Introduction
In the modern medical landscape, technology-based interventions are increasingly being developed to address a wide range of health issues. One such area that has seen significant attention is the management of human immunodeficiency virus (HIV), especially among youth and young adults who live with the virus. Studies show that this demographic is particularly vulnerable and bears a disproportionate share of the HIV burden, leading to an urgent call for targeted interventions (Bekker et al., 2015; Zanoni & Mayer, 2014).
Against this backdrop, a pilot study protocol has been designed for WYZ, a mobile health application aimed at fostering engagement in HIV care and enhancing antiretroviral therapy (ART) adherence among youth and young adults living with HIV (YLWH). This paper delves into the innovative design and development of WYZ for YLWH, the design of a forthcoming pilot trial to evaluate WYZ, and how WYZ compares to other mobile health applications in this domain.
Design and Development of WYZ
The WYZ app is conceived as a tool that empowers YLWH to surmount barriers to medication adherence and engagement with healthcare services. The app, developed with input from YLWH aged 18-29 years, adopts an agile methodology—a process often used in software development that facilitates adaptive planning, evolutionary development, and continuous improvement (Stare, 2013). The modular and personalized nature of WYZ, coupled with feedback collected during beta testing, ensures that the application is genuinely reflective of user needs.
Equipped with the information, motivation, behavioral skills (IMB) model (Fisher et al., 2006), WYZ aims to address the complex array of factors influencing health behaviors in YLWH, fostering:
1. Enhanced medication adherence self-efficacy
2. Greater awareness and use of community resources
3. Reduced communication barriers between youth and their healthcare team
4. Secure platform for the creation of a private online community of individuals living with HIV
Pilot Trial Evaluation
A forthcoming 6-month single-arm pilot study will scrutinize the feasibility and acceptability of the WYZ app among 76 YLWH based in the San Francisco Bay Area. All study activities, from recruitment to exit interviews, will be conducted remotely, aligning with contemporary trends necessitated by public health measures (Erguera et al., 2020).
The UCSF Institutional Review Board has granted approval for the trial, ensuring ethical oversight, and the study is registered under ClinicalTrials.gov (NCT03587857). The UCSF Center for AIDS Prevention Studies’ Community Engagement Core and the Youth Advisory Panel will assist in disseminating the findings to stakeholders through various channels such as social media and community forums.
Comparison with Other Interventions
WYZ sets itself apart from other mobile health interventions by the extent of its specificity to the challenges faced by YLWH in HIV care and ART adherence. While other apps target broader populations or focus solely on information dissemination, WYZ is uniquely positioned to address the nuances of young individuals’ experiences with HIV management (Navarra et al., 2017).
Furthermore, the embrace of an agile development process allows WYZ to iterate rapidly based on user feedback, a critical component that promises continuous refinement in real-world settings (Kachirskaia et al., 2018).
Implications and Future Directions
Should the pilot study affirm WYZ’s efficacy, this mobile health intervention has the potential to revolutionize HIV care for young people. By leveraging technology, WYZ can bridge gaps in healthcare access and bolster medication adherence, which are significant determinants of long-term health outcomes (Shubber et al., 2016; Marks et al., 2015).
Moreover, the app’s design can serve as a blueprint for other health interventions targeting similar demographics, highlighting the versatility of technology in healthcare (Matheson et al., 2015).
Conclusion
WYZ exemplifies how theory, innovation, and collaboration can culminate in a tool with the potential to markedly improve health behaviors among YLWH. As the pilot study progresses, WYZ may well become a substantial addition to the arsenal of strategies combating the HIV epidemic in this vulnerable population.
DOI and References
DOI: 10.1136/bmjopen-2019-030473
1. Bekker LG, Johnson L, Wallace M, et al. Building our youth for the future. J Int AIDS Soc. 2015;18:1-7. doi:10.7448/IAS.18.2.20027.
2. Zanoni BC, Mayer KH. The adolescent and young adult HIV cascade of care in the United States: exaggerated health disparities. AIDS Patient Care STDS. 2014;28:128-135. doi:10.1089/apc.2013.0345.
3. Erguera XA, Johnson MO, Neilands TB, et al. WYZ: a pilot study protocol for designing and developing a mobile health application for engagement in HIV care and medication adherence in youth and young adults living with HIV. BMJ Open. 2020;9(5):e030473. doi:10.1136/bmjopen-2019-030473.
4. Navarra AD, Gwadz MV, Whittemore R, et al. Health Technology-Enabled Interventions for Adherence Support and Retention in Care Among US HIV-Infected Adolescents and Young Adults: an Integrative Review. AIDS Behav. 2017;21:3154-3171. doi:10.1007/s10461-017-1867-6.
5. Shubber Z, Mills EJ, Nachega JB, et al. Patient-Reported Barriers to Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis. PLoS Med. 2016;13:e1002183. doi:10.1371/journal.pmed.1002183.
Keywords
1. WYZ mobile app for HIV care
2. Youth HIV medication adherence
3. Mobile health applications HIV
4. Engagement in HIV care technology
5. Antiretroviral therapy adherence app