Implementation Science (With Adolescents)

What is Implementation Science?

Implementation science is the scientific study of methods and strategies that facilitate the uptake of evidence-based practices and research into routine use by practitioners, health systems, and policymakers. The field seeks to systematically close the gap between what we know (research evidence) and what we do (practice)—often called the “know–do gap”—by identifying and addressing the barriers that slow or halt the uptake of proven health interventions and evidence-based practices.

Implementation science has been defined in many ways by different people and agencies. Some definitions focus on the methods and strategies that support adoption, while others emphasize its central goal of closing the know–do gap. Importantly, it is not just concerned with whether an intervention works, but also with how best to deliver it, to whom, in what context, and how to ensure it is scaled up and sustained.

In public health and healthcare, implementation science studies the real-world application of evidence-based interventions, examining factors such as training, resource allocation, system bottlenecks, community needs, stigma, and cultural context. For example, it might explore how to integrate long-acting injectable PrEP into primary care, how mobile health apps can improve TB treatment adherence, or what policy adjustments enable equitable access to HIV prevention and treatment.

At its core, implementation science ensures that scientific discoveries and effective interventions do not remain “on the shelf,” but instead translate into meaningful, sustainable improvements in health outcomes.

Understanding Implementation Science Frameworks

Implementation science is not just about identifying what works—it is about understanding how to make proven interventions part of everyday practice. To guide this process, researchers and practitioners use frameworks: structured models that help make sense of the complex factors influencing implementation. These frameworks provide a shared language, highlight what to look out for, and offer step-by-step guidance to increase the chances of success.

Below are some of the most widely used frameworks in the field:

The CFIR Framework (Consolidated Framework for Implementation Research)

The CFIR is one of the most comprehensive and flexible frameworks in implementation science. It brings together multiple theories to create a practical guide for understanding why implementation succeeds or fails. CFIR looks at five main areas: the characteristics of the intervention itself (is it adaptable? complex?), the outer setting (like patient needs and external policies), the inner setting (such as organizational culture and resources), the people involved (their knowledge, attitudes, and confidence), and the processes used (planning, engaging, and evaluating). By systematically mapping barriers and facilitators, CFIR helps teams design smarter implementation strategies.

The RE-AIM Framework (Reach, Effectiveness, Adoption, Implementation, Maintenance)

Where CFIR is broad, RE-AIM is highly focused on evaluation. It asks practical questions: Who does the program reach? Does it actually improve outcomes? Which organizations adopt it? How well is it carried out? And is it sustained over time? RE-AIM is particularly useful for public health and community programs, where success depends not just on outcomes but also on whether interventions are scalable and sustainable in the real world.

The PRECEDE–PROCEED Model

The PRECEDE–PROCEED model is often described as a roadmap for health program planning and evaluation. The PRECEDE part helps teams diagnose and understand the problem: What are the health needs of a community? What social or environmental factors play a role? The PROCEED part then guides action—implementing, monitoring, and evaluating the program. This framework is especially valuable when designing health promotion or prevention programs that need strong community input and ongoing evaluation.

The EPIS Framework (Exploration, Preparation, Implementation, Sustainment)

Implementation is rarely a single event—it’s a journey. The EPIS framework captures this by dividing implementation into four phases: Exploration (considering new approaches), Preparation (building capacity and adapting interventions), Implementation (putting the plan into practice), and Sustainment (keeping it going long term). EPIS also emphasizes the importance of both outer context (policy, funding, system-level factors) and inner context (organizational culture, leadership, resources), making it a useful guide for long-term projects in healthcare, child welfare, and mental health.

Theoretical Domains Framework (TDF)

The TDF zooms in on the human side of implementation. It was developed by combining over 30 behavior change theories into a single, practical tool. Instead of focusing on systems or settings, TDF asks: What drives people’s behavior? It looks at factors such as knowledge, skills, professional roles, confidence, emotions, and environmental barriers. TDF is often used when the goal is to change professional practice, like improving how healthcare workers prescribe medication, counsel patients, or adopt new clinical guidelines.

The PRISM Framework (Practical, Robust Implementation and Sustainability Model)

PRISM builds on RE-AIM but adds a stronger focus on context—how the characteristics of organizations, external environments, and implementation infrastructure influence outcomes. PRISM emphasizes that successful implementation is not only about the intervention itself, but also how it fits into the real-world systems where it will be delivered. It highlights the interaction between:

  • Intervention design (is it practical, adaptable, and relevant?)
  • Implementation and sustainability infrastructure (training, resources, leadership support)
  • External environment (policies, incentives, funding)
  • Recipients (patients, staff, communities).

