eHealth to Enhance Treatment Adherence Among Youth Living with HIV
- 378 Downloads
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 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.
Expanding access to technology among YLWH, in the United States (US) 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.
KeywordseHealth mHealth Youth Adolescents SMS Technology HIV treatment
The authors would like to thank Dr. Kate Muessig for her review of this paper.
This work was supported by the US National Institutes of Health grant (U19HD089881; MPI: Hightow-Weidman/Sullivan).
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no competing interests.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Centers for Disease Control and Prevention Monitoring selected national HIV prevention and care objectives by using HIV surveillance data- US and 6 dependent areas 2015. 2017.Google Scholar
- 3.Ferrand RA, Briggs D, Ferguson J, Penazzato M, Armstrong A, MacPherson P, et al. Viral suppression in adolescents on antiretroviral treatment: review of the literature and critical appraisal of methodological challenges. Tropical Med Int Health. 2016;21(3):325–33. https://doi.org/10.1111/tmi.12656.CrossRefGoogle Scholar
- 5.• Kim SH, Gerver SM, Fidler S, Ward H. Adherence to antiretroviral therapy in adolescents living with HIV: systematic review and meta-analysis. AIDS (London, England) 2014;28(13):1945–56. doi: https://doi.org/10.1097/qad.0000000000000316. This article includes a systematic review and meta-analysis of published studies reporting adherence to ART for adolescents and young adults (ages 12-24 years) living with HIV. The authors identified 50 eligible articles reporting data from 53 countries.
- 9.Kuhns LM, Hotton AL, Garofalo R, Muldoon AL, Jaffe K, Bouris A, et al. An index of multiple psychosocial, Syndemic conditions is associated with antiretroviral medication adherence among HIV-positive youth. AIDS Patient Care STDs. 2016;30(4):185–92. https://doi.org/10.1089/apc.2015.0328.CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Gross IM, Hosek S, Richards MH, Fernandez MI. Predictors and profiles of antiretroviral therapy adherence among African American adolescents and young adult males living with HIV. AIDS Patient Care STDs. 2016;30(7):324–38. https://doi.org/10.1089/apc.2015.0351.CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Rudy BJ, Murphy DA, Harris DR, Muenz L, Ellen J. Patient-related risks for nonadherence to antiretroviral therapy among HIV-infected youth in the United States: a study of prevalence and interactions. AIDS Patient Care STDs. 2009;23(3):185–94. https://doi.org/10.1089/apc.2008.0162.CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Rudy BJ, Murphy DA, Harris DR, Muenz L, Ellen J. Prevalence and interactions of patient-related risks for nonadherence to antiretroviral therapy among perinatally infected youth in the United States. AIDS Patient Care STDs. 2010;24(2):97–104. https://doi.org/10.1089/apc.2009.0198.CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Arnett JJ. Emerging adulthood: the winding road from late teens through the twenties. New York: Oxford University Press; 2004.Google Scholar
- 19.• Muessig KE, LeGrand S, Horvath KJ, Bauermeister JA, Hightow-Weidman LB. Recent mobile health interventions to support medication adherence among HIV-positive MSM. Curr Opin HIV AIDS. 2017;12(5):432–41. https://doi.org/10.1097/COH.0000000000000401. This study describes recent mobile health (mHealth) interventions (January 2016–13 May 2017) supporting antiretroviral therapy (ART) medication adherence among HIV-positive MSM. Conclusions from seven publications [text messaging (4), smartphone apps (2), social media (1)] were that mHealth interventions to support ART adherence among MSM show acceptability, feasibility, and preliminary efficacy. CrossRefPubMedPubMedCentralGoogle Scholar
- 22.•• Navarra AD, Gwadz MV, Whittemore R, Bakken SR, Cleland CM, Burleson W, et al. Health technology-enabled interventions for adherence support and retention in care among US HIV-infected adolescents and young adults: an integrative review. AIDS Behav. 2017;21(11):3154–71. https://doi.org/10.1007/s10461-017-1867-6. This integrative review describes current US trends for health technology-enabled adherence interventions among behaviorally HIV-infected youth (ages 13–29 years), and provides data on the feasibility and efficacy of the nine identified interventions. Findings demonstrate the feasibility of computer-based interventions, and initial efficacy of SMS texting for adherence support among HIV-infected youth. CrossRefPubMedGoogle Scholar
- 23.Lenhart A, Pew Research Center. Teen, social media and technology overview. 2015.Google Scholar
- 24.Pew Research Center Smartphone ownership and internet usage continues to climb in emerging economies. 2016.Google Scholar
- 25.Pew Research Center. Emerging nations embrace internet, mobile Technology 2014.Google Scholar
- 26.Pew Research Center. Mobile Fact Sheet. 2017. http://www.pewinternet.org/fact-sheet/mobile/. Accessed 26 Jan 2018.
