A Social Media-Based Support Group for Youth Living With HIV in Nigeria (SMART Connections): Randomized Controlled Trial
A Social Media-Based Support Group for Youth Living With HIV in Nigeria (SMART Connections): Randomized Controlled Trial
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DOI：
10.2196/18343
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发表时间：
2020-06-02
影响因子：
7.4
通讯作者：
McCarraher, Donna R.
中科院分区：
文献类型：
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作者：
Dulli, Lisa;Ridgeway, Kathleen;McCarraher, Donna R.
背景资料：参加艾滋病毒治疗的青年艾滋病毒感染者（YLHIV）与年幼的儿童或成人相比，失访率更高，治疗依从性不佳，艾滋病毒相关死亡率更高。尽管健康结果较差，但很少有专门针对青年的干预措施。特别是在低收入和中等收入国家，扩大移动的电话技术的使用范围，增加了人们对利用这一技术改善健康结果的兴趣。移动健康干预措施可能为改善低收入国家YLHIV的依从性和保留率提供创新机会。本研究旨在测试结构化支持小组干预的有效性，社交媒体促进治疗依从性和保留（SMART）连接，通过社交媒体平台提供，对15至24岁的YLHIV患者的HIV治疗保留率以及抗逆转录病毒治疗（ART）依从性、HIV知识和社会支持的次要结局进行研究。我们进行了一项平行、非盲随机对照试验。参加HIV治疗不到12个月的YLHIV以1：1的比例随机接受SMART Connections（干预）或单独标准治疗（对照）。我们通过结构化访谈和病历提取收集基线和基线数据。我们还对干预组参与者的子集进行了深入访谈。主要结局是保留HIV治疗。我们进行了一个时间-事件分析检查时间保留在治疗从研究登记的日期，参与者不再被归类为积极的治疗。结果：共349 YLHIV参加了这项研究，并随机分配到干预组（n=177）或对照组（n=172）。我们的主要分析包括来自324名参与者的数据。在研究期间，2个研究组之间继续接受治疗的概率无显著差异。在基线时，保留率较高，干预组参与者中有75.7%（112/163），对照组参与者中有83.4%（126/161）积极接受治疗。艾滋病毒相关知识在干预组的终点线上明显更好，但在ART依从性或社会支持方面没有统计学显著差异。干预组的参与者压倒性地报告说，干预是有用的，他们喜欢参加，他们会推荐给其他YLHIV.Conclusions：我们的研究结果，提高艾滋病毒的知识和高的可接受性是令人鼓舞的，尽管缺乏可衡量的效果保留。两组的保留率都高于预期，可能是研究中途开始的外部努力的结果。定性数据表明，SMART连接干预可能有助于保留，坚持和社会支持的方式，没有定量捕获。基于网络的支持小组干预措施的交付可以允许人们在方便的时候私下访问信息和其他小组成员，而无需旅行。这种数字健康干预措施可能有助于填补YLHIV可用服务的关键空白。
Background: Youth living with HIV (YLHIV) enrolled in HIV treatment experience higher loss to follow-up, suboptimal treatment adherence, and greater HIV-related mortality compared with younger children or adults. Despite poorer health outcomes, few interventions target youth specifically. Expanding access to mobile phone technology, in low- and middle-income countries (LMICs) in particular, has increased interest in using this technology to improve health outcomes. mHealth interventions may present innovative opportunities to improve adherence and retention among YLHIV in LMICs.Objective: This study aimed to test the effectiveness of a structured support group intervention, Social Media to promote Adherence and Retention in Treatment (SMART) Connections, delivered through a social media platform, on HIV treatment retention among YLHIV aged 15 to 24 years and on secondary outcomes of antiretroviral therapy (ART) adherence, HIV knowledge, and social support.Methods: We conducted a parallel, unblinded randomized controlled trial. YLHIV enrolled in HIV treatment for less than 12 months were randomized in a 1:1 ratio to receive SMART Connections (intervention) or standard of care alone (control). We collected data at baseline and endline through structured interviews and medical record extraction. We also conducted in-depth interviews with subsets of intervention group participants. The primary outcome was retention in HIV treatment. We conducted a time-to-event analysis examining time retained in treatment from study enrollment to the date the participant was no longer classified as active-on-treatment.Results: A total of 349 YLHIV enrolled in the study and were randomly allocated to the intervention group (n=177) or control group (n=172). Our primary analysis included data from 324 participants at endline. The probability of being retained in treatment did not differ significantly between the 2 study arms during the study. Retention was high at endline, with 75.7% (112/163) of intervention group participants and 83.4% (126/161) of control group participants active on treatment. HIV-related knowledge was significantly better in the intervention group at endline, but no statistically significant differences were found for ART adherence or social support. Intervention group participants overwhelmingly reported that the intervention was useful, that they enjoyed taking part, and that they would recommend it to other YLHIV.Conclusions: Our findings of improved HIV knowledge and high acceptability are encouraging, despite a lack of measurable effect on retention. Retention was greater than anticipated in both groups, likely a result of external efforts that began partway through the study. Qualitative data indicate that the SMART Connections intervention may have contributed to retention, adherence, and social support in ways that were not captured quantitatively. Web-based delivery of support group interventions can permit people to access information and other group members privately, when convenient, and without travel. Such digital health interventions may help fill critical gaps in services available for YLHIV.