InTSHA: Interactive Transition Support for HIV-infected Adolescents Using Social Media
Condition: HIV-1-infection; Adolescent Behavior
Study type: Interventional

Summary: 
      The goal of this study is to develop and evaluate a social media behavioral intervention
      based on the Social-ecological Model of Adolescent and Young Adult Readiness to Transition
      (SMART) to improve transition care for adolescents living with HIV in South Africa.
      Participants will be randomized to receive the social media intervention or the standard of
      care.
    

Detailed description: 
      South Africa has the highest burden of adolescents living with HIV in the world and
      adolescents are poorly prepared for transition from pediatric to adult services. For a large
      majority of South Africans living with HIV, ART was not available until 2004. This delay
      contributed to nearly 500,000 perinatal HIV infections in the late 1990s and early 2000s.
      With large scale-up and improved access to ART in recent years, survivors of perinatal HIV
      infection are now reaching adolescence and beyond. As the wave of perinatally HIV-infected
      adolescents matures, an estimated 320,000 adolescents will transfer from pediatric- or
      adolescent-based clinics to adult services in the next 10 years in South Africa. Currently,
      perinatally HIV-infected adolescents enter adult care at variable ages and developmental
      stages, without necessary preparation or support through the process. This study will develop
      and evaluate an innovative intervention designed to address this critical problem.

      The SMART model incorporates modifiable factors such as knowledge, skills/self-efficacy,
      relationships and social support that can be targets of interventions to improve transition
      care. Medical care during adolescence is typically complicated by increased risk-taking
      behavior, as well as decreased caregiver involvement, which occur during a time of rapid
      physical, emotional, and cognitive development. When adolescents transition to adult care,
      they often do not receive the coordinated services that they received under pediatric care.
      Qualitative studies with adolescents and clinicians from sub-Saharan Africa suggest that peer
      support, collaboration with health providers, and communication between adult and pediatric
      providers might assist in transition to adult services. The SMART model emphasizes eight
      modifiable factors, three key stakeholders (adolescents, caregivers, and clinicians) and
      their interconnected relationship in influencing successful transition to adult care.The
      social media intervention for this study incorporates these stakeholders and addresses the
      modifiable factors in the SMART model to improve transition care for adolescents living with
      HIV.

      Social media is defined as internet-based applications that allow the creation and exchange
      of user generated content. A recent meta-analysis found that social support was the most
      common reason for patients to use social media for health purposes. Social media has also
      been used to improve the relationship between caregivers and patients when switching
      caregivers, a major barrier to transition for adolescents in South Africa. Although results
      vary in different settings, a recent meta-analysis has shown overall improved adherence and
      viral suppression among adults living with HIV using social media based health services
      technology. Social media can address the modifiable variables in the SMART model such as
      knowledge, self-efficacy, goals, relationships, peer and social support, which could
      ultimately improve virologic suppression and retention in care during the transition to adult
      services.

      The researchers will perform a pilot randomized controlled trial with 40 adolescents
      receiving the social media intervention and 40 adolescents receiving standard of care.
      In-depth interviews and quantitative surveys with adolescents living with HIV will be used to
      assess the acceptability and feasibility of the intervention. The secondary outcomes of peer
      support, connection to clinical staff, retention in care, and viral suppression will also be
      examined at baseline and 6 months after randomization.
    

Intervention name(s): Social Media Intervention; Standard of Care
Intervention type(s): Behavioral; Other
Intervention description(s): The social media intervention is a behavioral intervention developed by the study investigators and is delivered via mobile phones. The intervention uses the Social-ecological Model of Adolescent and Young Adult Readiness to Transition (SMART) model, highlighting modifiable targets of intervention that can be addressed through a social media platform. The SMART model incorporates modifiable factors such as knowledge, skills/self-efficacy, relationships and social support that can be targets of interventions to improve transition care. The SMART model emphasizes eight modifiable factors, three key stakeholders (adolescents, caregivers, and clinicians) and their interconnected relationship in influencing successful transition to adult care. The intervention is designed to overcome barriers and enhance facilitators to transitioning care among adolescents living with HIV who are transitioning to adult care in South Africa.; Standard of care transition from pediatric to adult care for HIV.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A pilot randomized controlled trial with 40 adolescents receiving a social media intervention and 40 adolescents receiving standard of care.
Masking: None (Open Label)
Primary purpose: Other
Keywords: Adolescent; HIV; Transition care; Mobile health; Social media; South Africa