- 29.• Badawy SM, Barrera L, Sinno MG, Kaviany S, O'Dwyer LC, Kuhns LM. Text Messaging and Mobile Phone Apps as Interventions to Improve Adherence in Adolescents With Chronic Health Conditions: A Systematic Review. JMIR mHealth uHealth. 2017;5(5):e66. https://doi.org/10.2196/mhealth.7798. This systematic review evaluated evidence for the efficacy of text messaging and mobile phone apps as interventions to promote medication adherence among adolescents with chronic health conditions (CHCs). Of 15 publications, [text messaging (n=12) and mobile phone apps (n=3)], the authors found promising feasibility and acceptability and modest efficacy for the use of text messaging and mobile phone app interventions to improve medication adherence among adolescents with CHCs. CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Badawy SM, Kuhns LM. Economic evaluation of text-messaging and smartphone-based interventions to improve medication adherence in adolescents with chronic health conditions: a systematic review. JMIR mHealth uHealth. 2016;4(4):e121. https://doi.org/10.2196/mhealth.6425.CrossRefPubMedPubMedCentralGoogle Scholar
- 31.Anand T, Nitpolprasert C, Kerr SJ, Muessig KE, Promthong S, Chomchey N, et al. A qualitative study of Thai HIV-positive young men who have sex with men and transgender women demonstrates the need for eHealth interventions to optimize the HIV care continuum. AIDS Care. 2017;29(7):870–5. https://doi.org/10.1080/09540121.2017.1286288.CrossRefPubMedGoogle Scholar
- 32.Holloway IW, Winder TJ, Lea CH, III, Tan D, Boyd D, Novak D. Technology use and preferences for mobile phone-based HIV prevention and treatment among black young men who have sex with men: exploratory research. JMIR mHealth uHealth 2017;5(4):e46. doi: https://doi.org/10.2196/mhealth.6436.
- 33.LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, et al. Epic allies: development of a gaming app to improve antiretroviral therapy adherence among young HIV-positive men who have sex with men. JMIR Serious games. 2016;4(1):e6. https://doi.org/10.2196/games.5687.CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Outlaw AY, Naar-King S, Tanney M, Belzer ME, Aagenes A, Parsons JT, et al. The initial feasibility of a computer-based motivational intervention for adherence for youth newly recommended to start antiretroviral treatment. AIDS Care. 2014;26(1):130–5. https://doi.org/10.1080/09540121.2013.813624.CrossRefPubMedGoogle Scholar
- 35.Rana Y, Haberer J, Huang H, Kambugu A, Mukasa B, Thirumurthy H, et al. Short message service (SMS)-based intervention to improve treatment adherence among HIV-positive youth in Uganda: focus group findings. PLoS One. 2015;10(4):e0125187. https://doi.org/10.1371/journal.pone.0125187.CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Dowshen N, Kuhns LM, Johnson A, Holoyda BJ, Garofalo R. Improving adherence to antiretroviral therapy for youth living with HIV/AIDS: a pilot study using personalized, interactive, daily text message reminders. J Med Internet Res. 2012;14(2):e51. https://doi.org/10.2196/jmir.2015.CrossRefPubMedPubMedCentralGoogle Scholar
- 40.Garofalo R, Kuhns LM, Hotton A, Johnson A, Muldoon A, Rice D. A randomized controlled trial of personalized text message reminders to promote medication adherence among HIV-positive adolescents and young adults. AIDS Behav. 2016;20(5):1049–59. https://doi.org/10.1007/s10461-015-1192-x.CrossRefPubMedPubMedCentralGoogle Scholar
- 41.Linnemayr S, Huang H, Luoto J, Kambugu A, Thirumurthy H, Haberer JE, et al. Text messaging for improving antiretroviral therapy adherence: no effects after 1 year in a randomized controlled trial among adolescents and young adults. Am J Public Health. 2017;107(12):1944–50. https://doi.org/10.2105/ajph.2017.304089.CrossRefPubMedGoogle Scholar
- 42.Menza TW, Choi SK, LeGrand S, Muessig K, Hightow-Weidman L. Correlates of self-reported viral suppression among HIV-positive, young, black men who have sex with men participating in a randomized controlled trial of an internet-based HIV prevention intervention. Sex Transm Dis. 2018;2017 https://doi.org/10.1097/olq.0000000000000705.
