A qualitative assessment of the perceived acceptability and feasibility of eHARTS, a mobile application for transition readiness assessment for adolescents living with HIV in South Africa.

• Type of Material: Article
• Authors: Messaline F Fomo, Emory University; John Newman, Emory University; Thobekile Sibaya, University of KwaZulu Natal; Nompumelelo Ndlela, University of KwaZulu Natal; Sophia Hussen, Emory University; Moherndran Archary, University of KwaZulu Natal; Brian Zanoni, Emory University
• Language: English
• Date: 2023-06
• Publisher: PLOS
• Publication Version: Final Published Version
• Copyright Statement: © 2023 Fomo et al
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pdig.0000272
• Title of Journal or Parent Work: PLOS Digit Health
• Volume: 2
• Issue: 6
• Start Page: e0000272
• End Page: e0000272
• Grant/Funding Information: Funding for this project was provided through the Emory Global Health Institute (EGHI). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
• Keywords: HIV; Adolescents; South Africa; Health care providers
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery; Health Sciences, Pathology; Biology, Microbiology; Health Sciences, Immunology

Abstract

South Africa has the highest burden of adolescents living with HIV (ALHIV) in the world. The transition from pediatric to adult centered HIV care is a vulnerable period during which many clinical outcomes of ALHIV suffer. Transition readiness assessments may help ALHIV transition from pediatric to adult care to improve their health outcomes. Here, we evaluated the perceived acceptability and feasibility of a mobile health (mHealth) application, eHARTS, to determine transition readiness for ALHIV in South Africa. We conducted in-depth interviews with adolescents (n = 15) and healthcare providers (n = 15) at three government-supported hospitals in KwaZulu-Natal, South Africa. We used a semi-structured interview guide comprising of open-ended questions based on the unified theory of acceptance and use of technology. We did a thematic analysis of the data using an iterative, team-based coding approach to develop themes that were representative of the participants' perspectives on the acceptability and feasibility of eHARTS. We found that 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. Additionally, eHARTS was found to have great utility for adolescents and healthcare providers. Clinicians saw it as a valuable tool to engage adolescents and prepare them for transition. Despite concerns that eHARTS may give adolescents a wrong impression about immediate transition, participants suggested that eHARTS be framed in an empowering way as they prepare for transition to adult care. Our data showed that eHARTS is a simple, mobile transition assessment tool with perceived acceptability and feasibility for use in HIV clinics in South Africa for ALHIV. It is particularly useful for ALHIV and transitioning to adult care as it can help identify gaps in readiness for transition.