Piloting a Smartphone App to Improve Treatment Adherence Among South African Adolescents Living With HIV

NCT ID: NCT04661878

Last Updated: 2025-06-13

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-06-21

Study Completion Date

2024-04-02

Brief Summary

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The overall goal of this pilot randomized-controlled trial (RCT) is to pilot MASI (MAsakhane Siphucule Impilo Yethu; Xhosa for "Let's empower each other and improve our health"), an ART adherence-supporting smartphone app with 50 adolescents and young adults living with HIV to assess its feasibility and acceptability and to explore preliminary effects on ART adherence and social support.

Detailed Description

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Interventions that engage adolescents and young adults with HIV (AYAHIV) to improve adherence to antiretroviral therapy (ART) are urgently needed. AYAHIV repeatedly demonstrate suboptimal adherence to ART, which is associated with increased morbidity and mortality. Developing adherence-promoting interventions for AYAHIV requires an understanding of factors that shape adherence from multiple levels. Developmental theories suggest that adolescents and young adults are particularly sensitive to their social networks. Mobile health (mHealth) interventions, those that use mobile technology (e.g., smartphones apps) to transmit health information, hold promise as an effective way to improve ART adherence. These smartphone apps can be used to engage social networks and provide social support. Access to mobile phone technology is rapidly increasing among youth in South Africa, making mHealth interventions feasible and potentially scalable in this setting.

We developed MASI (MAsakhane Siphucule Impilo Yethu; Xhosa for "Let's empower each other and improve our health"), an ART adherence-supporting smartphone app for AYAHIV in South Africa. MASI was culturally adapted to the South African context using the evidence based HealthMpowerment platform. HealthMpowerment is a smartphone app-based intervention originally developed by Dr. Lisa Hightow-Weidman, and was developed based on the Institute of Medicine's Integrated Behavior Model with extensive input from youth. The app is designed to foster social support, offer tools for self-monitoring and habit formation, provide resources for goal setting and action planning, and present users with engaging informational resources.

This pilot randomized-controlled trial (RCT) is funded through a K01 Mentored Research Scientist Development Award. Prior to the pilot RCT, the study team developed and customized MASI through in-depth interviews and beta-testing with adolescents living with HIV in Cape Town. For the pilot RCT, participants will be randomized to either the full version of the MASI app or an information-only version of MASI control condition (1:1, with stratification by gender). Participants will be asked to engage with MASI for 6 months. All participants will complete baseline and follow-up assessments at 3- and 6-months.

Conditions

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HIV Infections Adolescent Behavior

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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MASI

Participants randomized to the intervention condition will receive access to MASI, the smartphone app customized for this study. MASI is an adapted version of HealthMpowerment, a theory-based smartphone app with features including an anonymous interactive discussion forum, a medication and adherence tracker, a platform to ask questions to an expert, a section with engaging activities (including quizzes, self-assessments, and goal-setting activities), and a multi-media resource center.

Group Type EXPERIMENTAL

Social Support

Intervention Type BEHAVIORAL

The app will provide opportunities for participants to interact with each other as well as trained peer mentors to receive and provide social support.

Informational Resources

Intervention Type BEHAVIORAL

The app will provide opportunities for participants to review HIV-related health information in engaging formats (e.g., activities, multi-media resources, and answer to users' health questions)

Self-Monitoring and habit formation

Intervention Type BEHAVIORAL

The app will provide opportunities for participants to track their treatment adherence and schedule tailored reminders.

Goal setting and action planning

Intervention Type BEHAVIORAL

The app will provide opportunities for participants to identify goals, select action items, and receive tailored feedback on the action plan.

Information-only version of MASI

Participants randomized to the control condition will an information-only version of MASI which will include the Resources feature and the home page.

Group Type ACTIVE_COMPARATOR

Informational Resources

Intervention Type BEHAVIORAL

The app will provide opportunities for participants to review HIV-related health information in engaging formats (e.g., activities, multi-media resources, and answer to users' health questions)

Interventions

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Social Support

The app will provide opportunities for participants to interact with each other as well as trained peer mentors to receive and provide social support.

Intervention Type BEHAVIORAL

Informational Resources

The app will provide opportunities for participants to review HIV-related health information in engaging formats (e.g., activities, multi-media resources, and answer to users' health questions)

Intervention Type BEHAVIORAL

Self-Monitoring and habit formation

The app will provide opportunities for participants to track their treatment adherence and schedule tailored reminders.

Intervention Type BEHAVIORAL

Goal setting and action planning

The app will provide opportunities for participants to identify goals, select action items, and receive tailored feedback on the action plan.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Age \>= 15 years and \<= 21 years
* Knows HIV status (Screened adolescents who do not know their HIV status will receive information on free voluntary HIV counseling and testing services)
* Living with HIV
* Has been prescribed medication to treat HIV
* Not attending school for learners with special needs (e.g., School of Skills)
* Has not repeated a grade in school more than once
* Has a smartphone that can download apps
* Feels comfortable using an app with content in English
* No plan to move outside of Cape Town in the next six months
* Has not previously participated in the MASI app testing phase of our study
* Able to successfully install the MASI app on their smartphone

* Child dissent despite parent, legal guardian, caregiver informed consent
Minimum Eligible Age

15 Years

Maximum Eligible Age

21 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Cape Town

OTHER

Sponsor Role collaborator

University of North Carolina

OTHER

Sponsor Role collaborator

National Institute of Mental Health (NIMH)

NIH

Sponsor Role collaborator

Florida State University

OTHER

Sponsor Role collaborator

Duke University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Marta I Mulawa, PhD

Role: PRINCIPAL_INVESTIGATOR

Duke University

Locations

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University of Cape Town

Cape Town, , South Africa

Site Status

Countries

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South Africa

References

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Mulawa MI, Hoare J, Knippler ET, Mtukushe B, Matiwane M, Muessig KE, Al-Mujtaba M, Wilkinson TH, Platt A, Egger JR, Hightow-Weidman LB. MASI, a Smartphone App to Improve Treatment Adherence Among South African Adolescents and Young Adults With HIV: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc. 2023 Sep 19;12:e47137. doi: 10.2196/47137.

Reference Type DERIVED
PMID: 37725409 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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K01MH118072

Identifier Type: NIH

Identifier Source: secondary_id

View Link

Pro00103309

Identifier Type: -

Identifier Source: org_study_id

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