- 43.Hightow-Weidman L, LeGrand S, Simmons R, Egger J, Choi SK, Muessig K. healthMpowerment: effects of a mobile phone-optimized, internet-based intervention on condomless anal intercourse among young black men who have sex with men and transgender women. Abstract# WEPEC1001, 2017 International AIDS society conference. Paris, France, July 23-26, 2017.Google Scholar
- 44.Hightow-Weidman LB, Muessig KE, Pike EC, LeGrand S, Baltierra N, Rucker AJ, et al. HealthMpowerment.org: building community through a mobile-optimized, online health promotion intervention. Health Educ Behav. 2015;42(4):493–9. https://doi.org/10.1177/1090198114562043.CrossRefPubMedPubMedCentralGoogle Scholar
- 45.Naar-King S, Outlaw AY, Sarr M, Parsons JT, Belzer M, Macdonell K, et al. Motivational enhancement system for adherence (MESA): pilot randomized trial of a brief computer-delivered prevention intervention for youth initiating antiretroviral treatment. J Pediatr Psychol. 2013;38(6):638–48. https://doi.org/10.1093/jpepsy/jss132.CrossRefPubMedPubMedCentralGoogle Scholar
- 46.Stankievich E, Malanca A, Foradori I, Ivalo S, Losso M. Utility of mobile communication devices as a tool to improve adherence to antiretroviral treatment in HIV-infected children and young adults in Argentina. Pediatr Infect Dis J. 2017; https://doi.org/10.1097/inf.0000000000001807.
- 47.Inwani I, Chhun N, Agot K, Cleland CM, Buttolph J, Thirumurthy H, et al. High-yield HIV testing, facilitated linkage to care, and prevention for female youth in Kenya (GIRLS study): implementation science protocol for a priority population. JMIR Res Protoc. 2017;6(12):e179. https://doi.org/10.2196/resprot.8200.CrossRefPubMedPubMedCentralGoogle Scholar
- 48.Mavhu W, Willis N, Mufuka J, Mangenah C, Mvududu K, Bernays S, et al. Evaluating a multi-component, community-based program to improve adherence and retention in care among adolescents living with HIV in Zimbabwe: study protocol for a cluster randomized controlled trial. Trials. 2017;18(1):478. https://doi.org/10.1186/s13063-017-2198-7. CrossRefPubMedPubMedCentralGoogle Scholar
- 49.Tanner AE, Mann L, Song E, Alonzo J, Schafer K, Arellano E, et al. weCARE: a social media-based intervention designed to increase HIV care linkage, retention, and health outcomes for racially and ethnically diverse young MSM. AIDS Educ Prev. 2016;28(3):216–30. https://doi.org/10.1521/aeap.2016.28.3.216. CrossRefPubMedPubMedCentralGoogle Scholar
- 50.United Nations Department of Economic and Social Affairs. Definition of Youth. Fact sheet. 2016. http://www.un.org/esa/socdev/documents/youth/fact-sheets/youth-definition.pdf. Accessed 31 Jan 2018.
