PT  - JOURNAL ARTICLE
AU  - Akama, Eliud Omondi
AU  - Beres, Laura K
AU  - Kulzer, Jayne Lewis
AU  - Ontuga, Gladys
AU  - Adhiambo, Harriet
AU  - Bushuru, Sarah
AU  - Nyagesoa, Edwin
AU  - Osoro, Joseph
AU  - Opondo, Isaya
AU  - Sang, Norton
AU  - Oketch, Bertha
AU  - Nyanga, James
AU  - Osongo, Cirilus Ogollah
AU  - Nyandieka, Evelyn
AU  - Ododa, Evelyn
AU  - Omondi, Eunice
AU  - Ochieng, Felix
AU  - Owino, Clinton
AU  - Odeny, Thomas
AU  - Kwena, Zachary Arochi
AU  - Eshun-Wilson, Ingrid
AU  - Petersen, Maya
AU  - Bukusi, Elizabeth A
AU  - Geng, Elvin H
AU  - Abuogi, Lisa L
TI  - A youth-centred approach to improving engagement in HIV services: human-centred design methods and outcomes in a research trial in Kisumu County, Kenya
AID  - 10.1136/bmjgh-2023-012606
DP  - 2023 Nov 01
TA  - BMJ Global Health
PG  - e012606
VI  - 8
IP  - 11
4099  - http://gh.bmj.com/content/8/11/e012606.short
4100  - http://gh.bmj.com/content/8/11/e012606.full
SO  - BMJ Global Health2023 Nov 01; 8
AB  - Innovative interventions are needed to improve HIV outcomes among adolescents and young adults (AYAs) living with HIV. Engaging AYAs in intervention development could increase effectiveness and youth acceptance, yet research is limited. We applied human-centred design (HCD) to refine adherence-support interventions pretrial and assessed HCD workshop acceptability.Methods We applied an iterative, four-phased HCD process in Kenya that included: (1) systematic review of extant knowledge, (2) prioritisation of design challenges, (3) a co-creation workshop and (4) translation tables to pair insights with trial intervention adaptations. The co-creation workshop was co-led by youth facilitators employing participatory activities to inform intervention adaptations. Iterative data analysis included rapid thematic analysis of visualised workshop outputs and notes using affinity mapping and dialogue to identify key themes. We conducted a survey to assess workshop acceptability among participants.Results Twenty-two participants engaged in the 4-day workshop. Co-creation activities yielded recommendations for improving planned interventions (eg, message frequency and content; strategies to engage hard-to-reach participants), critical principles to employ across interventions (eg, personalisation, AYA empowerment) and identification of unanticipated AYA HIV treatment priorities (eg, drug holidays, transition from adolescent to adult services). We revised intervention content, peer navigator training materials and study inclusion criteria in response to findings. The youth-led HCD workshop was highly acceptable to participants.Conclusions Research employing HCD among youth can improve interventions preimplementation through empathy, youth-led inquiry and real-time problem solving. Peer navigation may be most influential in improving retention when engagement with young people is based on mutual trust, respect, privacy and extends beyond HIV-specific support. Identifying opportunities for personalisation and adaptation within intervention delivery is important for AYAs. Patient engagement interventions that target young people should prioritise improved transition between youth and adult services, youth HIV status disclosure, AYA empowerment and healthcare worker responsiveness in interactions and episodic adherence interruptions.Data are available on reasonable request. In accordance with our NIH-approved data sharing plan, and in order to protect the privacy of the small number of participants who participate in the study, we will limit sharing to insights and translation tables, available upon reasonable request.