Developing a Consensus for Adolescent and Young Adult mHealth HIV Prevention Interventions in the United States: Delphi Method (Preprint)

BACKGROUND Engaging adolescents and young adults (AYA) who are at elevated risk for HIV acquisition or who are living with HIV in healthcare has posed a major challenge in HIV prevention and care efforts. Mobile health (mHealth) interventions are a popular and accessible strategy to support AYA engagement despite barriers to care present along the HIV care continuum. Even with progress in the field of mHealth research, expert recommendations for the process of designing, evaluating, and implementing HIV-related mHealth interventions are underdeveloped. OBJECTIVE The aim of this study was to compile expert recommendations on the development, evaluation, and implementation of AYA-focused HIV prevention and care mHealth interventions. METHODS Experts from adolescent mHealth HIV research networks and investigators of recently funded HIV mHealth projects and programs were identified and invited to complete a series of electronic surveys related to the design, implementation, and evaluation of HIV-related mHealth interventions. A modified Delphi method was used to ask experts to score 35 survey items on a 4-point Likert scale from not important to very important and encouraged experts to leave additional comments in text boxes. Responses were reviewed by the researchers, a team of four HIV mHealth intervention experts. The average importance ratings from survey responses were calculated and then categorized as retained (high importance), flagged (mid-level importance), or dropped (no/low importance). Additionally, thematic analysis of expert comments helped modify survey items for the next survey round. An evaluation of the level of agreement among experts on the most important items followed each round until consensus was reached. RESULTS Of the 35 invited experts, 23 completed the first survey representing a variety of roles within a research team. Following two rounds of Delphi surveys, experts scored 86% of the 30 survey items included in round two as important to very important. The final consensus items included 24 recommendations related to the mHealth intervention design process (n=15), evaluation (n=2), and implementation (n=7). The three survey items with the highest average scores focused on the design process, specifically, (1) creating a diverse team including researchers, app software developers, youth representation, (2) the importance of AYA-focused content, and the (3) value of an iterative process. Additionally, experts highlighted the importance of establishing the best ways to collect data and the types of data for collection during the evaluation process as well as constructing a plan for participant technology disruption when implementing an mHealth intervention. CONCLUSIONS The modified Delphi method was a useful tool to convene experts to determine recommendations for AYA-focused HIV prevention and care mHealth interventions. These recommendations can inform future mHealth interventions. To ensure acceptability, feasibility, and efficacy of these AYA HIV prevention interventions, the focus must be on specific needs of AYA by including representation of AYA in the process, including consistent and relevant content, ensuring appropriate data is collected, and considering technology and health accessibility barriers.

Barriers and Facilitators to HIV Prevention Interventions for Reducing Risky Sexual Behavior Among Youth Worldwide: A Systematic Review

Background: Interventions aimed at reducing risky sexual behavior is considered an important strategy for averting Human Immunodeficiency Virus (HIV) among youth (15-24 years) who continue to be vulnerable to the disease. Enhancing intervention success requires a comprehensive understanding of the barriers and facilitators to interventions targeting youth. However, there is lack of a systematic review of both quantitative and qualitative studies to comprehensively identity and synthesize barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth worldwide. This review aimed to identify and synthesize barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth globally based on original peer-reviewed studies published in the last decade. Methods: The Joanna Briggs Institute approach for mixed methods systematic reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used to guide this review. Seven electronic databases, Cambridge and Oxford journals, Joint United Nations Programme on HIV/AIDS and World Health Organization websites, and reference lists of included studies were searched for eligible articles. Studies that met the inclusion criteria underwent quality appraisal and data extraction. Findings were analyzed using thematic synthesis and underpinned by the Determinant Framework.Results: Overall, eight qualitative studies, four quantitative studies and one mixed methods study were included in the review. Several barriers and facilitators across the five Determinant Framework domains were identified. Most of the barriers fell under the characteristics of the context domain (e.g., gender-biased norms). The next important group of barriers emerged within the characteristics of the end users domain (e.g., fear of relationship breakdown). In terms of facilitators, the majority fell under the characteristics of the context domain (e.g., financial support from family) and characteristics of the end users domain (e.g., fear of pregnancy and sexually transmitted infections). The next common set of facilitators appeared within the characteristics of the strategy of facilitating implementation domain (e.g., implementation of intervention with fidelity).Conclusion: This review identified several multi-level barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth. Multi-level and combination approaches are needed to address these factors and enhance intervention success.

