Can a Phone App Deliver More Teen-Friendly HIV Care?

There’s one group being left behind in the remarkable progress against AIDS: adolescents. While HIV transmission and HIV-related mortality is declining among adults, it isn’t decreasing as quickly among teenagers as health officials had projected. AIDS remains the leading cause of death among adolescents in Africa, and the second leading cause globally.

That gap has revealed a need for more teen-friendly HIV prevention and treatment programs, says Marta Mulawa, Ph.D., an assistant professor of nursing and global health at the Duke Global Health Institute.

“In the past, we shifted kids from pediatric to adult care without having adolescent-friendly care that’s appropriate, effective and accessible,” she says. “Adolescents deserve care and services tailored to their needs.”

So where do you go if you want to reach teens? Their phones, of course.  

Mulawa and researchers from the University of Cape Town and Florida State University developed a smartphone app called “Masakhane Siphucule Impilo Yethu,” also known as MASI. The phrase in Xhosa, a South African language, means, “Let’s empower each other and improve our health.” Users can identify goals and receive feedback on their action plan, learn health tips, and build community by interacting with each other.

“I don’t see tech as replacing support groups or in-person care, but as another platform for young people to make connections and get access to useful, credible information,” Mulawa says.

The app serves as a bridge between its users and care. In South Africa, receiving HIV treatment can be difficult. Many students can’t leave school to attend support clinics. Family members encourage teens to keep their diagnosis secret, and many HIV-positive youth fear how friends will treat them if they knew their status.

“Stigma is a really powerful force that has shaped our participants’ lives and behaviors such as treatment adherence,” Mulawa says. “Another goal of our app is to find coping methods for stigma-related experiences to prevent bad health outcomes.”

MASI was introduced in 2021 with an initial user group of 12 Cape Town teenagers, all born with HIV. The app received favorable reviews compared to other health apps, according to a 2023 paper published in JMIR Formative Research. Now, 50 adolescents and young adults are enrolled in a pilot phase, with goals to continue expanding the app’s use.

The app offers features such as “Health Tracker,” which allows users to monitor how often they take antiretroviral medication. The “Resources” tab includes educational materials on concepts such as “U=U,” short for “undetectable equals untransmittable.” It’s a reminder that people who keep their viral load undetectable through medication will not pass on the virus to sexual partners.

“Our team learned early on many young people haven’t heard about it,” Mulawa says about the importance of an undetectable viral load. “We think increasing awareness of U=U will improve treatment adherence.” 

Bulelwa Mtukushe, a project coordinator for the MASI app at the University of Cape Town, says participants self-reported adhering more to their medication routine throughout the study.

“They’re learning,” says Bulelwa, a native of the Eastern Cape Province in South Africa. “I never thought I’d see something like this working so well in South Africa. This app is empowering our participants.”

As important as its information may be, MASI also provides a safe community for teens living with HIV. Users are connected with peer mentors and encouraged to accept their HIV status.

“Because social networks can shape behaviors, it can shape behavior change for public health,” Mulawa says. “This technology is another way to reach underserved youth who have challenges accessing and staying in care.”