- 56.Kelders MS, Bohlmeijer TE, Van Gemert-Pijnen EWCJ. Participants, usage, and use patterns of a web-based intervention for the prevention of depression within a randomized controlled trial. J Med Internet Res. 2013;15(8):e172. https://doi.org/10.2196/jmir.2258.CrossRefPubMedPubMedCentralGoogle Scholar
- 57.Graham LM, Strawderman SM, Demment M, Olson MC. Does usage of an eHealth intervention reduce the risk of excessive gestational weight gain? Secondary analysis from a randomized controlled trial. J Med Internet Res. 2017;19(1):e6. https://doi.org/10.2196/jmir.6644.CrossRefPubMedPubMedCentralGoogle Scholar
- 59.•• Bauermeister JA, Golinkoff JM, Muessig KE, Horvath KJ, Hightow-Weidman LB. Addressing engagement in technology-based behavioural HIV interventions through paradata metrics. Curr Opin HIV AIDS. 2017;12(5):442–6. https://doi.org/10.1097/coh.0000000000000396. The goal of this review was to examine how often researchers report participants’ online engagement using paradata (i.e. intervention usage metrics) when describing the outcomes of online behavioural HIV prevention and care interventions. The authors provide insights on the utility of paradata collection and analysis for future technology-based trials. CrossRefPubMedPubMedCentralGoogle Scholar
- 60.Cherenack EM, Wilson PA, Kreuzman AM, Price GN. The feasibility and acceptability of using technology-based daily diaries with HIV-infected young men who have sex with men: a comparison of internet and voice modalities. AIDS Behav. 2016;20(8):1744–53. https://doi.org/10.1007/s10461-016-1302-4.CrossRefPubMedPubMedCentralGoogle Scholar
- 63.Collins LM, Murphy SA, Strecher V. The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART): new methods for more potent eHealth interventions. Am J Prev Med. 2007;32(5 Suppl):S112–8. https://doi.org/10.1016/j.amepre.2007.01.022. CrossRefPubMedPubMedCentralGoogle Scholar
- 66.World Health Organization. Health for the world’s adolescents: a second chance in the second decade. 2014.Google Scholar
- 68.World Health Organization. HIV and adolescents: guidance for HIV testing and counselling and care for adolescents living with HIV. Geneva: WHO; 2013.Google Scholar
- 71.Lowenthal ED, Bakeera-Kitaka S, Marukutira T, Chapman J, Goldrath K, Ferrand RA. Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges. Lancet Infect Dis. 2014;14(7):627–39. https://doi.org/10.1016/S1473-3099(13)70363-3.CrossRefPubMedPubMedCentralGoogle Scholar
- 72.World Health Organization. Why focus on adolescents (10–19 years)? http://apps.who.int/adolescent/second-decade/section/section_2/level2_3.php. Accessed 2 Febr 2018.
- 73.Pew Research Center. Parents, teens and digital monitoring. 2016.Google Scholar
- 74.National Institutes of Health (NIH) Research Portfolio Online Reporting Tools (RePORT). U01MD011274 (PI: Bauermeister): Reducing HIV Vulnerability through a Multilevel Life Skills Intervention for Adolescent Men (2016–2021). https://projectreporter.nih.gov/project_info_description.cfm?aid=9322370&icde=37901692&ddparam=&ddvalue=&ddsub=&cr=2&csb=default&cs=ASC&pball. Accessed 4 Febr 2018.
- 75.National Institutes of Health (NIH) Research Portfolio Online Reporting Tools (RePORT). U01MD011279 (PI: Schnall): A Pragmatic Clinical Trial of MyPEEPS Mobile to Improve HIV Prevention Behaviors in Diverse Adolescent MSM (2016–2021). https://projectreporter.nih.gov/project_info_description.cfm?aid=9321397&icde=37901692. Accessed 4 Febr 2018.
- 76.National Institutes of Health (NIH) Research Portfolio Online Reporting Tools (RePORT). U01MD011281 (PI: Mustankski): A Pragmatic Trial of an Adaptive eHealth HIV Prevention Program for Diverse Adolescent MSM (2016–2020). https://projectreporter.nih.gov/project_info_description.cfm?aid=9562779&icde=37901728&ddparam=&ddvalue=&ddsub=&cr=7&csb=default&cs=ASC&pball. Accessed 4 Febr 2018.
- 77.Hightow-Weidman L, Knudtson K, Muessig K, Srivatsa M, Lawrence E, LeGrand S et al. AllyQuest: engaging HIV+ young MSM in care and improving adherence through a social networking and gamified smartphone application (App). Abstract# TUPED1273, 2017 International AIDS Society Conference. Paris, France, July 23–26, 2017.Google Scholar
- 78.Scott H, Vittinghoff E, Irvin R, Liu A, Fields S, Magnus M et al. Sex pro: a personalized HIV risk assessment tool for men who have sex with men. Abstract #1017, 2015 Conference on Retroviruses and Opportunistic Infections. Seattle, Washington, February 23–26, 2015.Google Scholar