Effectiveness and implementation of text messaging to improve HIV testing in sexual and gender minority adolescents

项目摘要 青少年性少数男性，变性女孩和性别多样化青少年（ASMM/TGD;年龄13-18） 艾滋病毒感染者比例过高，占该年龄组新感染者的79%。虽然CDC 和USPTF建议在青少年中进行艾滋病毒筛查，ASMM/TGD的检测率非常低（1/4 ASMM; <1/10 TGD）。在ASMM/TGD增加艾滋病毒检测对于降低传播率和 联系，以照顾那些谁测试呈阳性。尽管存在这一令人担忧的公共卫生问题， 艾滋病毒预防干预措施存在ASMM/TGD，迄今为止，没有CDC对此的最佳证据干预措施 小组的重点是增加艾滋病毒检测作为一个主要成果。G2 G是一种为期6周的基于短信的艾滋病毒 风险行为减少计划最初是为ASMM设计的。活性治疗组内容侧重于 提供艾滋病预防信息，提高艾滋病预防的积极性，提高艾滋病预防的自我意识， G2 G试点随机对照试验显示， 积极治疗组在随访时报告接受艾滋病毒检测的可能性是对照组的3倍以上。 控制臂，即使只有少数消息集中在测试。我们建议更新G2 G， 最新的艾滋病毒预防和检测科学，使内容包括TGD，并测试其对 经验证的HIV检测结果（例如，测试结果照片）。此外，数字艾滋病毒的广泛采用 由于在整个软件开发过程中缺乏对实现的关注， 干预设计和测试。例如，谁应该实施数字艾滋病毒预防/检测干预措施 对于青少年（例如，直接面向消费者，诊所）仍然是一个悬而未决的问题， 开发过程可以确保干预措施的成功;更新内容和技术的最佳做法 数字艾滋病毒预防/检测计划，以防止其过时是缺乏的;也缺乏 就如何最好地接触SGM青少年进行此类计划达成共识。我们提出了一个混合1型试验， 建立G2 G的有效性，并确定为青少年实施数字艾滋病毒预防/检测的最佳做法 三个具体目标。在目标1中，我们将与青年咨询理事会合作，增加反映我们 更加重视艾滋病毒检测，更新现有内容的性别包容性和文化相关性。与 未来的实施者的投入，我们还将现代化的G2 G软件平台，着眼于 实施.在目标2中，我们将在全国范围内随机对照试验中测试G2 G对HIV检测的有效性。 360例ASMM/TGD患者，年龄13-18岁。最后，目标3将召集ASMM/TGD青年研究专家， 提供服务，以确定并达成共识的过程，要求，和障碍/促进者， 与ASMM/TGD接触并参与艾滋病毒检测/预防。目标3的目标是提供信息、发展和 * 传播具体工具，确保艾滋病毒预防方案能够普及到ASMM/TGD。专家小组还将 建议在真实的世界环境中扩大G2 G所需的潜在实施模式和适应措施。

Project Summary Adolescent sexual minority males, transgender girls, and gender diverse teens (ASMM/TGD; ages 13-18) are disproportionately affected by HIV, accounting for 79% of new infections among this age group. Although CDC and USPTF recommend HIV screening among teens, testing rates among ASMM/TGD are very low (1 in 4 ASMM; <1 in 10 TGD). Increasing HIV testing in ASMM/TGD is critical in mitigating transmission rates and in linkage to care for those who test positive. Despite this alarming public health issue, few developmentally tailored HIV prevention interventions exist for ASMM/TGD, and to date, no CDC best-evidence interventions for this group are focused on increasing HIV testing as a primary outcome. G2G was a 6-week text message-based HIV risk behavior reduction program originally designed for ASMM. Active treatment arm content focused on providing HIV prevention information, increasing HIV prevention motivation, and increasing HIV prevention self- efficacy relative to an information-only healthy lifestyle control arm. The G2G pilot RCT showed adolescents in the active treatment arm were >3x more likely to report being tested for HIV at follow-up versus those in the control arm, even though only a minority of messages focused on testing. We propose to update G2G with the latest HIV prevention and testing science, make content inclusive of TGD, and test its effectiveness on the outcome of validated HIV testing (e.g., photo of test result). Moreover, widespread adoption of digital HIV prevention programs has lagged due to lack of attention to implementation throughout software development, intervention design, and testing. For instance, who should implement digital HIV prevention/testing interventions for teens (e.g., direct-to-consumer, clinics) remains an open question, and involving potential implementers in the development process can ensure intervention success; best practices for updating content and technology for digital HIV prevention/testing programs to prevent their obsolescence are lacking; and there is a lack of consensus on how best to reach SGM adolescents for such programs. We propose a Hybrid Type 1 trial that will establish G2G effectiveness and identify best practices for implementing digital HIV prevention/testing for teens via three specific aims. In Aim 1 we will collaborate with a youth advisory council to add content reflecting our increased emphasis on HIV testing and update gender inclusivity and cultural relevance of existing content. With prospective implementers’ input, we will also modernize the G2G software platform with an eye toward implementation. In Aim 2 we will test G2G effectiveness on HIV testing in a nationwide randomized controlled trial with 360 ASMM/TGD aged 13-18. Finally, Aim 3 will convene a experts in ASMM/TGD youth research and service provision to identify and achieve consensus in processes of, requirements for, and barriers/facilitators to reaching and engaging ASMM/TGD for HIV testing/prevention. The goal of Aim 3 is to inform, develop, and disseminate concrete tools to ensure HIV prevention programs reach ASMM/TGD. The panel will also recommend potential implementation models and adaptations needed to scale up G2G in real world settings.