JMIR Publications

ABSTRACT

Over 20% of HIV diagnoses in the United States are among youth aged 12-24. Because youth have the lowest rates of uptake and adherence to antiretroviral medications (ARV) and are least aware of their HIV status, we have designed a set of inter-related studies to promote completion of each step of the HIV Prevention Continuum by uninfected youth at high risk (YHR), as well as completion of steps in the Treatment Continuum by youth living with HIV (YLH). Methods/Design: Gay, bisexual, and transgender youth (GBTY), homeless youth, substance-abusing youth, youth with criminal justice contact, and youth with significant mental health challenges, particularly those who are Black and Latino, are being recruited from 13 community-based organizations, clinics, drop-in centers, and shelters in Los Angeles and New Orleans. Youth are screened based on self-reports and rapid diagnostic tests for HIV, drug use, and sexually transmitted infections (STI) and then triaged into one of three studies: 1) an observational cohort of YLH who have never received ARV who are then treated, half initially are in the acute infection period (N=36) and half with established HIV infection (N=36); 2) a randomized controlled trial (RCT) for YLH (N=220); or 3) a RCT for YHR (N=1340). Each study contrasts efficacy and costs of three interventions: an automated messaging and weekly monitoring program delivered via text messages; a peer support intervention delivered via social media forums; or coaching, delivered via text-message, phone, in-person, or telehealth contacts. The primary outcomes are assessing youths’ uptake, retention, and adherence in the HIV Prevention or Treatment Continua. Repeat assessments are conducted every four months over 24 months to engage, retain, and monitor youth’s status. Discussion: By using similar, flexible and adaptable intervention approaches for YLH and YHR, this set of studies may provide a roadmap for communities to broadly address HIV risk among youth. We evaluate if the interventions are cost-efficient strategies that can be leveraged to help youth adhere to the actions in the HIV Prevention and Treatment Continua.