# Adapting mHealth interventions to improve self-management of HIV and substance use among emerging adults in Zambia

> **NIH NIH R34** · UNIV OF MASSACHUSETTS MED SCH WORCESTER · 2024 · $209,791

## Abstract

Sub-Saharan Africa is most severely affected by the HIV epidemic, particularly Zambia. Young people with
HIV (YPWH) are disproportionately impacted by HIV/AIDS. Emerging adulthood (ages 18-24) is characterized
by increasing independence, risk-taking behaviors, identity exploration, and changing social supports, which
may impact HIV management behaviors, including medication adherence, retention in care, sexual risk
behavior, and substance abuse. Substance use has synergistic and additive effects on health and HIV-related
comorbidities, and accelerated HIV disease. Self-management interventions targeting HIV and substance use
reduction in Zambian YPWH are urgently needed. We propose to develop and pilot a multi-component,
mHealth intervention to promote HIV self-management and reduce substance use. We will adapt the 4-
session, in-person Healthy Choices (HC) intervention for mHealth (mHC) to increase access and delivery of
HC. In addition, we will develop and pilot test Motivational Text Messaging (MTM) to enhance the impact of
mHC. mHC and MTM will be delivered using Computerized Intervention Authoring System (CIAS). Our
primary aim is to develop and assess the preliminary efficacy of the resulting mHealth intervention. We will
utilize a Multiphase Optimization Strategy (MOST) framework to identify the most effective intervention
component or combination of components that addresses self-management and substance use among YPWH
in Zambia. The proposed study includes 3 phases. Phase I includes focus groups with Zambian YPWH to
explore barriers and facilitators of HIV self-management and substance use to inform the intervention. Phase
II consists of adapting and beta testing of mHC and MTM for functionality and feasibility using a community
advisory board of Zambian YPWH, local healthcare personnel, and community leaders. In Phase III, we will
conduct a pilot using the MOST framework to assess feasibility, acceptability, and preliminary efficacy of
intervention components (mHC and MTM) to improve HIV self-management and reduce alcohol and other
drug use. One hundred YPWH be randomized to four experimental conditions: 1) Standard ART Counseling
(SAC), 2) mHC + SAC, 3) MTM + SAC, and 4) mHC + MTM + SAC. Feasibility and acceptability of the
intervention will be assessed through paradata of usage patterns and the System Usability Scale. Preliminary
impact will be assessed by evaluating ART Adherence and substance use. YPWH will complete assessments at
baseline and 3-, and 6-months post-intervention. Biomarkers of adherence to ART and HIV/STI will be
collected. Upon project completion, we will have an optimized mHealth intervention to support YPWH’s self-
management of HIV which will be ready for testing in a larger efficacy trial.

## Key facts

- **NIH application ID:** 10930900
- **Project number:** 5R34DA059935-02
- **Recipient organization:** UNIV OF MASSACHUSETTS MED SCH WORCESTER
- **Principal Investigator:** Karen MacDonell
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $209,791
- **Award type:** 5
- **Project period:** 2023-09-30 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10930900

## Citation

> US National Institutes of Health, RePORTER application 10930900, Adapting mHealth interventions to improve self-management of HIV and substance use among emerging adults in Zambia (5R34DA059935-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10930900. Licensed CC0.

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