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Bauermeister JA, Horvath KJ, Lin WY, Golinkoff JM, Claude KF, Dowshen N, Castillo M, Sullivan PS, Paul M, Hightow-Weidman L, Stephenson R. Enhancing routine HIV and STI testing among young men who have sex with men: primary outcomes of the get connected clinical randomized trial (ATN 139). BMC Public Health 2024; 24:1072. [PMID: 38632603 PMCID: PMC11025185 DOI: 10.1186/s12889-024-18522-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Regular HIV and STI testing remain a cornerstone of comprehensive sexual health care. In this study, we examine the efficacy of Get Connected, a WebApp that combines test locators with personalized educational resources, in motivating young men who have sex with men (YMSM) to undergo regular HIV and STI testing. METHODS Participants were randomly placed in one of two conditions. The first condition included the full version of GC (GC-PLUS), which included content tailored to users' psychosocial characteristics (e.g., age, race/ethnicity, relationship status, HIV/STI testing history). The second condition served as our attention-control and only included the testing locator (GC-TLO) for HIV/STI testing services. Participants were recruited from three cities (Houston, Philadelphia, and Atlanta) characterized by high HIV incidence. Assessments were collected at 1, 3-, 6-, 9- and 12-month follow-ups. RESULTS Both versions of GC were acceptable and efficacious in increasing routine HIV and STI testing over a 12-month period. 40% of the sample reported testing at least twice, with no main effects observed across the two intervention arms (OR = 1.11; 95% CI: 0.69, 1.80), p =.66). Greater intervention effects were observed among YMSM who engaged more frequently with the intervention, with regional differences observed. CONCLUSIONS Our findings underscore the need to cater to the diverse needs of YMSM through multilevel approaches. Broadly, mHealth HIV/STI testing interventions, such as Get Connected, would benefit from matching technologies to the local context to have the greatest impact. TRIAL REGISTRATION This study is registered on ClinicalTrials.gov (NCT03132415).
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Affiliation(s)
- J A Bauermeister
- University of Pennsylvania, 418 Curie Blvd, Room 222L, 19104, Philadelphia, PA, USA.
| | - K J Horvath
- San Diego State University, San Diego, CA, USA
| | - W Y Lin
- University of Pennsylvania, 418 Curie Blvd, Room 222L, 19104, Philadelphia, PA, USA
| | - J M Golinkoff
- University of Pennsylvania, 418 Curie Blvd, Room 222L, 19104, Philadelphia, PA, USA
| | - K F Claude
- Florida State University, Tallahassee, FL, USA
| | - N Dowshen
- University of Pennsylvania, 418 Curie Blvd, Room 222L, 19104, Philadelphia, PA, USA
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M Castillo
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - M Paul
- Baylor College of Medicine, Houston, TX, USA
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Rutstein SE, Muessig KE. Leveling Up PrEP: Implementation Strategies at System and Structural Levels to Expand PrEP Use in the United States. Curr HIV/AIDS Rep 2024; 21:52-61. [PMID: 38517670 DOI: 10.1007/s11904-024-00697-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE OF REVIEW Despite highly effective biomedical HIV pre-exposure prophylaxis (PrEP) options, suboptimal PrEP uptake impedes progress towards ending the epidemic in the United States of America (USA). Implementation science bridges what we know works in controlled clinical trial settings to the context and environment in which efficacious tools are intended to be deployed. In this review, we focus on strategies that target PrEP use barriers at the system or structural level, exploring the implications and opportunities in the context of the fragmented USA healthcare system. RECENT FINDINGS Task shifting could increase PrEP prescribers, but effectiveness evidence is scarce in the USA, and generally focused in urban settings. Integration of PrEP within existing healthcare infrastructure concentrates related resources, but demonstration projects rarely present the resource implications of redirecting staff. Changing the site of service via expanded telehealth could improve access to more rural populations, though internet connectivity, technology access, and challenges associated with determining biomedical eligibility remain logistical barriers for some of the highest burden communities in the USA. Finally, a tailored care navigation and coordination approach has emerged as a highly effective component of PrEP service provision, attempting to directly modify the system-level determinants of PrEP use experienced by the individual. We highlight recent advances and evidence surrounding task shifting, integration, service delivery, and tailoring. With the exception of tailored care navigation, evidence is mixed, and the downstream impact and sustainability of task shifting and care integration require further attention. To maximize PrEP outcomes, research will need to continue to examine the interplay between individuals, clinics, and the healthcare system and associated policies within which they operate.
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Affiliation(s)
- Sarah E Rutstein
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA.
| | - Kathryn E Muessig
- Institute On Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, USA
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Micalizzi L, Mattingly DT, Hart JL, Jensen JK, Mahabee-Gittens EM, Garrison KA. Smartphone Apps Targeting Youth Tobacco Use Prevention and Cessation: An Assessment of Credibility and Quality. CURRENT ADDICTION REPORTS 2023; 10:649-663. [PMID: 38680515 PMCID: PMC11052596 DOI: 10.1007/s40429-023-00524-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 05/01/2024]
Abstract
Purpose of Review The goals of this study were to identify smartphone apps targeting youth tobacco use prevention and/or cessation discussed in the academic literature and/or available in the Apple App Store and to review and rate the credibility of the apps. We took a multiphase approach in a non-systematic review that involved conducting parallel literature and App Store searches, screening the returned literature and apps for inclusion, characterizing the studies and apps, and evaluating app quality using a standardized rating scale. Recent Findings The negative consequences of youth tobacco use initiation are profound and far-reaching. Half of the youth who use nicotine want to quit, but quit rates are low. The integration of smartphone apps shows promise in complementing and enhancing evidence-based youth tobacco prevention and treatment methods. Summary Consistent with prior reviews, we identified a disconnect between apps that are readily accessible and those that have an evidence base, and many popular apps received low quality scores. Findings suggest a need for better integration between evidence-based and popular, available apps targeting youth tobacco use.