PRISM is especially useful for understanding long-term sustainability and adaptation of interventions in complex healthcare systems.

 

Choosing a Framework: What to Consider

With so many implementation science frameworks available, one of the most common questions is: “Which one should I use?” The truth is, there’s no single right answer. The “best” framework depends on your goals, setting, and stage of implementation. Here are some key considerations to guide your choice:

  1. Purpose of Your Work

If your goal is to understand barriers and facilitators in detail, frameworks like CFIR or TDF are particularly useful. If you want to evaluate outcomes and sustainability, RE-AIM or PRISM may be a better fit. If you are designing and planning an intervention, the PRECEDE–PROCEED model or EPIS can provide a roadmap.

  1. Stage of Implementation

Frameworks can be especially helpful at different points in the process:

  • Early stages (exploration and planning): PRECEDE–PROCEED, EPIS
  • During rollout: CFIR, TDF (to understand behavior change), EPIS
  • Evaluating outcomes and long-term impact: RE-AIM, PRISM
  1. Level of Focus

Think about whether your main interest is in:

  • Individual behavior change (TDF, some aspects of CFIR)
  • Organizational context and processes (CFIR, EPIS, PRISM)
  • Population and public health outcomes (RE-AIM, PRECEDE–PROCEED)
  1. Practical Considerations
  • Complexity vs. usability: Some frameworks (like CFIR) are comprehensive but can feel overwhelming. Others (like RE-AIM) are more straightforward and user-friendly.
  • Adaptability: Consider whether the framework has been applied in your context or population before. Has it been adapted for low- and middle-income countries? For your specific health condition?
  • Audience: If your work involves policymakers or community partners, choose a framework that communicates clearly without too much jargon.

5. Combining Frameworks

Sometimes, no single framework does it all. Researchers often combine frameworks to get a fuller picture—for example, using CFIR to diagnose barriers and RE-AIM to evaluate outcomes.

When choosing a framework, the key is alignment: select the one that matches your research question, stage of implementation, and context. A well-chosen framework doesn’t just guide your study design—it also helps ensure that your findings are clear, relevant, and useful for real-world practice.

 

TABLE OF CONTENTS

  1. why adolescents?
  2. where do adults fit in?
  3. research methods and designs
  4. ethical concerns with adolescents
  5. protocol development
  6. adolescent friendly site assessment
  7. adolescent peer supporters
  8. implementation frameworks
  9. standard operating procedures
  10. data collection
  11. dissemination
LINKS TO KEY RESOURCES

 General:

NIH Fogarty International: Implementation Science Researchers Toolkit

https://www.fic.nih.gov/About/center-global-health-studies/neuroscience-implementation-toolkit/Pages/resources.aspx

NIH free training in IS

https://obssr.od.nih.gov/training/training-supported-by-the-obssr/training-tidirh/

An interactive web tool for using Dissemination and Implementation Models in Health

https://dissemination-implementation.org/tool/

IS Frameworks:

RE-AIM and PRISM:

https://www.re-aim.org/

CFIR:

https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-4-50

https://cfirguide.org/

EPIS: https://episframework.com/

PRECEED-PROCEED:

https://www.ruralhealthinfo.org/toolkits/health-promotion/2/theories-and-models/precede-proceed#:~:text=The%20PRECEDE%2DPROCEED%20model%20is,and%20focused%20public%20health%20program.

https://pubmed.ncbi.nlm.nih.gov/21656942/

TDF:

https://implementationscience.biomedcentral.com/articles/10.1186/s13012-017-0605-9

IS Designs

Overview of IS designs:

https://doi.org/10.1146/annurev-publhealth-031816-044215

Hybrid designs:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731143/

Outcomes in IS:

https://implementationscience.biomedcentral.com/articles/10.1186/s13012-015-0342-x

https://pmc.ncbi.nlm.nih.gov/articles/PMC3068522/

Designing an IS study

Types of Study Designs in Implementation Science

Implementation science makes use of many traditional study designs—such as randomized controlled trials (RCTs), quasi-experimental designs, and observational studies—but adapts them to focus on implementation questions.

