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

Abstract

Adolescents and young adults (AYA) in low to middle income countries (LMIC) have poorer outcomes along each step in the HIV continuum of prevention and care compared to younger children or older adults. The use of mHealth technology provides a potentially promising implementation strategy for interventions to remedy these disparities. We therefore conducted a systematic review of the English literature and conference proceedings from January 1, 2000 to April 1, 2021 evaluating mHealth interventions targeting AYA along each step of the HIV continuum of care in LMIC. We identified 27 mHealth interventions across the HIV continuum, with no interventions addressing transition from pediatric to adult care. The majority of studies were single arm, uncontrolled or underpowered, with few randomized trials resulting in mixed and inconclusive outcomes. mHealth interventions have potential to remedy disparities along the HIV continuum of care for AYA in LMIC but larger, powered randomized trials are needed.

Adolescent HIV Prevent and Care Framework: A Global Scoping Review Protocol-BSGH 006

“…The prevention and care of HIV among adolescents pose signi cant global challenges due to various factors, including their transitional stage in life, vulnerability associated with their age groups, and the complex interplay of biological, structural, and social factors [19][20][21] . These factors individually and collectively may hinder efforts to reduce adolescent HIV-related deaths and transmission.…”

“…Adolescent sexual and reproductive health remains a signi cant public health concern globally, especially in communities where child marriage and adolescent childbearing are high, with low exposure to modern contraceptives 18 . Several factors contribute to the high prevalence of HIV among adolescents, including vulnerability during their transitional stage in life and biological changes that can affect their social relationships, potentially leading to risky behaviors that increase the risk of HIV infections 19,2020,21 . The severity of addressing HIV prevention and care in adolescence is crucial, as many adolescents with HIV are unaware of their status and fail to consistently use condoms in sexual encounters or face challenges when accessing preventive options due to alcohol-drug abuse, sex-HIVage stigma and discrimination 22,23 .…”

Characterizing provider-led adaptations to mobile phone delivery of the Adolescent Transition Package (ATP) in Kenya Using the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS): a mixed methods approach

“…The limited capacity of telemedicine for physical examination, HCW-patient relationship-building and as a medium for patient education has been noted as a persistent barrier and fuel for HCWs' resistance to the use of this and other digital health strategies. 42,45,49 Of note, the use of WhatsApp to deliver the ATP intervention was proposed up to three times across all CQI meetings but not selected for testing in the PDSA cycle. HCWs in non-clinical cadres who are primarily tasked with retaining clients in care noted that communication via WhatsApp had been effective for maintaining contact, information sharing including appointment reminders and engaging youth in support groups.…”

“…These and other barriers appear elsewhere in literature examining the implementation of digital technologies for health. 41,42 Additionally, the role of stigma on youth engagement with health services is not new and has impact on adoption and uptake of health services in the clinic setting as well as virtually. 43,44 Our study demonstrates how using CQIs facilitated identi cation of challenges and selection of adaptations to address them successfully.…”

The Development of Android-Based Basic Services Media to Measure Conceptual Understanding of Adolescents Sexual Behavior

“…In this context, the basic service media that gains the best response is an android-based considering the character of generation Z and Alpha currently is in urgent need of educational media and counseling guidance services that are appropriate for the adolescent psyche using language of the adolescent development. (Rofi'ah & Widatiningsih, 2021); (Setianingsih & Naimah, 2021), (Maharani, 2022); (Handayani et al, 2022); (Mataka & Taibu, 2020), (Goldstein et al, 2022).…”