A social media mHealth intervention to improve retention in care for adolescents and young adults with HIV in Uganda

PROJECT SUMMARY/ABSTRACT Background: Only about 50% of adolescents and young adults with HIV (AYWH) who initiate HIV care remain in care at 12 months. Moreover, in 2020, AYWH recorded a 50% increase in AIDS-related mortality. These poor clinical outcomes are multi-factorial and heavily influenced by their neurodevelopmental stage and by route of infection (perinatal vs non-perinatal). Current interventions to retain AYWH in care are limited and do not address these key aspects of HIV care for AYWH. Social media-based mobile health (mHealth) interventions offer flexible and attractive features to AYWH to help overcome barriers to retention in care. Candidate: The goal of the proposed K43 Emerging Global Leader Award is to support Dr. Julian Adong’s research training to attain independence as a clinician-scientist focused on improving treatment and care for AYWH in low resourced settings. Dr. Adong is currently a research fellow at Mbarara University of Science and Technology, Uganda. The proposed study will enable training in three areas: 1) Qualitative and mixed methods research, including design, data collection, analysis and interpretation; 2) Behavioural science skills to better understand influences of adolescent behaviour and implications for mHealth-based intervention development and deployment; and 3) Statistical methods for clinical trials, including longitudinal data analysis. This application builds on Dr, Adong’s current clinical experience and background in epidemiology, as well as ongoing formative work in mHealth intervention development. Research: The research goals of this proposal are to develop and test the feasibility and acceptability of an adolescent-tailored social media-based mHealth intervention to improve retention in HIV care for AYWH. The intervention will be informed by Social Cognitive Theory and the Theory of Planned Behaviour, and the development process will be guided by the IDEAS Framework. First, Dr. Adong will define the cognitive, environmental, and behavioural challenges among AYWH who are new or newly re-engaging in HIV care, characterizing these factors by neurodevelopmental stage and route of infection and their impact on behavioural intention (Aim 1). She will then iteratively develop the intervention with input from AYWH and clinic counsellors (Aim 2). Finally, she will test the acceptability, feasibility, and preliminary effectiveness of the intervention on one-year retention in care through a pilot wait-list controlled trial among AYWH who are new or newly re-engaging in HIV care (Aim 3). Innovation: This study will be the first to address the important role of neurodevelopmental stage and route of infection for retention in care and will leverage the strong potential of mHealth interventions in this mHealth-receptive population. Future directions: Dr. Adong’s research and training aims are well aligned and supported by a multidisciplinary team of dedicated mentors. At the end of the award, she will be an excellent candidate for an R01 application to definitively assess mHealth interventions to improve HIV treatment outcomes among AYWH in low resourced settings.