A unique feature of IS research is the use of Hybrid Designs, which intentionally blend clinical effectiveness and implementation research:

Type 1 Hybrid:

Primary focus is on testing the effectiveness of a clinical intervention, while also gathering preliminary data on implementation (e.g., barriers, feasibility).

EXAMPLE: A research team evaluates whether daily oral PrEP reduces HIV incidence among adolescent girls in South Africa. The primary aim of the study is to measure HIV outcomes and determine if PrEP is effective in this population. Alongside this, the researchers collect preliminary data on implementation by asking adolescents about barriers to pill-taking, such as stigma, forgetfulness, or disclosure concerns, and by interviewing clinic staff about the feasibility of incorporating PrEP into busy youth-friendly services. The central question is whether PrEP works in adolescents, while early insights into implementation help guide future scale-up.

Type 2 Hybrid:
Dual focus on testing both the clinical effectiveness of an intervention and the effectiveness of implementation strategies.

EXAMPLE: Researchers introduce long-acting injectable cabotegravir (CAB-LA) as an HIV prevention option for adolescents. Here, the focus is equally split between testing whether CAB-LA effectively prevents HIV and whether it can be delivered in real-world adolescent settings. The study measures HIV incidence and safety outcomes while also comparing different models of delivery, such as school-based injections, clinic-based services, and mobile outreach. Acceptability among adolescents and caregivers, provider readiness, and cost-effectiveness of delivery models are studied alongside clinical outcomes, ensuring that both the intervention’s effectiveness and the strategies to implement it are tested in tandem.

Type 3 Hybrid:

Primary focus is on testing an implementation strategy, while also monitoring the clinical outcomes of the intervention being implemented.

EXAMPLE: A study is designed to understand the best ways to deliver mental health interventions for adolescents living with HIV in community clinics. The primary focus is on evaluating different implementation strategies — for example, training peer mentors versus training nurses to provide cognitive-behavioural therapy sessions. Researchers measure outcomes such as fidelity to the intervention, provider workload, sustainability, and adolescent engagement. At the same time, they also track clinical outcomes like reductions in depressive symptoms and improvements in ART adherence, but these serve as secondary endpoints. The study’s central purpose is to determine how to implement adolescent-friendly mental health services effectively, while still monitoring whether those services produce meaningful health benefits.

Hybrid designs are especially valuable because they help shorten the research-to-practice timeline by studying both effectiveness and implementation in parallel, rather than in sequence.

 

What Outcomes Should Be Measured?

In IS studies, it’s not enough to measure only health outcomes (like reduced HIV incidence or better TB cure rates). Researchers must also examine implementation outcomes—whether and how the intervention is successfully put into practice.

The most widely used guide here is Proctor’s Implementation Outcomes Framework, which identifies eight key outcomes:

  1. Acceptability – How stakeholders perceive the intervention (is it agreeable, satisfactory, appealing?).
  2. Adoption – The initial decision or action to try to employ an intervention.
  3. Appropriateness – The perceived fit or relevance of the intervention within a given setting or for a specific population.
  4. Feasibility – The extent to which the intervention can be successfully used or carried out within a given setting.
  5. Fidelity – The degree to which the intervention is implemented as intended by its designers.
  6. Implementation Cost – The financial impact of implementation, including both direct and indirect costs.
  7. Penetration (Coverage/Reach) – The extent to which the intervention integrates into a service setting and reaches its intended population.
  8. Sustainability – The extent to which an intervention is maintained or institutionalized within a setting over time.

These outcomes are distinct from (but complementary to) clinical outcomes (e.g., reduced viral load, improved survival) and service outcomes (e.g., efficiency, equity, timeliness). Measuring across these domains allows researchers to understand why an intervention succeeds or fails in practice.

Proctor’s Implementation Outcomes vs. CFIR 
  • CFIR gives you the determinants of implementation — i.e., the contextual factors that influence success (e.g., inner setting, outer setting, intervention characteristics, individual characteristics, process).
  • Proctor’s framework gives you the endpoints you measure to know if implementation was successful (acceptability, adoption, fidelity, etc.).

Think of CFIR as describing the conditions and drivers, and Proctor’s outcomes as describing the results.
Example: CFIR might highlight that adolescents’ mistrust of health services (outer setting) is a barrier; Proctor’s framework would then prompt you to measure acceptability and adoption as outcomes of an adolescent-focused PrEP program.

