Get Connected: Linking YMSM to adequate care through a multilevel, tailored WebApp intervention

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The number of HIV infections among men who have sex with men aged 15-24 (YMSM) has grown significantly in the past decade. The HIV epidemic among YMSM is marked by staggering disparities by race and ethnicity. Despite this burgeoning epidemic, there is a dearth of interventions that have proven efficacious for reducing HIV risk among this population. For YMS to successfully engage in HIV prevention and care services requires that they navigate a series of multilevel barriers operating at the individual (e.g., risk awareness, self-efficacy to get tested), systems (e.g., costs, medical mistrust, lack of culturally competent care), and structural (e.g., homelessness, costs, stigma) levels. We developed Get Connected (GC) as an online brief intervention that employs individual and systems-level tailoring technology to reduce barriers to linkage to competent prevention care (e.g., HIV/STI testing, PrEP) for YMSM (ages 15-24). GC is responsive to the ATN RFA as its multilevel approach recognizes and addresses individual and structural factors that may impede HIV/STI testing and PrEP uptake among YMSM. As part of the proposed iTech U19, we will test the efficacy of GC for increasing YMSM's successful engagement in locally appropriate HIV prevention and care. With a large (n=400) and diverse sample of YMSM, drawn from three sites characterized by high HIV incidence among youth (Houston, Philadelphia and New Orleans) we propose of two-arm randomized control trial with 12 months of follow-up. Primary outcomes include (1) HIV/STI risk behaviors, (2) repeat HIV/STI testing among HIV-negative high risk YMSM, and (3) awareness and uptake of PrEP services. Secondary outcomes include treatment of incident STIs and linkage and retention in care among incident HIV+ cases. We will also examine changes in GC's theorized mechanisms of change, including YMSM's (1) self-efficacy to get tested, (2) perceived benefits and barriers to get tested. To address structural influences on successful engagement in care, HIV/STI testing sites listed in GC will receive quarterly performance assessments based on ratings that YMSM provide after visiting their locations. We will examine sites' satisfaction with the quarterly performance assessments and their improvements in service delivery when working with YMSM across the three study sites selected to test GC. These activities will be paralleled by a cost input analysis to inform discussions of sustainability and roll out of the GC intervention. If proven efficacious, Get Connected has the potential to significantly inform mechanisms for linking YMSM to locally available HIV prevention services.