An Online Support Group Intervention for Adolescents Living with HIV in Nigeria: A Pre-Post Test Study

Abstract

Background: Adolescents living with HIV (ALHIVs) enrolled in HIV treatment services experience greater loss to follow-up and suboptimal adherence than other age groups. HIV-related stigma, disclosure-related issues, lack of social support, and limited HIV knowledge impede adherence to antiretroviral therapy (ART) and retention in HIV services. The 90-90-90 goals for ALHIVs will only be met through strategies targeted to meet their specific needs.

Objectives: We aimed to evaluate the feasibility of implementing a social media-based intervention to improve HIV knowledge, social support, ART adherence, and retention among ALHIV aged 15-19 years on ART in Nigeria.

Methods: We conducted a single-group pre-post test study from June 2017 to January 2018. We adapted an existing support group curriculum and delivered it through trained facilitators in 5 support groups by using Facebook groups. This pilot intervention included five 1-week sessions. We conducted structured interviews with participants before and after the intervention, extracted clinical data, and documented intervention implementation and participation. In-depth interviews were conducted with a subset of participants at study completion. Quantitative data from structured interviews and group participation data were summarized descriptively, and qualitative data were coded and summarized.

Results: A total of 41 ALHIV enrolled in the study. At baseline, 93% of participants reported existing phone access; 65% used the internet, and 64% were Facebook users. In addition, 37 participants completed the 5-session intervention, 32 actively posted comments in at least one session online, and at least half commented in each of the 5 sessions. Facilitators delivered most sessions as intended and on-time. Participants were enthusiastic about the intervention. Aspects of the intervention liked most by participants included interacting with other ALHIVs; learning about HIV; and sharing questions, experiences, and fears. The key recommendations were to include larger support groups and encourage more group interaction. Specific recommendations on various intervention components were made to improve the intervention.

Conclusions: This novel intervention was feasible to implement in a predominantly suburban and rural Nigerian setting. Social media may be leveraged to provide much-needed information and social support on platforms accessible and familiar to many people, even in resource-constrained communities. Our findings have been incorporated into the intervention, and an outcome study is underway.

Trial registration: ClinicalTrials.gov NCT03076996; https://ichgcp.net/clinical-trials-registry/NCT03076996 (Archived by WebCite at http://www.webcitation.org/73oCCEBBC).

Keywords: HIV care continuum; adolescents; digital health intervention; social support.

Conflict of interest statement

Conflicts of Interest: None declared.

©Lisa Dulli, Kathleen Ridgeway, Catherine Packer, Kate F Plourde, Tolulope Mumuni, Tosin Idaboh, Adesola Olumide, Oladosu Ojengbede, Donna R McCarraher. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 28.11.2018.

Figures

Figure 1

At a glance. *ART: antiretroviral therapy.

Figure 2

Word of the week.

Figure 3

Sample cartoon. *ART: antiretroviral therapy.

Figure 4

Study flow chart. *ALHIV: adolescent living with HIV. **In 5 cases, the guardians refused to let the child participate because they had not yet disclosed their child's HIV status to him or her. ***One participant did not complete the endpoint structured interview, but completed the in-depth interview.

Figure 5

Group posts per session.

Figure 6

Individual posts per group.

Figure 7

Number of posts or comments by group facilitators per session.