Proctor’s Framework vs. RE-AIM

  • RE-AIM has five domains: Reach, Effectiveness, Adoption, Implementation, and Maintenance.
  • Notice the overlap:
    • Reach ≈ Proctor’s penetration
    • Adoption is present in both
    • Implementation ≈ fidelity + cost + feasibility
    • Maintenance ≈ sustainability

RE-AIM is broader — it integrates clinical and implementation outcomes — while Proctor’s framework sharpens the focus specifically on implementation constructs.
Example: A school-based CAB-LA program might be assessed with RE-AIM for reach (how many students got injections) and effectiveness (HIV incidence), while Proctor’s framework allows deeper measurement of acceptability (what do students and parents think?) and fidelity (were injections given according to protocol?).

Proctor’s Framework vs. PRISM
  • PRISM blends RE-AIM with a stronger emphasis on contextual factors (like CFIR).
  • Proctor’s outcomes give you a clear set of measures to plug into
  • For example, PRISM would highlight how organizational perspectives, external environment, and sustainability planning shape success, while Proctor’s outcomes give you metrics like appropriateness, feasibility, and sustainability to measure within that model.

A well-designed IS study goes beyond proving that an intervention works. It asks:

  • Which strategies help it get adopted?
  • Which factors support or block sustainability?
  • What does it cost, and is it acceptable to those delivering and receiving it?

By carefully choosing an appropriate study design—often through hybrid approaches—and by measuring both clinical and implementation outcomes, researchers can generate evidence that truly informs policy and practice.

Examples of IS studies involving adolescents

HIV Prevention

  • Baron et al., 2024 (South Africa) – A qualitative CFIR-guided study examining barriers to delivering HIV pre-exposure prophylaxis (PrEP) to adolescent girls and young women in rural clinics. Researchers identified multi-level implementation challenges – e.g. shifting national policies, clinic resource constraints, and low community engagement – which led to fragmented planning, conflicting clinic priorities, and poor PrEP uptake. The CFIR analysis highlighted opportunities to improve clinic readiness and inter-sector communication to strengthen PrEP service delivery informing strategies to boost adoption and fidelity of PrEP interventions.

Baron D, Leslie HH, Mabetha D, Becker N, Kahn K, Lippman SA. Applying CFIR to assess multi-level barriers to PrEP delivery in rural South Africa: Processes, gaps and opportunities for service delivery of current and future PrEP modalities. Soc Sci Med. 2024 Nov;361:117370. doi: 10.1016/j.socscimed.2024.117370. Epub 2024 Sep 26. PMID: 39366151; PMCID: PMC11554290.

 

  • Rousseau et al., 2024 (South Africa) – The FastPrEP protocol is a type 2 hybrid implementation science study designed to evaluate uptake, persistence, and effectiveness of youth-focused, differentiated PrEP delivery in the Klipfontein/Mitchells Plain sub-district of Cape Town. Using a hub-and-spokes service model, the project delivers PrEP initiation through government and mobile clinics, with maintenance via schools, courier delivery, youth clubs, quick depots, and pharmacies. Guided by the RE-AIM framework, the study targets approximately 25,000 adolescents and young people (15–29 years) and their partners, offering oral, vaginal ring, and injectable PrEP within integrated SRH services. Researchers aim to assess whether choice of PrEP product and delivery platform improves uptake, persistence, and reduces HIV incidence. Mixed-methods evaluation, including biometric tracking, surveys, and qualitative interviews, will measure implementation outcomes, barriers, and facilitators. Findings will inform cost-effectiveness, scalability, and policy for district-wide and national PrEP rollout.

Rousseau E, Davey D, Fynn L, Wallace M, Macdonald P, Pike C, Mathola N, Little F, Leonard B, Lebelo K, Bekker L-G. FastPrEP: A protocol to evaluate uptake, coverage, and effectiveness of a youth-focused, decentralised and differentiated district-wide HIV pre-exposure prophylaxis program. Research Square. 2024. doi:10.21203/rs.3.rs-4949179/v1

  • Wood et al., 2022 (USA) – A mixed-methods study (Philadelphia) used CFIR to assess HIV test counselors’ perceived facilitators and barriers in implementing HIV testing and PrEP referral services. Testers reported high self-efficacy in HIV testing but noted gaps in STI knowledge and only moderate willingness to recommend PrEP. Qualitative findings revealed outer-setting barriers like siloed funding and competition between agencies, and inner-setting issues such as insufficient cultural competency for key youth populations. These insights guided a multi-level “train-the-trainer” program (skill-building, technical assistance, capacity building) to improve acceptability and integration of HIV prevention services across agencies.

