eHARTS: A qualitative assessment of the acceptability and feasibility of a mobile application for transition readiness assessment for adolescents living with HIV in South Africa Open Access

Fomo, Messaline (Spring 2022)

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Background: South Africa bears one of the world’s highest burden of adolescents living with HIV (ALHIV). ALHIV have low rates of retention in care and viral suppression after transition from adolescent-based care to adult care, leading to poor health outcomes. Transition readiness assessments are required to identify and prepare ALHIV for transition. The study’s objective is to evaluate the acceptability and feasibility of a mobile application in transition readiness assessments for ALHIV in South Africa.

Methods: We conducted in-depth interviews with 15 ALHIV and 15 healthcare providers at three government-supported hospitals in KwaZulu Natal, South Africa. The semi-structured interview guide comprised of open-ended questions based on the theory of the mobile acceptance model. We used a thematic analysis approach to develop themes that were representative of the participants’ perspectives on the acceptability and feasibility of eHARTS.

Results: Most participants found eHARTS to be acceptable because of its simplicity and lack of stigma. Participants believed eHARTS was feasible as it could easily be administered within a hospital setting and integrated into regular clinic activity without disrupting patient care. eHARTS was also found to have great utility for adolescents and healthcare providers. Healthcare providers saw it as a valuable tool to engage adolescents and prepare them for transition to adult care. Despite fears that eHARTS may give adolescents a wrong idea about how quickly ALHV have to move to adult clinics, participants suggested that eHARTS can be framed in a way that empowers adolescents as they prepare for transition to adult care.

Conclusion: Research on transition readiness assessment for ALHIV in South Africa and other low-income countries is limited. Our findings show that eHARTS is a simple mobile transition assessment tool that is acceptable and feasible for use in HIV clinics in South Africa for transition readiness assessment for ALHIV. In assessing the acceptability and feasibility of eHARTS, this study aims to inform further research on transition readiness assessments for ALHIV. It also serves as a catalyst to increase transition readiness assessments by healthcare providers to identify gaps in transition readiness for ALHIV and transitioning to adult care.

Table of Contents

Chapter 1: Introduction and rationale. 1

Problem statement. 3

Purpose statement. 4

Research objectives. 4

Significance statement. 4

Definition of terms. 5

Chapter 2: Comprehensive literature Review. 6

Historical context of the HIV epidemic in South Africa. 6

HIV infection among adolescents. 9

Transition to adult HIV care. 15

Transition readiness assessment. 17

HIV transition readiness assessment scale. 18

Mobile Health Interventions. 19

Conclusion. 20

Chapter 3: Manuscript. 22

Abstract. 23

Introduction. 24

Methods. 26

Results. 31

Discussion. 40

Chapter 4: Conclusion and Public health implication. 44

Conclusion. 44

Public health implications. 44

References. 46

Appendices. 55

Appendix A: Interview guide for interviews with adolescents and health professionals. 55

Appendix B: COREQ (COnsolidated criteria for REporting Qualitative research) Checklist. 56

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