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 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 youth living with HIV to continue working on and maintaining their health goals and achievements (e.g., undetectable viral load).
Unfortunately, youth living with HIV face several barriers to health care transition on the individual, clinical and structural levels. For example, insufficient preparation for disease self-management 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 youth living with HIV 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 youth living with HIV in the health care transition process to keep young adults engaged and retained in care during their care transition.
Description
iTransition: Developing and Testing a Web App to Support Youth Living with HIV and the Transition from Pediatric to Adult Care
iTransition: Developing and Testing a Web App to Support Youth Living with HIV and the Transition from Pediatric to Adult Care
We seek to inform the development of culturally sensitive and appropriate digital interventions to improve health care transition for youth living with HIV.
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 followed a multi-step process in collaboration with Emory University and University of Carolina Greensboro. We first created a development framework and held 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 were about to experience this health care transition from pediatric/adolescent care to adult care. We also received feedback from clinical providers who directly helped youth through the health care transition process.
To test iTransition and determine its preliminary efficacy, we conducted a non-randomized intervention trial with youth living with HIV, comparing a historical control group who experienced standard health care transition and an intervention group who received iTransition. The trial also included HIV care providers who facilitate health care transition in their clinics and will test the iTransition web app. We consulted “transition champions” who were HIV care providers nominated by their peers to endorse and promote use of the iTransition web app to youth living with HIV and providers in the intervention.
Through this study, we implemented iTransition and reviewed how it was utilized, conducted surveys to assess iTransition satisfaction and past/current health experiences, organized qualitative interviews on the health care transition process and iTransition experiences, and reviewed medical charts of youth living with HIV to assess care retention and viral suppression. For more information on our implementation of iTransition, please read our published protocol paper.
Data collection concluded on June 30, 2024.
Next Steps
Data analysis is ongoing, and results will be presented in conferences in 2025.
This study was conducted during the COVID-19 pandemic which may have impacted results. We discuss lessons learned in this publication.
The iTransition study provided 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 February 2025.
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].