eHealth to Enhance Treatment Adherence Among Youth Living with HIV

Abstract

Purpose of review Multiple reviews have examined eHealth/mHealth interventions to address treatment adherence, including those focusing on youth living with HIV (YLWH). This review synthesizes results of prior reviews and recent studies (last 5 years) to provide a path forward for future research, acknowledging both lessons learned and gaps to be addressed. Recent findings Recent studies provide further evidence for the feasibility and acceptability of technology-based HIV interventions. Formative research of more comprehensive smartphone applications and pilot studies of computer-delivered interventions provide additional guidance on YLWH’s preferences for intervention components and show promising preliminary efficacy for impacting treatment adherence. Summary Expanding access to technology among YLWH, in the United States and globally, supports the continued focus on eHealth/mHealth interventions as a means to reduce disparities in clinical outcomes. Future research should lend greater focus to implementation and scale-up of interventions through the use of adaptive treatment strategies that include costing analyses, measuring and maximizing engagement, fostering information sharing between researchers, and building upon sustainable platforms.

mHealth Interventions to Promote Anti-Retroviral Adherence in HIV: Narrative Review

“…For instance, access to the internet and smartphones, health care, income, and psychiatric comorbidities could be vastly different in various groups. The majority of existing reviews homogenize and summarize the existing literature as a whole and do not consider the differences in patient populations [ 35 - 39 ]. An intervention may have varying levels of success in each group and likely needs to be tailored to fit unique needs.…”

Maximizing Digital Interventions for Youth in the Midst of Covid-19: Lessons from the Adolescent Trials Network for HIV Interventions

“…Moving iTech studies fully online and enrolling youth into these interventions could be particularly valuable during the disruptions of COVID-19. Given that youth often rely on online technologies to build social and sexual networks, receive social support, and obtain relevant health information [3,5], these interventions may provide social support at a time when access to community support is limited. Many of these interventions provide youth with spaces to interact socially and gain support from other youth (e.g.…”

“…Mobile technologies and social media offer powerful tools to reach, engage, and retain youth in HIV prevention and care interventions and deliver personalized, theory-based health content [1][2][3]. Technology use is ubiquitous among youth [4], from a variety of backgrounds and offers many opportunities for connecting youth to digital health interventions (DHIs), including those that address HIV prevention and care behaviors.…”

“…Overview and current status of iTech randomized controlled trials1 As of April 6, 2020: 1 = closed to new enrollments, follow-ups online only; 2 = open (all procedures online)2 Young men who have sex with men3 Young transgender women who have sex with men 4 Dried blood spot analysis5 Compare tests two apps, LYNX and MyChoices, shown to be feasible and acceptable in earlier iTech studies…”

Antiretroviral adherence for adolescents growing up with HIV: understanding real life, drug delivery and forgiveness

“…19–21 Recent reviews of interventions to improve ART adherence in adolescents highlight the potential benefits of community group and individual adherence support, youth friendly services and eHealth, but emphasise the small number of studies that include adolescents, inadequate sample sizes without appropriate comparison groups, use of surrogate measures of adherence rather than plasma HIV viral load and frequently inadequate length of follow-up post intervention required to assess sustainability. 22–25 The impact of cash transfers, both conditional and unconditional, and of multimodal economic strengthening interventions to improve child and adolescent health have been explored from pre-conception through to adolescence. 26–29 Aims at improving maternal–infant outcomes, relieving poverty, retention in education, improving mental health and psychosocial well-being and reducing sexual risk including HIV acquisition effects have been mixed.…”