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Affiliation(s)
- Lauren Micalizzi
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI 02912, USA
| | - Delvon T. Mattingly
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY 40536, USA
- Center for Health Equity Transformation, College of Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Joy L. Hart
- Department of Communication and Christina Lee Brown Environme Institute, University of Louisville, Louisville, KY 40292, USA
| | - Jessica King Jensen
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Health, New Brunswick, NJ 08901, USA
- Department of Family Medicine & Community Health, Johnson Medical School,, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
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Phillips VL, Xue A, Castillo M, Santiago D, Wimbly T, Hightow-Wideman LB, Stephenson R, Bauermeister JA. Cost of peer mystery shopping to increase cultural competency in community clinics offering HIV/STI testing to young men who have sex with men: results from the get connected trial. HEALTH ECONOMICS REVIEW 2023; 13:34. [PMID: 37266871 PMCID: PMC10236762 DOI: 10.1186/s13561-023-00447-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 05/17/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Cultural competency has been identified as a barrier to lesbian, gay, bisexual and transgender (LGBT) populations seeking care. Mystery shopping has been widely employed in the formal health care sector as a quality improvement (QI) tool to address specific client needs. The approach has had limited use in community-based organizations due in part to lack of knowledge and resource requirement concerns. Several mystery shopping initiatives are now being implemented which focus on the LGBT population with the goal of reducing barriers to accessing care. One subset targets men who have sex with men (MSM) to increase uptake of human immunodeficiency virus (HIV) testing. No study investigates the costs of these initiatives. Get Connected was a randomized control trial with the objective of increasing uptake of HIV-prevention services among young men who have sex with men (YMSM) through use of a resource-locator application (App). The initial phase of the trial employed peer-led mystery shopping to identify culturally competent HIV testing sites for inclusion in the App. The second phase of the trial randomized YMSM to test the efficacy of the App. Our objective was to determine the resource inputs and costs of peer-led mystery shopping to identify clinics for inclusion in the App as costs would be critical in informing possible adoption by organizations and sustainability of this model. METHODS Through consultation with study staff, we created a resource inventory for undertaking the community-based, peer-led mystery shopping program. We used activity-based costing to price each of the inputs. We classified inputs as start-up and those for on-going implementation. We calculated costs for each category, total costs and cost per mystery shopper visit for the four-month trial and annually to reflect standard budgeting periods for data collected from September of 2019 through September of 2020. RESULTS Recruitment and training of peer mystery shoppers were the most expensive tasks. Average start-up costs were $10,001 (SD $39.8). Four-month average implementation costs per visit were $228 (SD $1.97). Average annual implementation costs per visit were 33% lower at $151 (SD $5.60). CONCLUSIONS Peer-led, mystery shopping of HIV-testing sites is feasible, and is likely affordable for medium to large public health departments.
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Affiliation(s)
- Victoria L Phillips
- Rollins School of Public Health of Emory University, 1518 Clifton Road, Room 614, Atlanta, GA, 30322, USA.
| | - Ashley Xue
- Rollins School of Public Health of Emory University, 1518 Clifton Road, Room 614, Atlanta, GA, 30322, USA
| | - Marné Castillo
- Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Dalia Santiago
- Department of Pediatrics-Retrovirology, Baylor College of Medicine, Texas Children's Hospital, Dallas, USA
| | - Taylor Wimbly
- Prevention Research Center, Morehouse School of Medicine, Atlanta, USA
| | - Lisa B Hightow-Wideman
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, USA
| | - Rob Stephenson
- School of Nursing and the Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA
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DeMonte J, McCumber M, Slye N, Amico KR, Arnold EM, Comulada WS, Hayati Rezvan P, Hightow-Weidman LB, Muessig KE, Nichols SL, Nielsen-Saines K, Sanchez TH, Shook-Sa BE, Swendeman D, Valencia RK, Hudgens MG. Adolescents Living With or at Risk for HIV: A Pooled Descriptive Analysis of Studies From the Adolescent Medicine Trials Network for HIV/AIDS Interventions. J Adolesc Health 2023; 72:712-721. [PMID: 36803999 PMCID: PMC10121857 DOI: 10.1016/j.jadohealth.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/13/2022] [Accepted: 12/15/2022] [Indexed: 02/18/2023]
Abstract
PURPOSE This study aims to describe the cohort of Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) research program participants and evaluate whether the ATN's recently completed 5-year cycle recruited study participants who parallel the populations most impacted by HIV in the United States. METHODS Harmonized measures across ATN studies collected at baseline were aggregated for participants aged 13-24 years. Pooled means and proportions stratified by HIV status (at risk for or living with HIV) were calculated using unweighted averages of study-specific aggregate data. Medians were estimated using a weighted median of medians method. Public use 2019 Centers for Disease Control and Prevention surveillance data for state-level new HIV diagnoses and HIV prevalence among US youth aged 13-24 years were obtained for use as reference populations for ATN at-risk youth and youth living with HIV (YLWH), respectively. RESULTS Data from 3,185 youth at-risk for HIV and 542 YLWH were pooled from 21 ATN study phases conducted across the United States. Among ATN studies tailored to at-risk youth, a higher proportion of participants were White and a lower proportion were Black/African American and Hispanic/Latinx compared to youth newly diagnosed with HIV in the United States in 2019. Participants in ATN studies tailored to YLWH were demographically similar to YLWH in the United States. DISCUSSION The development of data harmonization guidelines for ATN research activities facilitated this cross-network pooled analysis. These findings suggest the ATN's YLWH are representative, but that future studies of at-risk youth should prioritize recruitment strategies to enroll more participants from African American and Hispanic/Latinx populations.
