TY - JOUR
T1 - Text-messaging, online peer support group, and coaching strategies to optimize the HIV prevention continuum for youth
T2 - Protocol for a randomized controlled trial
AU - Swendeman, Dallas
AU - Arnold, Elizabeth Mayfield
AU - Harris, Danielle
AU - Fournier, Jasmine
AU - Comulada, W. Scott
AU - Reback, Cathy
AU - Koussa, Maryann
AU - Ocasio, Manuel
AU - Lee, Sung Jae
AU - Kozina, Leslie
AU - Fernández, Maria Isabel
AU - Rotheram, Mary Jane
N1 - Funding Information:
ATN CARES is a program project grant funded by the ATN for HIV/AIDS Interventions at the National Institutes of Health (U19HD089886). The Eunice Kennedy NICHD is the primary funder of this network, with support of the National Institute of Mental Health, National Institute of Drug Abuse, and National Institute on Minority Health and Health Disparities. Other support was provided by the Center for HIV Identification, Prevention, and Treatment (CHIPTS) NIMH Grant MH58107; the UCLA Center for AIDS Research (CFAR) Grant 5P30AI028697; and the National Center for Advancing Translational Sciences through UCLA CSTI Grant UL1TR000124. The content is solely the responsibility of the authors and does not necessarily represent the views of the National Institutes of Health.
Funding Information:
ATN CARES is a program project grant funded by the ATN for HIV/AIDS Interventions at the National Institutes of Health (U19HD089886). The Eunice Kennedy NICHD is the primary funder of this network, with support of the National Institute of Mental Health, National Institute of Drug Abuse, and National Institute on Minority Health and Health Disparities. Other support was provided by the Center for HIV Identification, Prevention, and Treatment (CHIPTS) NIMH Grant MH58107; the UCLA Center for AIDS Research (CFAR) Grant 5P30AI028697; and the National Center for Advancing Translational Sciences through UCLA CSTI Grant UL1TR000124. The content is solely the responsibility of the authors and does not necessarily represent the views of the National Institutes of Health
Publisher Copyright:
© 2019 Journal of Medical Internet Research. All rights reserved.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - Background: America's increasing HIV epidemic among youth suggests the need to identify novel strategies to leverage services and settings where youth at high risk (YAHR) for HIV can be engaged in prevention. Scalable, efficacious, and cost-effective strategies are needed, which support youth during developmental transitions when risks arise. Evidence-based behavioral interventions (EBIs) have typically relied on time-limited, scripted, and manualized protocols that were often delivered with low fidelity and lacked evidence for effectiveness. Objective: This study aims to examine efficacy, implementation, and cost-effectiveness of easily mountable and adaptable, technology-based behavioral interventions in the context of an enhanced standard of care and study assessments that implement the guidelines of Centers for Disease Control and Prevention (CDC) for routine, repeat HIV, and sexually transmitted infection (STI) testing for high-risk youth. Methods: Youth aged between 12 and 24 years (n=1500) are being recruited from community-based organizations and clinics serving gay, bisexual, and transgender youth, homeless youth, and postincarcerated youth, with eligibility algorithms weighting African American and Latino youth to reflect disparities in HIV incidence. At baseline and 4-month intervals over 24 months (12 months for lower-risk youth), interviewers monitor uptake of HIV prevention continuum steps (linkage to health care, use of pre- or postexposure prophylaxis, condoms, and prevention services) and secondary outcomes of substance use, mental health, and housing security. Assessments include rapid diagnostic tests for HIV, STIs, drugs, and alcohol. The study is powered to detect modest intervention effects among gay or bisexual male and transgender youth with 70% retention. Youth are randomized to 4 conditions: (1) enhanced standard of care of automated text-messaging and monitoring (AMM) and repeat HIV/STI testing assessment procedures (n=690); (2) online group peer support via private social media plus AMM (n=270); (3) coaching that is strengths-based, youth-centered, unscripted, based on common practice elements of EBI, available over 24 months, and delivered by near-peer paraprofessionals via text, phone, and in-person, plus AMM (n=270); and (4) online group peer support plus coaching and AMM (n=270). Results: The project was funded in September 2016 and enrollment began in May 2017. Enrollment will be completed between June and August 2019. Data analysis is currently underway, and the first results are expected to be submitted for publication in 2019. Conclusions: This hybrid implementation-effectiveness study examines alternative models for implementing the CDC guidelines for routine HIV/STI testing for YAHR of acquiring HIV and for delivering evidence-based behavioral intervention content in modular elements instead of scripted manuals and available over 24 months of follow-up, while also monitoring implementation, costs, and effectiveness. The greatest impacts are expected for coaching, whereas online group peer support is expected to have lower impact but may be more cost-effective.
