OPT-In For Life is a social media-based intervention that promotes advancement along the HIV care continuum for young adults (ages 18 to 34) with HIV. During the 18-month intervention, OPT-In For Life used multiple social media platforms and a mobile application (app) to provide HIV-related and positive lifestyle resources for young adults. Led by Pennsylvania State University, it was implemented in collaboration with HIV care providers in Central Pennsylvania, including Alder Health Services, Hamilton Health Center, Hershey Medical Center, and the Pinnacle Health REACCH Program. OPT-In For Life was part of a Ryan White HIV/AIDS Program (RWHAP) Part F Special Projects of National Significance (SPNS) initiative, launched in 2015. Young adults enrolled in OPT-in For Life demonstrated improved retention in HIV care and higher rates of viral suppression after participation.
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Young adults (ages 18 to 34) with HIV are less likely to be retained in care and virally suppressed than their older counterparts.1 Therefore, there is an essential need to create effective HIV care continuum interventions for this population. However, many HIV interventions do not focus on young adults. OPT-In For Life addresses this need through an app and social media presence that provides appointment and medication reminders, education, goal setting/planning, secure messaging with a care team, and community engagement.
“Our results suggest that this intervention was an effective tool to help prevent [young adults with HIV] from falling out of care, so they could eventually achieve HIV viral suppression.”
The app was built in collaboration with a developer who specialized in designing health applications that adhered to the Health Insurance Portability and Accountability Act (HIPAA) confidentiality, privacy, and data security requirements. Through the app, clients can view their three-year HIV viral load and CD4 count lab values, maintain a journal of their care journey, set their health goals, and watch education videos. The app also allowed clients to better manage their care by displaying contact information for their healthcare site and for each HIV care team member, to schedule visits with their care team, and to transfer their care to another associated clinic. To engage clients in care, the care team members could also send them general or individualized messages. Clients were also reminded of upcoming appointments and to take their medications through the app.
OPT-In For Life also included social media posts focused on health and wellness, with an HIV-specific emphasis. This social media presence aimed to raise awareness among at-risk or HIV positive young adults about the OPT-In For Life brand and the HIV care and prevention services available. The secondary objective was to make the Central Pennsylvania community more comfortable discussing HIV. Posts included videos, journals, images, and serial fiction. Facebook, Twitter, YouTube, and Instagram were the most popular social media platforms among clients under the brand name "OPT-In For Life."
The care team consisted of physicians, nurses, and case managers who provided HIV and primary care at each of the clinics hosting the intervention—Alder Health Services, Hamilton Health Center, Hershey Medical Center, and the Pinnacle Health REACCH Program. These staff engaged clients in the intervention and provided comprehensive medical care and support services. The care team communicated with clients during their in-person and virtual visits, as well as messaged with clients through the OPT-In For Life app’s secure message portal.
The OPT-In For Life evaluation team tracked retention in care and viral suppression rates of the 92 people participating in the program. Participants were eligible for the study if they were aged 18–34, out of care or at risk of falling out of care, and living in the catchment area. The evaluation found that clients participating in the intervention were significantly more likely to be retained in care and virally suppressed at six, 12, and 18 months compared to baseline.
| Category | Information |
|---|---|
| Evaluation data | Clients’ medical data abstracted from participating clinics’ electronic health record systems. |
| Measures |
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| Results |
* statistically significant |
Source: Zurlo J, Du P, Haynos A, et al. OPT-In For Life: A mobile technology–based Intervention to improve HIV care continuum for young adults living with HIV. Health Promot Pract. 2020;21(5):727–737.
Project team. The OPT-In For Life team consisted of people knowledgeable about social media and experienced in providing care to people with HIV. The team consisted of three smaller ones: a clinical care team, including clinicians and case managers, a social media content development team, and an administrative support team, which was crucial for client recruitment. The administrators supported timely communication between care team members and clients, matching clients to appropriate services, and addressing clients' barriers to care.
Community engagement. The OPT-In For Life team created a community advisory board of young adults with HIV from the participating clinics, and held 90-minute focus group sessions to inform the needs assessment and gather feedback for the intervention. The team also engaged with communities in Central Pennsylvania through social media over the course of the intervention.
App development. A developer created a health app that complied with HIPAA confidentiality and privacy regulations and was connected to a client’s specific care team. Clients who got medical care at one location but case management at a different location could register on the app for both locations. The OPT-In For Life implementation team developed protocols to specify who would reply to clients in these cases.
Intervention promotion. Social marketing campaigns and advertisements of the OPT-In For Life brand were conducted through traditional media platforms (such as local news stations, bus and bus stop posters, and flyers at social events) to further promote the awareness of HIV prevention resources and reduce social stigma of HIV.
SPNS funding covered the cost of the intervention, including staff and app development. The OPT-In For Life team reported that the minimum number of staff needed to sustain the intervention were two care team members, one administrative staff person, and one social media expert. For 100 clients enrolled in the intervention, the OPT-In For Life team recommended the following staffing plan: 5-10% of clinical staff time during the recruitment stage and 5% during the implementation stage; 50–75% of social media expert time throughout the intervention; and 5–10% of administrative staff time throughout the intervention.
- Clients most often used the OPT-In For Life app for text messaging (46% of all app use) and to review test results (28% of all app use).
- Social media platforms are constantly changing, so it was difficult to develop “how to” guides on these technologies. Having dedicated staff highly experienced in social media helped OPT-In For Life navigate this changing landscape.
- New, authentic, and relevant content was a must. OPT-In For Life staff needed to be imaginative and flexible when developing content for social media, tailoring messaging for priority populations, and to keep the app's appearance fresh.
- OPT-In For Life staff needed to be prepared for negative content being posted on their social media pages. Instead of deleting these posts, they learned to respond quickly and honestly.
- App development faced implementation hurdles related to contract, security, and Institutional Review Board (IRB) requirements. OPT-In For Life staff planned for these delays and avoided technology issues by selecting a vendor with experience in the healthcare industry and a solid track record.
- Maintaining client confidentiality makes people more comfortable interacting on social media platforms. Protected health information should not be shared through the app. OPT-In For Life staff took into account privacy issues in rural areas where people were more likely to be identifiable.