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Affiliation(s)
- Justin DeMonte
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Micah McCumber
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nicole Slye
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - K Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Elizabeth M Arnold
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - W Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Panteha Hayati Rezvan
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Lisa B Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathryn E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sharon L Nichols
- Department of Neurosciences, University of California San Diego, La Jolla, California
| | - Karin Nielsen-Saines
- Department of Pediatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Travis H Sanchez
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Bonnie E Shook-Sa
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dallas Swendeman
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | | | - Michael G Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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English D, Smith JC, Scott-Walker L, Lopez FG, Morris M, Reid M, Lashay C, Bridges D, McNeish D. Feasibility, Acceptability, and Preliminary HIV Care and Psychological Health Effects of iTHRIVE 365 for Black Same Gender Loving Men. J Acquir Immune Defic Syndr 2023; 93:55-63. [PMID: 36706362 PMCID: PMC10840385 DOI: 10.1097/qai.0000000000003167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/29/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES This uncontrolled pilot study examined the feasibility, acceptability, and preliminary HIV and psychological health effects of iTHRIVE 365, a multicomponent intervention designed by and for Black same gender loving men (SGLM) to promote: health knowledge and motivation, Black SGLM social support, affirming health care, and housing and other economic resources. DESIGN METHODS We conducted a 14-day daily diary study with 32 Black SGLM living with HIV connected to THRIVE SS in Atlanta, GA. Daily surveys assessed intervention engagement, antiretroviral medication (ART) use, depressive symptoms, anxiety symptoms, and emotion regulation difficulties. App paradata (ie, process data detailing app usage) assessed amount of intervention engagement via page access. Participants began receiving access to the intervention on day 7. After the 14-day daily diary period, participants responded to follow-up items on the user-friendliness, usefulness, helpfulness, and whether they would recommend iTHRIVE 365 to others. Chi-square analyses examined associations between intervention engagement and ART use, and dynamic structural equation modelling assessed longitudinal associations from intervention engagement to next-day psychological health. This intervention trial is registered on ClinicalTrials.gov (NCT05376397). RESULTS On average, participants engaged with iTHRIVE 365 over once every other day and accessed intervention pages 4.65 times per day. Among participants who engaged with the intervention, 78% reported it was helpful to extremely helpful, 83% reported it was moderately to extremely useful, and 88% reported it was user-friendly and they would recommend it to others. On intervention engagement days, participants had higher odds of ART use, χ 2 (1) = 4.09, P = 0.04, than intervention nonengagement days. On days after intervention engagement, participants showed non-null decreases in depressive symptoms (τ = -0.14; 95% CI : = [-0.23, -0.05]) and emotion regulation difficulties (τ = -0.16; 95% CI : = [-0.24, -0.02]). CONCLUSIONS Findings suggest iTHRIVE 365 is feasible, acceptable, and positively affects daily ART use, depressive symptoms, and emotion regulation difficulties.
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Affiliation(s)
- Devin English
- Department of Urban-Global Public Health, Rutgers School of Public Health, Newark, NJ, USA
| | | | | | | | - Michael Morris
- THRIVE Social Services (THRIVE SS), Inc., Atlanta, GA, USA
| | - Malcolm Reid
- THRIVE Social Services (THRIVE SS), Inc., Atlanta, GA, USA
| | | | - Dwain Bridges
- THRIVE Social Services (THRIVE SS), Inc., Atlanta, GA, USA
| | - Daniel McNeish
- Department of Psychology, Arizona State University, Tempe, AZ
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Arnold T, Gaudiano BA, Barnett AP, Elwy AR, Whiteley L, Giorlando KK, Rogers BG, Ward LM, Leigland A, Brown LK. Development of An Acceptance Based PrEP Intervention ( ACTPrEP) to Engage Young Black MSM in the South Utilizing the Adaptome Model of Intervention Adaptation. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023; 28:60-70. [PMID: 37008800 PMCID: PMC10062414 DOI: 10.1016/j.jcbs.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Objectives HIV disproportionately affects young Black men who have sex with men (YBMSM) in the Southern United States. Pre-exposure prophylaxis (PrEP) is an efficacious, biomedical approach to prevent HIV. While Mississippi (MS) has among the highest rates of new HIV infections, it also ranks among the top three states for unmet PrEP need. Thus, increasing engagement in PrEP care for YBMSM in MS is imperative. A potential method to improve psychological flexibility and promote PrEP uptake, explored by this study, is the incorporation of Acceptance and Commitment Therapy (ACT) into PrEP interventions. ACT is an evidence-based intervention used to treat a wide range of mental and physical illnesses. Methods Twenty PrEP-eligible YBMSM and ten clinic staff working with YBMSM in MS were surveyed and interviewed between October 2021 and April 2022. The brief survey covered PrEP structural barriers, PrEP stigma, and psychological flexibility. Interview topics included internal experiences related to PrEP, existing health behaviors, PrEP related personal values, and relevant constructs from the Adaptome Model of Intervention Adaptation (service setting, target audience, mode of delivery, and cultural adaptations). Qualitative data were coded based on ACT and the Adaptome model, organized using NVivo, then thematically analyzed. Results Patients identified side effects, costs, and taking a daily prescription as top barriers to taking PrEP. Staff reported the top barrier to PrEP for clients was concern others would believe they were living with HIV. Levels of psychological flexibility and inflexibility varied widely among participants. The resulting thematic categories derived from the interviews included 1) thoughts, emotions, associations, memories, and sensations (TEAMS) related to PrEP and HIV, 2) general health behaviors (existing coping techniques, views on medication, HIV/PrEP approach and avoidance), 3) values related to PrEP use (relationship values, health values, intimacy values, longevity values), and 4) Adaptome Model adaptations. These results informed the development of a new intervention, ACTPrEP. Conclusions Interview data organized by the Adaptome Model of Intervention Adaptation determined appropriate ACT-informed intervention components, content, intervention adaptations, and implementation strategies. Interventions informed by ACT that help YBMSM endure short-term discomfort related to PrEP by relating it to their values and long-term health goals are promising for increasing individuals' willingness to initiate and maintain PrEP care.
