Effect of a Male-Targeted Digital Decision Support Application Aimed at Increasing Linkage to HIV Care Among Men: Findings from the HITS Cluster Randomized Clinical Trial in Rural South Africa

Hae-Young Kim; Maxime Inghels; Thulile Mathenjwa; Maryam Shahmanesh; Janet Seeley; Phillippa Matthews; Sally Wyke; Nuala McGrath; Oluwafemi Adeagbo; Dickman Gareta; H Manisha Yapa; Thembelihle Zuma; Adrian Dobra; Ann Blandford; Till Bärnighausen; Frank Tanser

doi:10.1007/s10461-024-04465-1

Effect of a Male-Targeted Digital Decision Support Application Aimed at Increasing Linkage to HIV Care Among Men: Findings from the HITS Cluster Randomized Clinical Trial in Rural South Africa

AIDS Behav. 2024 Sep 11. doi: 10.1007/s10461-024-04465-1. Online ahead of print.

Authors

Hae-Young Kim^{1

2}, Maxime Inghels³, Thulile Mathenjwa⁴, Maryam Shahmanesh^{4

5}, Janet Seeley^{4

6}, Phillippa Matthews⁴, Sally Wyke⁷, Nuala McGrath^{4

8

9}, Oluwafemi Adeagbo^{10

11}, Dickman Gareta⁴, H Manisha Yapa^{12

13}, Thembelihle Zuma⁴, Adrian Dobra¹⁴, Ann Blandford¹⁵, Till Bärnighausen^{4

16

17}, Frank Tanser^{4

18

19

9}

Affiliations

¹ New York University Grossman School of Medicine, 227 East 30th Street, New York, NY, USA. hae-young.kim@nyulangone.org.
² Africa Health Research Institute, KwaZulu-Natal, South Africa. hae-young.kim@nyulangone.org.
³ Lincoln Institute for Rural and Coastal Health, University of Lincoln, Lincoln, UK.
⁴ Africa Health Research Institute, KwaZulu-Natal, South Africa.
⁵ Institute for Global Health, University College London, London, UK.
⁶ London School of Hygiene and Tropical Medicine, London, UK.
⁷ University of Glasgow, Glasgow, UK.
⁸ University of Southampton, Southampton, UK.
⁹ School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
¹⁰ University of Johannesburg, Johannesburg, South Africa.
¹¹ College of Public Health, University of Iowa, Iowa, USA.
¹² The Kirby Institute, University of New South Wales Sydney, Sydney, Australia.
¹³ Sydney Infectious Diseases Institute, University of Sydney, Sydney, Australia.
¹⁴ University of Washington, Washington, USA.
¹⁵ University College London Interaction Centre, University College London, London, UK.
¹⁶ Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany.
¹⁷ Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁸ Centre for Epidemic Response and Innovation, School for Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa.
¹⁹ South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.

PMID: 39259239
DOI: 10.1007/s10461-024-04465-1

Abstract

Linkage to HIV care remains suboptimal among men. We investigated the effectiveness of a male-targeted HIV-specific decision support app, Empowering People through Informed Choices for HIV (EPIC-HIV), on increasing linkage to HIV care among men in rural South Africa. Home-Based Intervention to Test and Start (HITS) was a multi-component cluster-randomized controlled trial conducted among 45 communities in uMkhanyakude, KwaZulu-Natal. The development of EPIC-HIV was guided by self-determination theory and human-computer interaction design to increase intrinsic motivation to seek HIV testing and care among men. EPIC-HIV was offered in two stages: EPIC-HIV 1 at the time of home-based HIV counseling and testing (HBHCT), and EPIC-HIV 2 at 1 month after a positive HIV diagnosis if not linked to care. Sixteen communities were randomly assigned to the arms to receive EPIC-HIV, and 29 communities to the arms without EPIC-HIV. Among all eligible men, we compared linkage to care (initiation or resumption of antiretroviral therapy after > 3 months of care interruption) at local clinics within 1 year of a home visit, ascertained from individual clinical records. Intention-to-treat analysis was performed using modified Poisson regression with adjustment for receiving another intervention (i.e., financial incentives) and clustering at the community level. We also conducted a satisfaction survey for EPIC-HIV 2. A total of 13,894 men were eligible (i.e., aged ≥ 15 years and resident in the 45 communities). The mean age was 34.6 (±16.8) years, and 65% were married or in an informal union. Overall, 20.7% received HBHCT, resulting in 122 HIV-positive and 6 discordant tests. Among these, 54 men linked to care within 1 year after HBHCT. Additionally, of the 13,765 eligible participants who did not receive HBHCT or received HIV-negative results, 301 men linked to care within 1 year. Overall, only 13 men received EPIC-HIV 2. The proportion of linkage to care did not differ between the arms randomized to EPIC-HIV and those without EPIC-HIV (adjusted risk ratio = 1.05; 95% CI:0.86-1.29). All 13 men who used EPIC-HIV 2 reported the app was acceptable, user-friendly, and useful for getting information on HIV testing and treatment. The reach was low, although the acceptability and usability of the app were very high among those who engaged with it. Enhanced digital support applications could form part of interventions to increase knowledge of HIV treatment among men. Clinical Trial Number: ClinicalTrials.gov # NCT03757104.

Keywords: Digital counseling application; Human-centered intervention design; Informed decision-making; Linkage to HIV care; Randomized controlled trial; South Africa.

Associated data

ClinicalTrials.gov/NCT03757104

Abstract

Associated data

Grants and funding