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A Northeast Ohio research team has secured a major grant to assess the impact of its Positive Peers app on the health outcomes of individuals aged 13-34 living with HIV.

The app, launched in 2016, is a private mobile resource designed for clinic-based intervention. The project evolved from a local HIV support group that wanted their own private Facebook group but found that wasn’t meeting their needs. Originally funded by the Special Projects of National Significance in HIV, a federal grant from the Health Resource Service Administration, the app was piloted with 128 MetroHealth patients before being made available nationwide in March 2020. An additional 220 patients from 32 states have since joined the app.

The research project is co-led by Mary Step, Ph.D., an associate professor of social and behavioral sciences in ����ֱ�� State University’s College of Public Health and Dr. Ann Avery of MetroHealth. Other members of the project team include Vinay Cheruvu, Ph.D., and Jeff Hallam, Ph.D., both co-investigators from the College of Public Health, as well as MetroHealth social worker Jennifer McMillen Smith (who helped launch the app with Step and Avery in 2016), and Steven Lewis, a biostatistician from the MetroHealth Research Institute, who also is a Ph.D. student in ����ֱ��'s College of Public Health. 

As a founding member of the group to originally develop the app, Step said they really focused on the user experience when building the app, which took about a year and a half. Available only to young people ages 13-34, the app established credibility as a safe place to process the stigma and challenges that come with an HIV diagnosis. The pilot study also found that when compared to those with HIV who didn’t use the app, those utilizing Positive Peers were more likely to be consistently engaged in medical care.

Here, Step talks about the positive outcomes from the initial pilot study. Step also was .

As membership in the app grows, with this new $5.7 million grant from the National Institutes of Health, Step says they will keep recruiting organically, through targeted ads on various popular social media platforms, as well as by running a pragmatic clinical trial, partnering with six clinical sites across the country.

Step received her Ph.D. in communication studies from ����ֱ�� State in 1998 and has expertise in media effects and social science models, which have been applied to this project.

“A lot of this science has adapted to the internet age, so we’re looking at the different ways people use the app, their devices and other social psychology variables,” she said. “One of the most interesting things about the app is the community forum, where we can get an idea of what kind of information our population really needs in the first months of living with HIV. We are already seeing pleas for support and direction from the peers. Our admins keep on the lookout for that and are ready to step in to assist with referrals if need be."

This high-risk population often lacks social support, and Step said one of the primary questions of the study is to explore if Positive Peers still has the same effect if access to the app is delayed. Half of the trial sample will be randomized to receive immediate access to the app, and the other half will be randomized to a delayed start of three months after their initial diagnosis or after returning to care.

“One of our primary questions with this clinical trial is whether or not Positive Peers is adding value to what is likely to be a typical adjustment to a difficult illness,” Step said. “When someone is diagnosed with cancer, regardless of whether it’s aggressive or not, over time people acclimate to that. They will marshal support, and they will adjust to that. We don’t know about that with Positive Peers.”

Starting in March 2024, the team will enroll participants in a randomized control study across six high HIV prevalence areas, including Houston, Los Angeles, Newark, Seattle, Columbus and Cincinnati. The study will include 50 participants per location who are either newly diagnosed with HIV or not optimally engaged in their HIV care.

The initial pilot of the app found that those with HIV who consistently engaged with the app were three times more likely to be virally suppressed.

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