AB - Background: America's increasing HIV epidemic among youth suggests the need to identify novel strategies to leverage services and settings where youth at high risk (YAHR) for HIV can be engaged in prevention. Scalable, efficacious, and cost-effective strategies are needed, which support youth during developmental transitions when risks arise. Evidence-based behavioral interventions (EBIs) have typically relied on time-limited, scripted, and manualized protocols that were often delivered with low fidelity and lacked evidence for effectiveness. Objective: This study aims to examine efficacy, implementation, and cost-effectiveness of easily mountable and adaptable, technology-based behavioral interventions in the context of an enhanced standard of care and study assessments that implement the guidelines of Centers for Disease Control and Prevention (CDC) for routine, repeat HIV, and sexually transmitted infection (STI) testing for high-risk youth. Methods: Youth aged between 12 and 24 years (n=1500) are being recruited from community-based organizations and clinics serving gay, bisexual, and transgender youth, homeless youth, and postincarcerated youth, with eligibility algorithms weighting African American and Latino youth to reflect disparities in HIV incidence. At baseline and 4-month intervals over 24 months (12 months for lower-risk youth), interviewers monitor uptake of HIV prevention continuum steps (linkage to health care, use of pre- or postexposure prophylaxis, condoms, and prevention services) and secondary outcomes of substance use, mental health, and housing security. Assessments include rapid diagnostic tests for HIV, STIs, drugs, and alcohol. The study is powered to detect modest intervention effects among gay or bisexual male and transgender youth with 70% retention. Youth are randomized to 4 conditions: (1) enhanced standard of care of automated text-messaging and monitoring (AMM) and repeat HIV/STI testing assessment procedures (n=690); (2) online group peer support via private social media plus AMM (n=270); (3) coaching that is strengths-based, youth-centered, unscripted, based on common practice elements of EBI, available over 24 months, and delivered by near-peer paraprofessionals via text, phone, and in-person, plus AMM (n=270); and (4) online group peer support plus coaching and AMM (n=270). Results: The project was funded in September 2016 and enrollment began in May 2017. Enrollment will be completed between June and August 2019. Data analysis is currently underway, and the first results are expected to be submitted for publication in 2019. Conclusions: This hybrid implementation-effectiveness study examines alternative models for implementing the CDC guidelines for routine HIV/STI testing for YAHR of acquiring HIV and for delivering evidence-based behavioral intervention content in modular elements instead of scripted manuals and available over 24 months of follow-up, while also monitoring implementation, costs, and effectiveness. The greatest impacts are expected for coaching, whereas online group peer support is expected to have lower impact but may be more cost-effective.
KW - HIV/AIDS
KW - MSM
KW - adolescents
KW - homelessness
KW - mHealth
KW - prevention
KW - transgender
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UR - http://www.scopus.com/inward/citedby.url?scp=85071448081&partnerID=8YFLogxK
U2 - 10.2196/11165
DO - 10.2196/11165
M3 - Article
C2 - 31400109
AN - SCOPUS:85071448081
SN - 1929-0748
VL - 8
JO - JMIR Research Protocols
JF - JMIR Research Protocols
IS - 8
M1 - e11165
ER -