Design and evaluation of strategies to implement HIV prevention interventions for pregnant women in community pharmacy settings in western Kenya: a mixed-methods study protocol

IntroductionCommunity pharmacies play an important role in the healthcare system: they are frequently accessed and have increasing capacity to deliver HIV prevention services. In communities where the prevalence of HIV is high and access to antenatal care clinics is delayed or irregular, there is a unique opportunity to leverage pharmacies to enhance early and sustained access to HIV prevention among pregnant women. This study will identify women’s preferences for delivery of HIV prevention services and provider-level and system-level strategies to design a new pharmacy-based model of care for pregnant women. The overall objective of this study is to design and evaluate strategies to implement HIV prevention interventions for pregnant women in community pharmacy settings in western Kenya.Methods and analysisWe propose to conduct a discrete choice experiment to quantify preferences for delivery of HIV prevention interventions (including pre-exposure prophylaxis, partner testing and sexually transmitted infection screening and treatment) for pregnant women in community pharmacy settings. Latent class analysis will be used to quantify women’s stated preferences and identify packages of intervention components that will optimise uptake among different subgroups of women. We will apply the Theoretical Domains Framework to identify provider-level and system-level factors that might influence the implementation of the optimal intervention packages. We will then use the Behaviour Change Wheel and survey a panel of experts to select and gain consensus on strategies to improve implementation. Finally, we will evaluate the potential costs of extending the implementation of HIV prevention interventions from the clinic to community pharmacy settings.Ethics and disseminationThe protocol was approved by the Kenyatta National Hospital-University of Nairobi Ethics Research Committee and the University of Washington Institutional Review Board. The results of this research will be published in peer-reviewed journals and shared with various stakeholders, including community members, policymakers and researchers, through local and international conferences.

Community Based HIV Prevention Interventions In Africa: A Systematic Review

This systematic review is the first to examine the characteristics of community-based HIV prevention interventions, specifically the theoretical underpinning, type and number of components, dose, mode of delivery, and teaching method; and explore the effects of the intervention characteristics on HIV-related knowledge and engagement in risk behaviour among young persons in Africa. A total of 5 studies were included in this review. Conceptual and operational definitions of the intervention characteristics guided the coding and extraction of data from the reports. The overall results of this study showed variability in theoretical underpinning, dose, and mode of delivery of interventions. Multi-component interventions using mixed teaching method produced the desired effect on knowledge and risk behaviour. The examination of community based HIV prevention intervention characteristics provides direction for the development of efficient future interventions to decrease the transmission of HIV among young persons in Africa.

Community Based HIV Prevention Interventions In Africa: A Systematic Review

This systematic review is the first to examine the characteristics of community-based HIV prevention interventions, specifically the theoretical underpinning, type and number of components, dose, mode of delivery, and teaching method; and explore the effects of the intervention characteristics on HIV-related knowledge and engagement in risk behaviour among young persons in Africa. A total of 5 studies were included in this review. Conceptual and operational definitions of the intervention characteristics guided the coding and extraction of data from the reports. The overall results of this study showed variability in theoretical underpinning, dose, and mode of delivery of interventions. Multi-component interventions using mixed teaching method produced the desired effect on knowledge and risk behaviour. The examination of community based HIV prevention intervention characteristics provides direction for the development of efficient future interventions to decrease the transmission of HIV among young persons in Africa.