Wood SM, Meanley S, Bonett S, Torres ME, Watson DL, Williams JL, Brady KA, Bauermeister JA. Strengthening HIV Prevention Services Through an Implementation Science Approach: Perspectives From the HIV Testers in Philadelphia. J Acquir Immune Defic Syndr. 2022 Jul 1;90(S1):S90-S97. doi: 10.1097/QAI.0000000000002969. PMID: 35703760; PMCID: PMC9204788.

Mental Health Interventions

  • Biber & Brandenburg, 2023 (USA) – An evaluation of a school-based suicide/opioid prevention program (Sources of Strength) in a U.S. high school using the RE-AIM framework. Post-implementation surveys showed excellent Reach (100% of 1,250 students engaged in at least one activity) and Adoption (program delivered in 100% of classrooms). Implementation was robust (18 peer-led meetings facilitated), and student feedback informed Maintenance (the school sustained the program after initial evaluation). Protective factors (happiness, coping skills knowledge/practice) were high on average, and the program was well-received, demonstrating strong acceptability and potential for sustained impact.

Biber DD, Brandenburg G. A RE-AIM analysis of the sources of strength program in a United States high school. Prev Med Rep. 2023 Feb 11;32:102137. doi: 10.1016/j.pmedr.2023.102137. PMID: 36798792; PMCID: PMC9925958.

  • Dow et al., 2020 (Tanzania) – A pilot hybrid trial of a group counseling intervention (Sauti ya Vijana) for youth living with HIV, focusing on mental health and ART adherence. The study measured implementation outcomes of feasibility and acceptability alongside clinical indicators. Results showed high session attendance (86% of sessions) and nearly 100% fidelity to the intervention protocol. Six-month follow-up was 88%, and participants in the intervention arm had modest improvements in self-reported adherence and viral suppression trends compared to standard care. These findings indicate the intervention was well-accepted and feasible in an African adolescent context, warranting scale-up to a full efficacy trial.

Dow, D.E., Mmbaga, B.T., Gallis, J.A. et al. A group-based mental health intervention for young people living with HIV in Tanzania: results of a pilot individually randomized group treatment trial. BMC Public Health 20, 1358 (2020). https://doi.org/10.1186/s12889-020-09380-3

  • Sorsdahl et al., 2021 (South Africa) – A feasibility randomized controlled trial protocol testing ASPIRE, a four-session, blended multi-component counselling intervention for adolescents (15–18 years) at risk of depression and/or alcohol use disorders. Conducted in Cape Town communities with high unemployment and youth mental health burdens, 100 participants will be randomized to ASPIRE or a comparison condition (single-session counselling plus referral). The intervention integrates motivational interviewing, behavioral activation, and problem-solving therapy, delivered by trained lay counsellors with structured supervision. Guided by Lazarus and Folkman’s coping theory, ASPIRE targets maladaptive coping linked to heavy alcohol use and depression. The study’s primary aims are to assess feasibility (recruitment, retention, randomization, fidelity) and acceptability (via satisfaction ratings and qualitative interviews). Secondary outcomes include changes in heavy drinking days, depression symptoms, and related psychosocial indicators. Findings will inform progression to a fully powered effectiveness trial and provide critical evidence on scalable, task-shared counselling models for adolescent mental health in low-resource settings.

Sorsdahl K, Petersen Williams P, Carney T, Hatherill S, Olivier L, Myers B, Stein DJ. Feasibility and acceptability of a blended, multi-component counselling intervention for adolescent mental health problems in South Africa: A randomized controlled trial. Pilot Feasibility Stud. 2021;7:207. doi:10.1186/s40814-021-00803-5

Integrated Service Delivery

  • Velloza et al., 2024 (South Africa) – A human-centered implementation research project integrating a depression intervention into PrEP services for adolescent girls and young women. In the “Discover” phase, interviews and a rapid CFIR-guided analysis identified multi-domain barriers to combined mental health and HIV prevention services (e.g. stigma in the community, clinic workflow gaps, counselor training needs). These data informed the co-design (“Design/Build” phases) of an adapted Friendship Bench counseling package and a set of 10 implementation strategies mapped to CFIR barrier domains. Pilot testing in clinics found the adapted intervention package acceptable and feasible, leading to its use in a subsequent hybrid trial to improve integrated PrEP/mental-health outcomes.