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Affiliation(s)
- Trisha Arnold
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA 02903
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906
| | - Brandon A. Gaudiano
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906
| | - Andrew P. Barnett
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA 02903
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906
| | - A. Rani Elwy
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | - Laura Whiteley
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906
| | - Kayla K. Giorlando
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA 02903
| | - Brooke G. Rogers
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02903
| | - Lori M. Ward
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, Mississippi USA 39217
| | - Avery Leigland
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA 02903
| | - Larry K. Brown
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA 02903
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906
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Wang Y, Mitchell J, Liu Y. Evidence and implication of interventions across various socioecological levels to address HIV testing uptake among men who have sex with men in the United States: A systematic review. SAGE Open Med 2022; 10:20503121221107126. [PMID: 35795867 PMCID: PMC9251980 DOI: 10.1177/20503121221107126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/25/2022] [Indexed: 12/20/2022] Open
Abstract
Objectives Strengthening HIV testing uptake is critical to curtail the HIV epidemics among men who have sex with men in the United States. Despite the implementation of various interventions to promote HIV testing among men who have sex with men, few aggregated evidence is presented to reflect the "lessons learned" and inform future directions. The objective of this systematic review is to comprehensively summarize published studies that described, tested, and evaluated outcomes (e.g. efficacy, effectiveness, acceptability, feasibility and/or qualitative opinions) associated with an HIV testing intervention and identify gaps as well as opportunities to inform the design and implementation of future interventions to enhance HIV testing uptake among men who have sex with men in the United States. Methods We followed the PRISMA guidelines and conducted a systematic review of articles (published by 23 July 2021) by searching multiple databases (PubMed, MEDLINE, Web of Science and PsycINFO). Results Among the total number of 3505 articles found through multiple databases, 56 papers were included into the review. Interventional modules that demonstrated acceptability, feasibility and efficacy to improve HIV testing uptake among men who have sex with men include: HIV self-testing, interpersonal-level (e.g. peer-led, couple-based) interventions, personalized interventions and technology-based interventions (e.g. mHealth). Aggregated evidence also reflects the lack of individualized interventions that simultaneously address time-varying needs across multiple socioecological levels (e.g. individual, interpersonal, community, structural and societal). Conclusion Development of interventions to improve HIV testing rates and frequency of men who have sex with men has proliferated in recent years. Our review presents important implications in sustaining and improving interventions to address HIV testing uptake among men who have sex with men in the United States.
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Affiliation(s)
- Ying Wang
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Jason Mitchell
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Yu Liu
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
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9
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Wang Y, Mitchell JW, Zhang C, Liu Y. Evidence and implication of interventions across various socioecological levels to address pre-exposure prophylaxis uptake and adherence among men who have sex with men in the United States: a systematic review. AIDS Res Ther 2022; 19:28. [PMID: 35754038 PMCID: PMC9233830 DOI: 10.1186/s12981-022-00456-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/16/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) represents a proven biomedical strategy to prevent HIV transmissions among men who have sex with men (MSM) in the United States (US). Despite the design and implementation of various PrEP-focus interventions in the US, aggregated evidence for enhancing PrEP uptake and adherence is lacking. The objective of this systematic review is to synthesize and evaluate interventions aimed to improve PrEP uptake and adherence among MSM in the US, and identify gaps with opportunities to inform the design and implementation of future PrEP interventions for these priority populations. METHODS We followed the PRISMA guidelines and conducted a systematic review of articles (published by November 28, 2021) with a focus on PrEP-related interventions by searching multiple databases (PubMed, MEDLINE, Web of Science and PsycINFO). Details of PrEP interventions were characterized based on their socioecological level(s), implementation modalities, and stage(s) of PrEP cascade continuum. RESULTS Among the 1363 articles retrieved from multiple databases, 42 interventions identified from 47 publications met the inclusion criteria for this review. Most individual-level interventions were delivered via text messages and/or apps and incorporated personalized elements to tailor the intervention content on participants' demographic characteristics or HIV risk behaviors. Interpersonal-level interventions often employed peer mentors or social network strategies to enhance PrEP adoption among MSM of minority race. However, few interventions were implemented at the community-, healthcare/institution- or multiple levels. CONCLUSIONS Interventions that incorporate multiple socioecological levels hold promise to facilitate PrEP adoption and adherence among MSM in the US given their acceptability, feasibility, efficacy and effectiveness. Future PrEP interventions that simultaneously address PrEP-related barriers/facilitators across multiple socioecological levels should be enhanced with a focus to tackle contextual and structural barriers (e.g., social determinants of health, stigma or medical mistrust) at the community- and healthcare/institution-level to effectively promote PrEP use for MSM of color.
