The MetroHealth System developed the Positive Peers mobile application (app) in collaboration with Blue Star Design, Blackbird Digital, and a youth community advisory board. The app motivates youth and young adults with HIV to stay engaged in HIV care through self-management tools and virtual support. The Positive Peers mobile app was developed with funding from the Ryan White HIV/AIDS Program (RWHAP) Part F Special Projects of National Significance (SPNS) initiative, Use of Social Media to Improve Engagement, Retention, and Health Outcomes along the HIV Care Continuum, 2015–2019. Although specific outcomes vary by age group, individuals who used the app were more likely to attend their medical appointments, receive labs, and reach viral suppression.
Cleveland , OH
The transition to adulthood is hard, regardless of HIV status. The typical challenges associated with more independence and responsibility can be even more daunting with HIV. Youth and young adults may struggle to navigate through a complicated healthcare system and keep track of their treatment needs (e.g., medical appointments, labs, daily medication).1 In addition, youth with HIV, especially those within the LGBTQ+ community, may face stigma and isolation, creating more barriers to care.2 Mobile apps can play an important role in engaging young people in HIV care, given their high use of phones and social media to communicate.3
The Positive Peers app, available on Apple and Android devices, motivates youth to engage in their HIV care through multiple features:
- It provides self-management tools like an editable calendar and “fun, interactive, and discreet” medication and appointment reminders.
- Users can connect with peers and professionals through private chat and group forums, helping to reduce perceptions of stigma and isolation surrounding their status.
- A wellness tracker also allows users to win badges and points based on their wellness activities.
Positive Peers offers educational and community-level resources. Users can access health and wellness tips, patient stories, and information on agencies that provide food, housing, HIV and gender-affirming care, and other support. Administrators keep calendars up-to-date with community events and support groups.
“The virtual community allows users to communicate with each other, ask questions, post comments, and reply to one another in an ongoing thread of posts/replies.”
Users can make the Positive Peers app their own through customization. They can create their user name, select an avatar image, decide how much personal information to share publicly, set reminders, and change the look and feel of the app by picking a color scheme and design.
Youth and young adults directly enroll into the program through the Positive Peers app. MetroHealth encouraged enrollment during case management meetings, on dating sites and other social media platforms, and through flyers and palm cards, distributed at events frequented by youth. MetroHealth then confirmed client eligibility (i.e., age and HIV status) through its local data management system. However, people can also “self-approve” by attesting to their eligibility.
MetroHealth conducted a study, from 2016–2019, comparing health outcomes of 114 Positive Peers users to 145 non-users. Study participants were ages 13–34 and had received a diagnosis of HIV in the last 12 months, not virally suppressed, or not in care six of the last 24 months. Positive Peers users, especially among the younger age group (13–24) were more likely to attend office visits, complete lab visits, and reach viral suppression.
* statistically significant
Source: U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau. Positive Peers Intervention Implementation Guide. Rockville, Maryland: U.S. Department of Health and Human Services, 2023.
“The Positive Peers app offers users access to reliable and vetted social and medical information in a supportive, monitored community, motivating engagement with content and HIV care self-management.”
- Partnership with Positive Peers. Interested providers contract with Positive Peers as a Key Health Partner. This contract provides access for professionals to interact with users through the app. Positive Peers offers other benefits such as the ability for users to contribute personal stories (i.e., Tales of Triumph), monthly virtual support groups for users, and marketing materials and swag. Providers can participate in quarterly meetings with Positive Peers, provide feedback on the app, and submit health data for analysis.
- Staffing. Under the Positive Peers contract, providers must designate an administrative lead (i.e., admin). This admin is the main point of contact for users, answering questions, posting resources, and monitoring comments. Ideally, the admin is comfortable with mobile apps and shares lived experience with the population engaged through the app. Once hired, the admin receives a 90-minute training, in addition to training materials (e.g., communication protocol, style guide, tutorials, and “how to” guides) from Positive Peers.
- Adding local content. Providers also add content about local events and resources to keep the information shared through the app fresh.
- Positive Peers requires the largest financial investment the first year, which then is reduced in the subsequent years.
- Providers also need to dedicate resources or staff time to fill the admin role. While MetroHealth used SPNS funds to cover these costs, other providers may use RWHAP or HIV/AIDS Bureau Ending the HIV Epidemic in the U.S. (EHE) initiative dollars.
- Using Positive Peers, an off-the-shelf product, may be less costly for providers than building their own app, which is an expensive and time-consuming process. In addition, Positive Peers, developed with extensive feedback from youth and young adults to meet their needs, has been demonstrated to positively impact HIV health outcomes.
- Incorporating youth and adults transitioning from youth in recruitment activities can help generate interest in the app. Providers should share information about the app and garner feedback on how to best encourage enrollment, through a community advisory board or support groups. Participants not only can provide information on how to best “get the word out,” but can also serve as ambassadors for the app in the community.
- Leadership buy-in is important for acquiring the staff and funds required to purchase and maintain the Positive Peers app. Providers can garner this support by sharing local statistics on HIV outcomes for youth and young adults and providing evidence that Positive Peers can improve these outcomes.
- Not all users engage in Positive Peers the same way. Some just send private messages or post on forums, while others use all available features. This flexibility allows users to benefit from Positive Peers in the way that makes the most sense to them.
- Positive Peers Intervention Implementation Guide and Fact Sheet - 2023
- Positive Peers IHIP Webinar - 2023
- Positive Peers Demonstration Site Summary - 2020
- Positive Peers Demonstration Site Summary - 2019
- Step MM, McMillen Smith J, Lewis SA, Avery AK. Using the Positive Peers mobile app to improve clinical outcomes for young people with HIV: Prospective observational cohort comparison. JMIR Mhealth Uhealth. 2022;10(9):e37868. doi:10.2196/37868
- Step MM, Smith JM, Kratz J, Briggs J, Avery A. “Positive Peers”: Function and content development of a mobile app for engaging and retaining young adults in HIV care. JMIR Formative Research. 2020;4(1):e13495. doi:10.2196/13495
- Step MM, Knight K, McMillen Smith J, Lewis SA, Russell TJ, Avery AK. Positive Peers mobile application reduces stigma perception among young people living with HIV. Health Promot Pract. 2020;21(5):744-754. doi:10.1177/1524839920936244
- Crepaz N. Racial and ethnic disparities in sustained viral suppression and transmission risk potential among persons receiving HIV care — United States, 2014. MMWR Morb Mortal Wkly Rep. 2018;67. doi:10.15585/mmwr.mm6704a2
- Hong JS, Kim J, Lee JJ, Shamoun CL, Lee JM, Voisin DR. Pathways From Peer Victimization to Sexually Transmitted Infections Among African American Adolescents. West J Nurs Res. 2019;41(6):798-815. doi:10.1177/0193945918797327
- Vogels EA, Gelles-Watnick R, Massarat N. Teens, Social Media and Technology 2022. Pew Research Center: Internet, Science & Tech. 2022.