WhatsApp-based sexual and reproductive health education for adolescents with perinatally acquired HIV: lessons learned from an mHealth pilot intervention in South Africa

Adolescents with perinatally-acquired HIV in South Africa have limited access to relevant sexual and reproductive health (SRH) education. Mobile health (mHealth) can discreetly deliver such education but has not been tested with members of this population. In this study, we describe the effects of an mHealth intervention to support transition to adult care-Interactive Transition Support for Adolescents with HIV (InTSHA)-on SRH attitudes. Between May 2021 and February 2022, we enrolled adolescents with perinatally-acquired HIV aged 15-19 from a government clinic in urban KwaZulu-Natal, South Africa. Baseline and six-month SRH questionnaires were adapted from a WHO adolescent SRH survey, consisting of nine positively worded items on a four-point Likert scale. Transcripts of the mHealth intervention modules were thematically analysed. Of 80 participants enrolled, 47 completed the SRH survey at both time points (mean age: 17.2 years); 25 (53.2%) were female and 19 (40.4%) were randomised to InTSHA. Likert scores improved from baseline to follow-up for the InTSHA group for specific SRH questions, overlapping with the frequency that topics such as 'Defining Sexuality', 'Discussing Sex with Caregivers', and 'Comfort Saying No to Sex'-were discussed by adolescents. mHealth is a tool for interactive SRH education that should be further developed.