JMIR Publications

ABSTRACT

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 for HIV infection can be engaged in prevention. Scalable, efficacious, and cost-effective strategies are needed that support youth during developmental transitions when risks arise. Evidence-based behavioral interventions (EBIs) have typically relied on time-limited, scripted and manualized protocols, which were often delivered with low fidelity and lacked evidence for effectiveness. This study aims to test alternative approaches for intervention design and delivery based on evidence-based practice elements implemented via mobile and social media technologies.

Methods:

Youth aged 12 to 24 years (n= 1500) are being recruited from community-based organizations (CBO) and clinics serving gay, bisexual, and transgender youth, homeless youth, and post-incarcerated youth, with eligibility algorithms weighting African-American and Latino youth to reflect disparities in HIV incidence. This study’s overarching aim examines 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 Centers for Disease Control and Prevention (CDC) guidelines for routine, repeat HIV and sexually transmitted infection (STI) testing for high-risk youth. At baseline and four-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 post-exposure prophylaxis, condoms, prevention services), and secondary outcomes of substance use, mental health, and housing insecurity. Assessments include rapid diagnostic tests for HIV, STIs, drugs and alcohol. The study sample is powered to detect modest interventions effects among the highest risk men who have sex with men (MSM) and transgender youth, with 70% retention over 24 months. Intervention Design: Youth are randomized in a factorial design to four conditions: 1) enhanced standard of care automated text-messaging and monitoring (AMM), which includes repeat HIV/STI testing assessment procedures (n = 690); 2) online group peer support via private social media, with cash incentivizes and facilitation by study coaches plus AMM (n= 270); 3) coaching that is strengths-based, youth-centered, unscripted, based on common practice elements of EBI, available on-demand 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). Discussion: This hybrid implementation-effectiness study examines alternative models for implementing the CDCs guidelines for routine HIV/STI testing for youth at high-risk of acquiring HIV, and for delivering evidence-based interventions in modular elements instead of scripted manuals and available over 24 months of follow-up, while also mounting implementation, costs, and effectiveness. The greatest impacts are expected for coaching, while online group peer support is expected to have lower impact but may be more cost-effective. Trial Registration: ClinicalTrials.gov registration #NCT03134833, registered April 28, 2017.