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Affiliation(s)
- Ying Wang
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Jason W Mitchell
- Department of Health Promotion and Disease Prevention, Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Chen Zhang
- School of Nursing, University of Rochester Medical Center, Rochester, NY, USA
| | - Yu Liu
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
- Division of Epidemiology, Department of Public Health Sciences, University of Rochester Medical Center, 256 Crittenden Blvd, Ste. 3305, Rochester, NY, 14642, USA.
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Li C, Xiong Y, Muessig KE, Tang W, Huang H, Mu T, Tong X, Yu J, Yang Z, Sherer R, Hazra A, Lio J, Matthews DD, Fisher EB, Li L, Tucker JD. Community-engaged mHealth intervention to increase uptake of HIV pre-exposure prophylaxis (PrEP) among gay, bisexual and other men who have sex with men in China: study protocol for a pilot randomised controlled trial. BMJ Open 2022; 12:e055899. [PMID: 35537794 PMCID: PMC9092176 DOI: 10.1136/bmjopen-2021-055899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 04/12/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The large number of key populations in China who would benefit from HIV pre-exposure prophylaxis (PrEP) in the context of limited health system capacity and public awareness will pose challenges for timely PrEP scale-up, suggesting an urgent need for innovative and accessible interventions. This study aims to develop and pilot test a theory-informed, tailored mobile phone intervention that was codeveloped by young gay men, HIV clinicians and public health researchers to increase engagement in PrEP education and initiation among Chinese gay, bisexual and other men who have sex with men (GBMSM), who bear a disproportionate burden of HIV infections and remain underserved in the healthcare system. METHODS AND ANALYSIS This two-phase study includes a formative assessment using in-depth interviews (N=30) and a 12-week experimental pilot study using a two-arm randomised controlled trial design (N=70). The primary intervention is delivered through a WeChat-based mini-app (a program built into a Chinese multipurpose social media application) developed by young GBMSM from a 2019 crowdsourcing hackathon. Using mixed methods, we will further investigate the specific needs and concerns among GBMSM in terms of using PrEP as an HIV prevention strategy, how their concerns and PrEP use behaviours may change with exposure to the mini-app intervention during the study period and how we can further refine this intervention tool to better meet GBMSM's needs for broader implementation. ETHICS AND DISSEMINATION This study and its protocols have been reviewed and approved by the Institutional Review Boards of the University of North Carolina at Chapel Hill, USA (19-3481), the Guangdong Provincial Dermatology Hospital, China (2020031) and the Guangzhou Eighth People's Hospital, China (202022155). Study staff will work with local GBMSM community-based organisations to disseminate the study results to participants and the community via social media, workshops and journal publications. TRIAL REGISTRATION NUMBER The study was prospectively registered on clinicaltrials.gov (NCT04426656) on 11 June 2020.
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Affiliation(s)
- Chunyan Li
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Yuan Xiong
- University of North Carolina Project-China, Guangzhou, Guangdong, China
| | - Kathryn E Muessig
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, Guangdong, China
| | - Haojie Huang
- Wuhan Tongxing LGBTQ Center, Wuhan, Hubei, China
| | - Tong Mu
- Qingdao Eighth People's Hospital, Qingdao, Shandong, China
| | - Xiaokai Tong
- Xi'an Polytechnic University, Xi'an, Shaanxi, China
| | | | - Zeyu Yang
- University of North Carolina Project-China, Guangzhou, Guangdong, China
| | - Renslow Sherer
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Aniruddha Hazra
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jonathan Lio
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Derrick D Matthews
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Edwin B Fisher
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Linghua Li
- Infectious Diseases Research Department, Guangzhou Eighth People's Hospital, Guangzhou, Guangdong, China
| | - Joseph D Tucker
- Institute of Global Health and Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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11
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Drab R, Wolfe JR, Chavanduka TMD, Bonar EE, Guest JL, Hightow-Weidman L, Castel AD, Horvath KJ, Sullivan PS, Stephenson R, Bauermeister J. Constructing a web-based health directory for adolescent men who have sex with men: Strategies for development and resource verification. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:1597-1615. [PMID: 34716596 PMCID: PMC8916971 DOI: 10.1002/jcop.22738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/04/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
Online health directories are increasingly used to locate health services and community resources, providing contact and service information that assists users in identifying resources that may meet their health and wellness needs. However, service locations require additional vetting when directories plan to refer vulnerable populations. As a tool included as part of a trial of a mobile life skills intervention for cisgender adolescent men who have sex with men (AMSM; ages 13-18), we constructed and verified resources for an online resource directory focused on linking young people to LGBTQ+ friendly and affirming local health and community social services resources. We collected information for 2301 individual directory listings through database and internet searches. To ensure the listings aligned with the project's focus of supporting young sexual minority men, we developed multiple data verification assessments to ensure community appropriateness resulting in verification of 1833 resources suitable for inclusion in our locator tool at project launch (March 2018). We offer lessons learned and future directions for researchers and practitioners who may benefit from adapting our processes and strategies for building culturally-tailored resource directories for vulnerable populations.
