Social Media for ART Adherence and Retention in Adolescents and Young Adults: the Vijana-SMART Study

Study Overview
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Brief Summary
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The goal of this study is to investigate whether a virtual peer support group improves ART knowledge, adherence, and mental health in youth living with HIV in Kenya.

Detailed Description
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Adolescents and young adults (AYA) living with HIV show lower ART adherence, higher loss to follow-up and higher AIDS-related mortality than other age groups. Innovative approaches are needed that address AYA's unique needs and improve their adherence and retention in HIV care. There is evidence that peer support and mobile messaging with healthcare workers (HCW) are two strategies that may be effective in this group, but their evaluation has been limited and no interventions have combined them. Since 2014, youth-run virtual support groups have spontaneously started at HIV clinics, using the mobile social media application WhatsApp. These groups present valuable case studies from which the proposed project will develop a structured social media intervention that combines peer and HCW support to improve ART adherence and retention, guided by the preferences of AYA. The SPECIFIC AIMS are to (1) Characterize the existing WhatsApp groups through in-depth interviews with members and detailed content analysis of the group's communications during a 6-week observation period. This will define the elements and features desired by AYA in a social media intervention. (2) Guided by findings from Aim 1, behavioral theory, and the study team's ongoing research on mobile messaging to improve ART adherence, to develop and refine structured content for a reproducible WhatsApp intervention that incorporates peer and HCW interaction. (3) Pilot the structured intervention for 6 months in another clinic and evaluate its impact on intermediate outcomes ART knowledge, depression and stigma.

Official Title
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Social Media for ART Adherence and Retention in Adolescents and Young Adults: the Vijana-SMART Study

Conditions
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HIV-1-infection, Adherence, Medication, Depression

Intervention / Treatment
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* Behavioral: Vijana-SMART


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Living with HIV On ART Aware of HIV status Has access to WhatsApp Literate

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum Age: 24 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Interventional Model Description: Single-group pilot
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Pilot<br>Participants will be offered the Vijana-SMART WhatsApp group intervention | Behavioral: Vijana-SMART<br>* The Vijana-SMART intervention is a facilitated peer group, delivered through WhatsApp. Intervention messages were developed based on findings from formative interviews and social support theory, which posits that individuals experience social support through informational, instrumental, companionship and emotional forms. Groups will have approximately 25 members and will be facilitated by a study team member, by sending weekly scheduled messages, answering participant questions, and encouraging group discussion. Intervention messages were designed based on guidance from formative interviews; topics include ART adherence, medication side effects, nutritional practices, depression, social support, HIV status disclosure, stigma, positive prevention, substance use, and contraception.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ART information, motivation, behavioral skills | Self-reported score on abbreviated Lifewindows IMB instrument | 6 months | 
| Social support | Self-reported score on SS-B instrument | 6 months | 
| Stigma | Self-reported score on abbreviated ALHIV-SS instrument | 6 months | 
| ART adherence | Self-reported score on Wilson 3-item scale | 6 months | 
| Depression symptoms | Self-reported score on PHQ-9 scale | 6 months | 
| Resilience | Self-reported score on abbreviated Connor-Davidson scale | 6 months |