RT Journal Article
SR Electronic
T1 A youth-centred approach to improving engagement in HIV services: human-centred design methods and outcomes in a research trial in Kisumu County, Kenya
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e012606
DO 10.1136/bmjgh-2023-012606
VO 8
IS 11
A1 Akama, Eliud Omondi
A1 Beres, Laura K
A1 Kulzer, Jayne Lewis
A1 Ontuga, Gladys
A1 Adhiambo, Harriet
A1 Bushuru, Sarah
A1 Nyagesoa, Edwin
A1 Osoro, Joseph
A1 Opondo, Isaya
A1 Sang, Norton
A1 Oketch, Bertha
A1 Nyanga, James
A1 Osongo, Cirilus Ogollah
A1 Nyandieka, Evelyn
A1 Ododa, Evelyn
A1 Omondi, Eunice
A1 Ochieng, Felix
A1 Owino, Clinton
A1 Odeny, Thomas
A1 Kwena, Zachary Arochi
A1 Eshun-Wilson, Ingrid
A1 Petersen, Maya
A1 Bukusi, Elizabeth A
A1 Geng, Elvin H
A1 Abuogi, Lisa L
YR 2023
UL http://gh.bmj.com/content/8/11/e012606.abstract
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.