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Affiliation(s)
- Ryan Drab
- University of Pennsylvania, Philadelphia, Pennsylvania, US
| | - James R. Wolfe
- University of Pennsylvania, Philadelphia, Pennsylvania, US
| | - Tanaka MD Chavanduka
- The School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, US
| | - Erin E. Bonar
- The School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, US
- Department of Psychiatry, School of Medicine, Addiction Center, Ann Arbor, Michigan, US
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, US
| | - Jodie L. Guest
- Rollins School of Public Health, Emory University, Atlanta, Georgia, US
- Emory University School of Medicine, Emory University, Atlanta, Georgia, US
| | | | - Amanda D. Castel
- Milken Institute School of Public Health, George Washington University, Washington, D.C., US
| | | | | | - Rob Stephenson
- The School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, US
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12
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Wilbourn B, Howard-Howell T, Castel A, D'Angelo L, Trexler C, Carr R, Greenberg D. Barriers and Facilitators to HIV Testing Among Adolescents and Young Adults in Washington, District of Columbia: Formative Research to Inform the Development of an mHealth Intervention. JMIR Form Res 2022; 6:e29196. [PMID: 35275083 PMCID: PMC8956991 DOI: 10.2196/29196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/20/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adolescents and young adults (AYA) in the United States, and in Washington, District of Columbia (DC), specifically, are disproportionately affected by HIV. Both the national Ending the HIV Epidemic initiative and DC-specific plans emphasize HIV testing, and innovative strategies to encourage testing among AYA are needed. OBJECTIVE The purpose of this study is to identify sexual behaviors, HIV knowledge, HIV perceptions (eg, susceptibility and severity), and perceived barriers and facilitators to HIV testing among AYA at risk for HIV in DC. METHODS This study was part of a larger study to determine the acceptability of using a life-and-dating simulation game to increase HIV testing among AYA. Focus groups and surveys stratified by self-reported sexual orientation were conducted among, and administered to, AYA aged 13-24 years in DC. HIV knowledge was explored during focus groups and measured using an adapted version of the Brief HIV Knowledge Questionnaire. Survey data were summarized using descriptive statistics and compared by self-reported sexual orientation. Transcripts were thematically analyzed. RESULTS Of the 46 AYA who participated in the focus groups, 30 (65%) identified as heterosexual and 16 (35%) as lesbian, gay, bisexual, transgender, or queer. A higher proportion of lesbian, gay, bisexual, transgender, or queer AYA reported sexual activity (12/16, 75%, vs 18/30, 60%), condomless sex (11/12, 92%, vs 15/18, 83%), and HIV testing (13/16, 81%, vs 17/29, 58%) than heterosexual AYA. HIV prevention ("condoms" and "...PrEP") and transmission ("exchange of fluids") knowledge was high, and most (34/44, 77%) of the AYA perceived HIV testing as beneficial. However, the AYA also demonstrated some misinformation concerning HIV: an average of 67% (31/46; SD 0.474) of the participants believed that an HIV test could deliver accurate results 1 week after a potential exposure and an average of 72% (33/46; SD 0.455) believed that an HIV vaccine exists. The AYA also identified individual ("...people...are scared"), interpersonal ("it's an awkward conversation"), and structural ("...people don't...know where they can go") barriers to testing. Most of the AYA indicated that they were very likely to use the demonstrated game prototype to help with getting tested for HIV (median 3.0, IQR 2.0-3.0, using a scale ranging from 0 to 3, with 3 indicating high likelihood) and strongly agreed that the game was interesting (median 5.0, IQR 5.0-5.0), fun (median 5.0, IQR 4.0-5.0), and easy to learn (median 5.0, IQR 5.0-5.0, using a scale ranging from 1 to 5, with 5 indicating strong agreement). CONCLUSIONS These results suggest a need for multilevel HIV testing interventions and informed the development of a mobile health intervention aiming to increase HIV knowledge and risk perception among AYA, while reducing barriers to testing at the individual and structural levels, supporting efforts to end the domestic HIV epidemic.
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Affiliation(s)
- Brittany Wilbourn
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | | | - Amanda Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | | | | | - Rashida Carr
- Children's National Hospital, Washington, DC, United States
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13
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Iott BE, Loveluck J, Benton A, Golson L, Kahle E, Lam J, Bauermeister JA, Veinot TC. The impact of stigma on HIV testing decisions for gay, bisexual, queer and other men who have sex with men: a qualitative study. BMC Public Health 2022; 22:471. [PMID: 35264132 PMCID: PMC8908600 DOI: 10.1186/s12889-022-12761-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background Stigmatization may prompt gay, bisexual, queer and other men who have sex with men (GBQMSM) to avoid or delay HIV testing. There has been little attention to GBQMSMs’ perspectives about how stigma may influence their decisions about whether, where, and how often to get tested for HIV. Methods We conducted nine focus groups with 64 adult GBQMSM in Metropolitan Detroit, including HIV-negative men and people living with HIV (PLWH). Data were thematically analyzed deductively and inductively in three rounds. Results Three themes emerged regarding whether to get tested: (1) Perceived promiscuity, risk perceptions and HIV testing; (2) Fearing sexual rejection; and (3) Fearing friend and family member distancing and rejection. Themes concerning where to get tested included: (4) Conflating HIV testing and diagnosis; and (5) Seeking privacy and safety at specialized services. As for how often to get tested, themes included: (6) Reducing contact with healthcare providers due to intersectional stigma; (7) Responsibility and regular testing; and (8) HIV stigma and testing as routine care. Black participants articulated themes (3), (4), and (6) with greater frequency than other participants. Framing HIV testing as a personal responsibility may have created a “new stigma,” with unintended consequences not observed with “routine healthcare” messaging. Conclusions GBQMSMs’ perspectives indicate the potential for new foci for HIV testing promotion interventions based on stigma-related issues that they deem important. There is a need for interventions to challenge the “promiscuity” stereotype, and to reduce the sexual stigmatization of GBQMSM living with HIV/AIDS—especially online. Provider stigma requires both intervention and continued availability of specialized services. Future stigma-reduction interventions for Black GBQMSM could focus on building family support/acceptance, awareness of multiple testing options, and integrating LGBTQ-related issues into initiatives for racial justice in health care. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12761-5.
