iTransition: Developing and Testing a Web App to Support Youth Living with HIV and the Transition from Pediatric to Adult Care

Statement of Problem

Of the approximately 38,000 new HIV diagnoses in the U.S. in 2018, 21% of those cases were among youth ages 13-24 years. Youth living with HIV (YLH) will all experience a health care transition from pediatric/adolescent HIV care to adult care, and this care transition can be disruptive to care engagement. Yet, this period is crucial for YLH to continue working on and maintaining their health goals and achievements (e.g., undetectable viral load). Unfortunately, YLH face several barriers to health care transition on the individual, clinical and structural levels. For example, insufficient preparation for disease self-management over over 18 (individual), lack of quality inter-clinic communication to facilitate health care transition (clinical), and financial and transportation difficulties (structural) all contribute to poor health care transition outcomes.

Despite these challenges, there are no existing evidence-based interventions that are tailored by and for YLH to improve the health care transition process. However, mobile health (mHealth) and electronic Health (eHealth) interventions have been shown to be useful tools for improving medication adherence as well as care engagement for youth living with various chronic illnesses, and may be useful to YLH in the health care transition process to keep young adults engaged and retained in care during their care transition.

Description

iTransition is a dynamic Social Cognitive Theory-based mHealth website application (web app) to improve health care transition at the patient, provider, and clinic levels with features focused on medication and appointment reminders, direct messaging between patients and providers, and important health care transition tips and resources. As a web app, iTransition can be used on a range of devices (computer, tablet, smartphone), web browsers and operating systems (iOS, Android, Windows).

To develop iTransition, our team is following a multi-step process in a collaboration with Emory University and University of Carolina Greensboro. We first created a development framework and continue to hold iterative design meetings to receive feedback on health care transition needs and preferences for a web app with a youth advisory board comprised of individuals who had recently experienced or are about to experience this health care transition from pediatric/adolescent care to adult care. We are also receiving feedback from clinical providers who directly help youth through the health care transition process.

To test iTransition and determine its preliminary efficacy, we are conducting a non-randomized intervention trial with YLH, comparing a historical control group who experienced standard health care transition and an intervention group receiving iTransition. The trial will also include HIV care providers who facilitate health care transition in their clinics and will test the iTransition web app.  We will consult “transition champions” who are HIV care providers nominated by their peers to endorse and promote use of the iTransition web app to YLH and providers in the intervention.

Through this study, we will implement iTransition and review how it is utilized, conduct surveys to assess iTransition satisfaction and past/current health experiences, organize qualitative interviews on the health care transition process and iTransition experiences, and review YLH medical charts to assess care retention and viral suppression.

Next Steps

Our team’s next steps include conducting a randomized control trial for further evaluation. This study may provide key preliminary data for future development of mHealth interventions that are culturally sensitive and appropriate for health care transition engagement and retention, as well as have broad implications for improving the pediatric/adolescent to adult health care transition experience and clinical outcomes for youth and providers.

This project page was updated in October 2020.

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. iTransition: Developing and Testing a Web App to Support Youth Living with HIV and the Transition from Pediatric to Adult Care [Online]. Available at: http://www.policylab.chop.edu. [Accessed: plug in date accessed here]. 

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