Accepted for/Published in: JMIR Research Protocols
Date Submitted: Apr 28, 2020
Date Accepted: Jul 7, 2020
Evaluation of a stepped care eHealth HIV prevention program for diverse adolescent MSM: Protocol for a hybrid type 1 effectiveness-implementation trial of SMART
ABSTRACT
Background:
Adolescent men who have sex with men (AMSM), ages 13-18, account for more than 80% of teen HIV diagnoses. Despite this disproportionate burden, there is a conspicuous lack of evidence-based HIV prevention programs. Implementation issues are critical as traditional HIV prevention delivery channels (e.g., community-based organizations, schools) have significant access limitations for AMSM. As such, eHealth interventions, such as our proposed SMART Program, represent an excellent modality for delivering AMSM-specific intervention material where youth “are.”
Objective:
Through this trial, we plan to test the effectiveness of the SMART Program at reducing condomless anal sex and increasing HIV testing for AMSM. We also plan to test whether SMART has differential effectiveness across important sub-groups of AMSM based on race/ethnicity, urban/rural residence, age, socioeconomic status, and participation in an English vs. Spanish language version of SMART.
Methods:
Using a sequential multiple assignment randomized trial design, we will evaluate the impact of a stepped care package of increasingly intensive eHealth interventions (i.e., the universal, information-based SMART Sex Ed; the more intensive, selective SMART Squad; and a higher-cost, indicated SMART Sessions). All intervention content is available in English and Spanish.
Results:
To date, the trial has enrolled 1,216 AMSM ages 13-18, with a target enrollment of 1,878. Enrollment will conclude in May 2020. Assessments of intervention outcomes at 3-, 6-, 9-, and 12-months are ongoing.
Conclusions:
SMART is the first online program for AMSM to take a stepped-care approach to sexual education and HIV prevention. This design means SMART delivers resources to all adolescents, but more costly treatments (e.g., videochat counseling in SMART Sessions) are conserved for individuals who need them most. SMART has the potential to reach AMSM to provide them with a sex-positive curriculum that empowers them with the information, motivation, and skills to make better health choices. Clinical Trial: ClinicalTrials.gov Identifier NCT03511131; https://clinicaltrials.gov/ct2/show/NCT03511131
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