By: Ada Chong
October 2023
In 2008, Brian Zanoni started his research in South Africa soon after antiretroviral therapy was available for children with HIV in South Africa. At the time, there weren’t many clinical answers on how to get adolescents engaged in HIV treatment and care because most people thought children with HIV wouldn’t survive before reaching adolescence. Dr. Zanoni’s current research stems from his clinical work in South Africa. His research timeframe focuses on children born with HIV through adolescence to adulthood. He says some adolescents fall out of care because they don’t want to deal with adult clinics. Dr. Zanoni hopes to learn what can be done to keep adolescents engaged in care and their own health.
Dr. Zanoni and his team have designed a few interventions to help with adolescent engagement. One intervention involves peer support groups where adolescents with HIV have in-person or virtual chat groups moderated by healthcare providers. There’s an ongoing study comparing both of these methods to see which strategy works better to keep adolescents ages 15-19 engaged in care. The goal is to enroll 800 adolescents so researchers can compare the in-person and digital support groups. A recent pilot clinical trial found that adolescents with virtual support stayed in care more, compared to groups who didn’t have an online support group.
Another study Dr. Zanoni and his team are launching includes evaluating new long-acting antiretroviral therapy so patients can get an injectable shot every 4-8 weeks instead of taking pills daily. In preliminary studies in South Africa, researchers found shots can help change the patients’ outlook in life. The patients wouldn’t have to think about having HIV every day when taking their daily pills if they can get a shot six times a year. Dr. Zanoni hopes to enroll ~1,000 adolescents in this study.
Dr. Zanoni and his team have also launched an app called “eHARTS” that looks at risk factors for adolescents falling out of care and not taking their medicine. The app surveys patients about their knowledge of HIV, how they navigate the health system, asks about their demographic factors, and if they failed treatment regimens before. After taking the survey, the app will let them know whether they’ll likely do well when they transition to adult care. Those who score low and intermediate will be enrolled in an intervention to better prepare them for transition into adult care. Dr. Zanoni hopes to launch this study this November.
Another important pilot study involves looking at how effective virtual healthcare visits are in South Africa. Dr. Zanoni will interview clinicians and adolescents to see how their visit went. They use acceptability and feasibility scales to measure the visit. The first part of the study was conducted using mock visits. In the second part of the study, data will be gathered during real-time virtual visits.
Some adolescents are not engaged in care due to treatment fatigue. There’s also a stigma around treatment and sometimes adolescents don’t want their friends to know they have HIV. Since there is currently no cure for HIV, it’s important to treat it by taking medicine for the rest of their lives in order to stay healthy. If a patient stops taking medicine for HIV, the virus can come back. Taking short breaks in treatment can have detrimental health effects.
During the research process, Dr. Zanoni likes to use a bottom-up approach that way adolescents, healthcare providers, and caregivers can share their needs and the research team can build studies and interventions based on those needs.
Dr. Zanoni was inspired to study HIV after he worked in Botswana because of a hiring freeze at Baylor College of Medicine. He says, “when I saw the benefit you could do by helping children with HIV, it’s hard to not do that for a career. What was supposed to be a year, ended up being my career.”