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

短信改善性少数青少年艾滋病毒检测的有效性和实施

• 批准号: 10602498
• 负责人: Kathryn Rose Macapagal
• 金额: $ 72.02万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-05 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10602498
• 关键词: AIDS prevention; Accounting; Address; Adolescent; Adoption; Adult; Affect; Age; Attention; Behavioral; Bisexual; Caring; Clinic; Collaborations; Communities; Computer software; Consensus; Consolidated Framework for Implementation Research; Continuity of Patient Care; Development; Devices; Effectiveness; Ensure; Epidemic; Focus Groups; Gays; Gender; Generations; Goals; HIV; HIV Infections; HIV Seropositivity; HIV risk; Health Personnel; High School Student; Human immunodeficiency virus test; Hybrids; Incidence; Infection; Intervention; Intervention Trial; Interview; Left; Mediator; Minority; Modeling; Modernization; Motivation; Outcome; Population; Prevention; Prevention Research; Prevention program; Process; Provider; Public Health; Randomized; Randomized, Controlled Trials; Recommendation; Reporting; Research; Resources; Risk; Risk Reduction Behavior; Science; Self Efficacy; Service provision; Sexual and Gender Minorities; Strategic Planning; Surveys; Technology; Teenagers; Test Result; Testing; Text Messaging; Time; Unsafe Sex; Update; Youth; active method; age group; aged; antiretroviral therapy; arm; behavior change; behavior test; boys; cisgender; design; digital; digital health; digital intervention; digital technology; effective intervention; effectiveness outcome; effectiveness testing; effectiveness/implementation design; follow-up; forging; gender diversity; girls; group intervention; healthy lifestyle; hybrid type 1 trial; implementation barriers; implementation science; improved; innovation; minority children; pre-exposure prophylaxis; preference; prevent; preventive intervention; primary outcome; programs; prospective; recruit; scale up; screening; secondary outcome; sexual minority male; sexual minority youth; sexually active adolescent; skills; social media; software development; success; text messaging intervention; therapy design; tool; transgender; transmission process; treatment arm; uptake

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.

项目摘要 青春期性少数族裔男性、变性女孩和不同性别的青少年(ASMM/TGD；13-18岁)是 受艾滋病毒影响不成比例，占这一年龄段新感染人数的79%。虽然疾控中心 USPTF建议在青少年中进行HIV筛查，ASMM/TGD的检测率非常低(1/4 每10个TGD中就有1个)。在ASMM/TGD中增加艾滋病毒检测对于降低传播率和 联动以照顾那些检测呈阳性的人。尽管存在这一令人担忧的公共卫生问题，但很少有人在发展方面量身定做 存在针对ASMM/TGD的艾滋病毒预防干预措施，但到目前为止，还没有CDC对此进行最佳证据干预 该小组的重点是增加艾滋病毒检测，作为主要成果。G2G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。重点关注主动治疗ARM的内容 提供艾滋病预防信息，增加艾滋病预防动力，增强艾滋病预防自我 相对于仅提供信息的健康生活方式控制臂的疗效。G2G试点RCT显示，青少年在 主动治疗组在随访时报告接受艾滋病毒检测的可能性是那些接受治疗的人的3倍 控制臂，尽管只有一小部分消息专注于测试。我们建议将G2G更新为 最新的艾滋病毒预防和检测科学，使内容包括TGD，并在 有效的艾滋病毒检测结果(例如，检测结果的照片)。此外，数字艾滋病毒的广泛采用 预防计划由于在整个软件开发过程中缺乏对实施的关注而滞后， 干预设计，并进行测试。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，直接面向消费者的诊所)来说，仍然是一个悬而未决的问题，并涉及到 开发过程可以确保干预成功；更新内容和技术的最佳实践 缺乏数字艾滋病毒预防/检测计划以防止其过时；而且缺乏 就如何最好地向SGM青少年提供此类计划达成共识。我们提出了一种混合类型1试验，它将 建立G2G有效性并确定对青少年实施数字艾滋病毒预防/检测的最佳做法 通过三个具体目标。在目标1中，我们将与青年咨询委员会合作，添加反映我们 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。使用 未来实施者的投入，我们还将对G2G软件平台进行现代化改造，着眼于 实施。在目标2中，我们将在全国随机对照的情况下测试G2G对HIV检测的有效性 对360名13-18岁的ASMM/TGD进行了试验。最后，AIM 3将召集ASMM/TGD青年研究和 提供服务，以确定流程、需求和障碍/促进者，并达成共识 接触和使用ASMM/TGD进行艾滋病毒检测/预防。目标3的目标是提供信息、开发和 传播具体工具，以确保艾滋病毒预防项目达到ASMM/TGD。该小组还将 建议在现实环境中扩展G2G所需的潜在实施模式和调整。