Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Dec 22, 2020
Date Accepted: May 5, 2021
Efficacy of a Just-in-Time Adaptive Intervention to promote HIV Risk Reduction Behaviors among Young Adults Experiencing Homelessness: A Randomized Controlled Trial
ABSTRACT
Background:
People experiencing homelessness have higher rates of HIV than those who are stably housed. Mental health needs, substance use problems, and issues unique to homelessness such as lack of shelter and transiency need to be considered with regard to HIV prevention. To date, HIV prevention interventions for young adults experiencing homelessness (YEH) have not specifically addressed modifiable real-time factors such as stress, sexual or drug use urge, or substance use or been delivered at the time of heightened risk. Real-time, personalized HIV prevention messages may reduce HIV risk behaviors.
Objective:
This pilot study tested the feasibility and initial efficacy of an innovative smartphone-based just-in-time adaptive intervention (JITAI) that assessed predictors of HIV risk behaviors in real-time and automatically provided behavioral feedback and goal attainment information.
Methods:
A randomized attention control design was used with YEH (N=97) 18-25 years old recruited from shelters and drop-in centers in May, 2019. The intervention consisted of brief messages delivered via smartphone over 6 weeks in response to pre-identified predictors that were assessed using Ecological Momentary Assessments. Bayesian hierarchical regression models were used to assess intervention effects on sexual activity, drug use, alcohol use, and their corresponding urges.
Results:
Participants were predominantly youth (mean age 21.2, SD 2.1) who identified as heterosexual (52%), male (57%), and African American (57%). Sexual activity, drug use, alcohol use, stress, and all urges (i.e., sexual, drug, alcohol) reduced over time in both groups. Daily drug use reduced by a factor of 13.8 times over 6 weeks in the intervention group relative to the control group. Lower urges for sex were found in the intervention group relative to the control group over the duration of the study. Finally, there was a statistically significant (P = .03) reduction in reports of feeling stressed yesterday between the intervention and control condition.
Conclusions:
Findings indicate promising intervention effects on drug use, stress, and urges for sex among a hard-to-reach, high risk population. This innovative JITAI should be further tested in a larger randomized controlled trial to further investigate its efficacy and impact on sexual risk behaviors. Clinical Trial: Clinical Trials.gov NCT03911024
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