Keywords: mHealth, HIV transition support, South Africa, adolescent, SDG 3: Good health and well-being, SDG 4: Quality education
During the transition from pediatric to adult based care for adolescents with HIV, retention in care is commonly lower than for younger adolescents/children or older adults not transitioning. We describe the results of a pilot, type 3 hybrid, randomized clinical trial of a mobile phone-based intervention, InTSHA: Interactive Transition Support for Adolescents Living with HIV, compared to standard of care. InTSHA uses encrypted, closed group chats delivered via WhatsApp to provide peer support and improve communication between adolescents with HIV, their caregivers, and healthcare providers during transition from pediatric to adult care. We randomized 80 South African adolescents with perinatally-acquired HIV who were aware of their HIV status and aged between 15 to 19 years to receive either the InTSHA intervention (n=40) or standard of care (n=40). We measured acceptability (Acceptability of Intervention Measure [AIM]) and feasibility (enrollment, participation, Feasibility of Intervention Measure [FIM]) of the intervention as primary outcomes with goal thresholds of ≥80%. Although not powered for effectiveness, we evaluated impact on retention in care (missed clinic visits and/or late pharmacy refills) and viral suppression (viral load <200 copies/ml) after completion of the intervention and at least six months after randomization as secondary endpoints. We performed bivariable and multivariable analyses using logistic regression models to assess the effect of the InTSHA intervention compared to standard of care. Among the adolescents randomized to the InTSHA intervention (n=40), the median AIM was 4.1/5.0 (82%). Participation was variable, and median FIM was 3.9/5.0 (78%). Comparing adolescents randomized to InTSHA versus standard of care, we found no difference in retention in care (39/40 [98%] vs 35/40 [88%]; OR 5.6 [95%CI 0.6-50.0; p=0.20]) or in viral suppression (29/40 [73%] vs 33/40 [83%]; OR 0.6 [95%CI 0.2-1.6; p=0.42)]. Among adolescents randomized to the InTSHA intervention who attended three or more sessions, retention in care was 100% at 6 months. InTSHA is an acceptable and largely feasible mHealth intervention for adolescents with HIV and transitioning to adult care in South Africa. Although not statistically significant, the increase in retention in care is promising. Further study in a larger population is warranted.