Velloza J, Ndimande-Khoza N, Mills L, Concepcion T, Gumede S, Chauke H, Verhey R, Chibanda D, Hosek S, Weiner BJ, Celum C, Delany-Moretlwe S. Integrating a mental health intervention into PrEP services for South African young women: a human-centred implementation research approach to intervention development. J Int AIDS Soc. 2024 Jul;27 Suppl 1(Suppl 1):e26274. doi: 10.1002/jia2.26274. PMID: 38965973; PMCID: PMC11224591.

  • Zhang et al., 2024 (USA) – A cross-sectional study in integrated school-based mental healthcare, examining how alignment between organizations influences implementation outcomes. Clinicians from community agencies and school staff jointly rated their contexts and nine implementation outcomes (e.g. treatment integrity, service access, acceptability) for mental health services delivered on school campuses. The study found that stronger inter-organizational alignment in specific implementation climate factors (e.g. leadership support, implementation climate) was associated with better outcomes like higher treatment fidelity and perceived acceptability of services. Differences in organizational culture between schools and agencies impeded some outcomes, suggesting that harmonizing climate and leadership across partnering organizations can improve penetration and sustainment of integrated youth services.

Zhang, Y., Larson, M., Ehrhart, M.G. et al. Inter-organizational alignment and implementation outcomes in integrated mental healthcare for children and adolescents: a cross-sectional observational study. Implementation Sci 19, 36 (2024). https://doi.org/10.1186/s13012-024-01364-w

mHealth (Mobile Health)

  • Adams et al., 2021 (USA) – An iterative user-centered design study developing “Bright Path,” a mobile app to support adolescents with substance use and co-occurring mental health needs. In phased alpha/beta testing with 20 youths (14–17 years) and 20 clinicians, participants reported positive impressions of the app’s content and features (educational resources, interactive skill-building activities). Both teens and providers found the app easy to use, preferred it over traditional paper-based tools, and felt it could increase youth engagement between therapy sessions. Minor adaptations (e.g. privacy settings for teens, clearer instructions for clinicians) were made, and overall the app was deemed highly acceptable and scalable for supporting adolescent behavioral health treatment.

Adams Z, Grant M, Hupp S, Scott T, Feagans A, Phillips ML, Bixler K, Nallam PT, La Putt D. Acceptability of an mHealth App for Youth With Substance Use and Mental Health Needs: Iterative, Mixed Methods Design. JMIR Form Res. 2021 Dec 24;5(12):e30268. doi: 10.2196/30268. PMID: 34951593; PMCID: PMC8742212.

 

  • Zanoni et al., 2024 (South Africa) – A pilot type 3 hybrid randomized clinical trial tested InTSHA (Interactive Transition Support for Adolescents Living with HIV), an mHealth intervention delivered via closed, encrypted WhatsApp groups to support adolescents transitioning from pediatric to adult HIV care. Eighty adolescents (15–19 years, perinatally acquired HIV) were randomized to InTSHA or standard care. Guided by the Socioecological Model for Adolescent Readiness for Transition (SMART), the intervention combined peer support, caregiver involvement, and clinician engagement through weekly modules on stigma, disclosure, ART adherence, and sexual/reproductive health. Primary outcomes were acceptability (AIM: Acceptability of Intervention Measure)) and feasibility (FIM: Feasibility of Intervention Measure), with thresholds ≥80%. InTSHA showed high acceptability (82%) but feasibility fell slightly below target (78%) due to barriers such as phone access, data costs, and scheduling conflicts. While not powered for effectiveness, exploratory results showed higher retention in care among InTSHA participants (98% vs. 88%) and 100% retention for those attending ≥3 sessions, though viral suppression did not significantly differ. Findings highlight the promise of mHealth-based peer and caregiver support but also the structural challenges to sustained engagement in low-resource settings

Zanoni BC, Archary M, Sibaya T, Musinguzi N, Gethers CT, Goldstein M, Bergam S, Psaros C, Marconi VC, Haberer JE. Acceptability, feasibility and preliminary effectiveness of the mHealth intervention, InTSHA, on retention in care and viral suppression among adolescents with HIV in South Africa: A pilot randomized clinical trial. AIDS Care. 2024 Jul;36(7):983–992. doi:10.1080/09540121.2024.2361240