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Affiliation(s)
- Bradley E Iott
- School of Information, University of Michigan, Ann Arbor, MI, USA.,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Akilah Benton
- Detroit Health Department, City of Detroit, Detroit, MI, USA
| | - Leon Golson
- Unified - HIV Health and Beyond, Ypsilanti, MI, USA
| | - Erin Kahle
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Jason Lam
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | | | - Tiffany C Veinot
- School of Information, University of Michigan, Ann Arbor, MI, USA. .,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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14
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Sullivan PS, Stephenson R, Hirshfield S, Mehta CC, Zahn R, Bauermeister JA, Horvath K, Chiasson MA, Gelaude D, Mullin S, Downing MJ, Olansky EJ, Wiatrek S, Rogers EQ, Rosenberg E, Siegler AJ, Mansergh G. Behavioral Efficacy of a Sexual Health Mobile App for Men Who Have Sex With Men: Randomized Controlled Trial of Mobile Messaging for Men. J Med Internet Res 2022; 24:e34574. [PMID: 35025755 PMCID: PMC8851328 DOI: 10.2196/34574] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (GBMSM) face the highest burden of HIV in the United States, and there is a paucity of efficacious mobile health (mHealth) HIV prevention and care interventions tailored specifically for GBMSM. We tested a mobile app combining prevention messages and access to core prevention services for GBMSM. OBJECTIVE This study aims to measure the efficacy of the Mobile Messaging for Men (M-cubed) app and related services to increase HIV prevention and care behaviors in diverse US GBMSM. METHODS We conducted a randomized open-label study with a waitlist control group among GBMSM in 3 groups (low-risk HIV-negative group, high-risk HIV-negative group, and living-with-HIV [LWH] group) recruited online and in venues in Atlanta, Detroit, and New York City. Participants were randomly assigned to receive access to the app immediately or at 9 months after randomization. The app provided prevention messages in 6 domains of sexual health and offered ordering of at-home HIV and sexually transmitted infection test kits, receiving preexposure prophylaxis (PrEP) evaluations and navigation, and service locators. Serostatus- and risk-specific prevention outcomes were evaluated at baseline, at the end of the intervention period, and at 3, 6, and 9 months after the intervention period. RESULTS In total, 1226 GBMSM were enrolled and randomized; of these 611 (49.84%) were assigned to the intervention group and 608 (99.51%) were analyzed, while 615 (50.16%) were assigned to the control group and 612 (99.51%) were analyzed. For high-risk GBMSM, allocation to the intervention arm was associated with higher odds of HIV testing during the intervention period (adjusted odds ratio [aOR] 2.02, 95% CI 1.11-3.66) and with higher odds of using PrEP in the 3 months after the intervention period (aOR 2.41, 95% CI 1.00-5.76, P<.05). No changes in HIV prevention or care were associated with allocation to the intervention arm for the low-risk HIV-negative and LWH groups. CONCLUSIONS Access to the M-cubed app was associated with increased HIV testing and PrEP use among high-risk HIV-negative GBMSM in 3 US cities. The app could be made available through funded HIV prevention providers; additional efforts are needed to understand optimal strategies to implement the app outside of the research setting. TRIAL REGISTRATION ClinicalTrials.gov NCT03666247; https://clinicaltrials.gov/ct2/show/NCT03666247. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/16439.
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Affiliation(s)
- Patrick Sean Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Rob Stephenson
- Department of Systems, Population, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Sabina Hirshfield
- Special Treatment and Research Program, Department of Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, NY, United States
| | - Cyra Christina Mehta
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, NY, United States
| | - Ryan Zahn
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Jose A Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennslyvania, Philadelphia, PA, United States
| | - Keith Horvath
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Mary Ann Chiasson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.,Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Deborah Gelaude
- HIV Research Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Shelby Mullin
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Martin J Downing
- Department of Psychology, Lehman College, City University of New York, Bronx, NY, United States
| | - Evelyn Jolene Olansky
- HIV Research Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States.,Social & Scientific Systems, Inc, DLH Holdings Company, Atlanta, GA, United States
| | - Sarah Wiatrek
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Erin Q Rogers
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.,Department of Systems, Population, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Eli Rosenberg
- Department of Epidemiology, School of Public Health, University at Albany, State University of New York, Albany, NY, United States
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Gordon Mansergh
- HIV Research Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
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15
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Newton AS, March S, Gehring ND, Rowe AK, Radomski AD. Establishing a Working Definition of User Experience for eHealth Interventions of Self-reported User Experience Measures With eHealth Researchers and Adolescents: Scoping Review. J Med Internet Res 2021; 23:e25012. [PMID: 34860671 PMCID: PMC8686463 DOI: 10.2196/25012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/27/2021] [Accepted: 09/23/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Across eHealth intervention studies involving children, adolescents, and their parents, researchers have measured user experience to assist with intervention development, refinement, and evaluation. To date, no widely accepted definitions or measures of user experience exist to support a standardized approach for evaluation and comparison within or across interventions. OBJECTIVE We conduct a scoping review with subsequent Delphi consultation to identify how user experience is defined and measured in eHealth research studies, characterize the measurement tools used, and establish working definitions for domains of user experience that could be used in future eHealth evaluations. METHODS We systematically searched electronic databases for published and gray literature available from January 1, 2005, to April 11, 2019. We included studies assessing an eHealth intervention that targeted any health condition and was designed for use by children, adolescents, and their parents. eHealth interventions needed to be web-, computer-, or mobile-based, mediated by the internet with some degree of interactivity. We required studies to report the measurement of user experience as first-person experiences, involving cognitive and behavioral factors reported by intervention users. We appraised the quality of user experience measures in included studies using published criteria: well-established, approaching well-established, promising, or not yet established. We conducted a descriptive analysis of how user experience was defined and measured in each study. Review findings subsequently informed the survey questions used in the Delphi consultations with eHealth researchers and adolescent users for how user experience should be defined and measured. RESULTS Of the 8634 articles screened for eligibility, 129 articles and 1 erratum were included in the review. A total of 30 eHealth researchers and 27 adolescents participated in the Delphi consultations. On the basis of the literature and consultations, we proposed working definitions for 6 main user experience domains: acceptability, satisfaction, credibility, usability, user-reported adherence, and perceived impact. Although most studies incorporated a study-specific measure, we identified 10 well-established measures to quantify 5 of the 6 domains of user experience (all except for self-reported adherence). Our adolescent and researcher participants ranked perceived impact as one of the most important domains of user experience and usability as one of the least important domains. Rankings between adolescents and researchers diverged for other domains. CONCLUSIONS Findings highlight the various ways in which user experience has been defined and measured across studies and what aspects are most valued by researchers and adolescent users. We propose incorporating the working definitions and available measures of user experience to support consistent evaluation and reporting of outcomes across studies. Future studies can refine the definitions and measurement of user experience, explore how user experience relates to other eHealth outcomes, and inform the design and use of human-centered eHealth interventions.
