDS Service Organizations in the Southern United States: Cross-Sectional Survey

“…In the field of HIV/AIDS prevention, eHealth communication tools improve health outcomes across the HIV care continuum, which include diagnosis of HIV infection; linkage, engagement, retention in HIV care; and achieving viral suppression [ 4 , 5 ]. Recent studies [ 6 - 14 ] have shown how social media and technologies such as avatar-led and smartphone games can be leveraged to prevent the spread of HIV infection and sexually transmitted diseases, as well as improve HIV-related health outcomes such as diagnosis of HIV infection; linkage, engagement, retention in HIV care; and medication adherence.…”