An Intervention for the Transition From Pediatric or Adolescent to Adult-Oriented HIV Care: Protocol for the Development and Pilot Implementation of iTransition

Abstract

Background In the United States, adolescents and young adults are disproportionately affected by HIV and have poorer HIV-related health outcomes than adults. Health care transition (HCT) from pediatric or adolescent to adult-oriented HIV care is associated with disruptions to youths’ care retention, medication adherence, and viral suppression. However, no evidence-based interventions exist to improve HCT outcomes for youth living with HIV. Objective There are 2 phases of this project. Phase 1 involves the iterative development and usability testing of a Social Cognitive Theory–based mobile health (mHealth) HIV HCT intervention (iTransition). In phase 2, we will conduct a pilot implementation trial to assess iTransition’s feasibility and acceptability and to establish preliminary efficacy among youth and provider participants. Methods The iterative phase 1 development process will involve in-person and virtual meetings and a design team comprising youth living with HIV and health care providers. The design team will both inform the content and provide feedback on the look, feel, and process of the iTransition intervention. In phase 2, we will recruit 100 transition-eligible youth across two clinical sites in Atlanta, Georgia, and Philadelphia, Pennsylvania, to participate in the historical control group (n=50; data collection only) or the intervention group (n=50) in a pilot implementation trial. We will also recruit 28 provider participants across the pediatric or adolescent and adult clinics at the two sites. Data collection will include electronic medical chart abstraction for clinical outcomes as well as surveys and interviews related to demographic and behavioral characteristics; Social Cognitive Theory constructs; and intervention feasibility, acceptability, and use. Analyses will compare historical control and intervention groups in terms of HCT outcomes, including adult care linkage (primary), care retention, and viral suppression (secondary). Interview data will be analyzed using content analysis to understand the experience with use and acceptability. Results Phase 1 (development) of iTransition research activities began in November 2019 and is ongoing. The data collection for the phase 2 pilot implementation trial is expected to be completed in January 2023. Final results are anticipated in summer 2023. Conclusions The development and pilot implementation trial of the iTransition intervention will fill an important gap in understanding the role of mHealth interventions to support HCT outcomes for youth living with HIV. International Registered Report Identifier (IRRID) DERR1-10.2196/24565

A qualitative assessment of the perceived acceptability and feasibility of eHARTS, a mobile application for transition readiness assessment for adolescents living with HIV in South Africa

“…To the best of our knowledge, this is the first mHealth intervention that focuses on transition readiness assessments for ALHIV. An mHealth intervention iTRANSITION, is being developed in the US to facilitate transition of youths living with HIV from pediatric to adult clinics [25]. Although, the study is being conducted in a setting with different healthcare transition models, it could potentially be adapted to other settings in the future.…”

Mobile Phone–Based Intervention Among Adolescents Living With Perinatally Acquired HIV Transitioning from Pediatric to Adult Care: Protocol for the Interactive Transition Support for Adolescents Living With HIV using Social Media (InTSHA) Study

“…To our knowledge, only one other ongoing study is using mHealth to support the transition from pediatric to adult care for adolescents and young adults living with HIV. Specifically, Tanner et al [ 34 ] are evaluating a novel smartphone app, iTransition, based on social cognitive theory to support ALHIV in the United States. However, the development, evaluation, and implementation of effective and accessible mHealth interventions are needed to improve health care transition outcomes for adolescents living with perinatally acquired HIV in LMIC, where the majority of youth living with perinatally acquired HIV reside.…”

Systematic Review of mHealth Interventions for Adolescent and Young Adult HIV Prevention and the Adolescent HIV Continuum of Care in Low to Middle Income Countries

“…Despite studies showing poor clinical outcomes associated with healthcare transition, there is a paucity of interventions targeting this population. While our review showed that there are currently no evidence-based mHealth interventions focused on healthcare transition among youth living with HIV in LMIC, there was one protocol paper detailing a smart-phone app, iTransition, which is a Social Cognitive Theory-based mobile health intervention being developed for AYA living with HIV transitioning to adult care in the United States [ 73 ]. Additionally, a social media based mHealth intervention for AYA living with undergoing healthcare transition in South Africa, InTSHA, is currently being pilot tested [ 74 ].…”