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Affiliation(s)
- Amanda S Newton
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Sonja March
- School of Psychology and Counselling, Centre for Health Research, University of Southern Queensland, Springfield Central, Australia
| | - Nicole D Gehring
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Arlen K Rowe
- School of Psychology and Counselling, Centre for Health Research, University of Southern Queensland, Springfield Central, Australia
| | - Ashley D Radomski
- Knowledge Institute for Child and Youth Mental Health and Addictions, Ottawa, ON, Canada.,CHEO (Children's Hospital of Eastern Ontario) Research Institute, Ottawa, ON, Canada
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16
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Rosengren AL, Lelutiu-Weinberger C, Woodhouse EW, Sandanapitchai P, Hightow-Weidman LB. A Scoping Review of HIV Pre-exposure Prophylaxis Stigma and Implications for Stigma-Reduction Interventions for Men and Transwomen Who Have Sex with Men. AIDS Behav 2021; 25:2054-2070. [PMID: 33389319 PMCID: PMC10539076 DOI: 10.1007/s10461-020-03135-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 12/31/2022]
Abstract
HIV remains a public health concern in the United States. Although pre-exposure prophylaxis (PrEP) can be expected to reduce HIV incidence, its uptake, adherence, and persistence remain limited, particularly among highest priority groups such as men who have sex with men and transwomen (MSMTW). Using a socioecological framework, we conducted a scoping review to examine PrEP-related stigma to inform future research, policy, and programmatic planning. Using the PRISMA extension for scoping reviews, we conducted database searches from August 2018 to April 2020 for articles addressing PrEP stigma. Studies were independently screened and coded by three authors, resulting in thematic categorization of several types of PrEP stigma on four socioecological levels. Of 557 references, a final sample of 23 studies was coded, 61% qualitative, and 87% focusing exclusively on MSMTW. Most instances of PrEP-related stigma occurred on the interpersonal level and included associations of PrEP with risk promotion, HIV-related stigma, and promiscuity. Other frequent themes across socioecological levels included provider distrust and discrimination, government and pharmaceutical industry distrust, internalized homonegativity, PrEP efficacy distrust, and anticipated homonegativity. Notably, PrEP was also framed positively as having physical and psychological benefits, and assuming responsibility for protecting one's community via PrEP awareness-raising. PrEP-related stigma persists, demanding interventions to modify its impact. Leveraging PrEP-positive discourses to challenge PrEP stigma is an emerging avenue, alongside efforts to increase provider willingness to promote PrEP routinely by reducing provider bias, aligning with the national strategy to End the HIV Epidemic.
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Affiliation(s)
- A Lina Rosengren
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA.
| | - Corina Lelutiu-Weinberger
- Rutgers Biomedical and Health Sciences, School of Nursing, François-Xavier Bagnoud Center, Rutgers University, 65 Bergen Street, Room 846N, Newark, NJ, 07107, USA
| | - E Wilbur Woodhouse
- Department of Medicine, Vanderbilt University Medical center, 1161 21st Avenue South, Nashville, TN, 37122, USA
| | | | - Lisa B Hightow-Weidman
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
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17
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Parker JN, Choi SK, Bauermeister JA, Bonar EE, Carrico AW, Stephenson R. HIV and STI testing among substance-using sexual and gender minority adolescents and young adults: Results from the baseline survey of a randomized control trial (Preprint). JMIR Public Health Surveill 2021; 8:e30944. [PMID: 35776441 PMCID: PMC9288102 DOI: 10.2196/30944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 03/01/2022] [Accepted: 05/10/2022] [Indexed: 12/28/2022] Open
Affiliation(s)
- Jayelin N Parker
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Seul Ki Choi
- Program for Sexuality, Technology, and Action Research, University of Pennsylvania, Philadelphia, PA, United States
| | - Jose A Bauermeister
- Program for Sexuality, Technology, and Action Research, University of Pennsylvania, Philadelphia, PA, United States
| | - Erin E Bonar
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Adam W Carrico
- School of Public Health, University of Miami, Miami, FL, United States
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, United States
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18
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Technology-Based Interventions to Increase Point-of-Care HIV Testing and Linkage to Care Among Youth in the US: A Systematic Review. AIDS Behav 2021; 25:1829-1838. [PMID: 33231846 PMCID: PMC7684145 DOI: 10.1007/s10461-020-03112-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 12/28/2022]
Abstract
HIV testing rates remain low among youth ages 13–24 in the US, with only 55% of HIV-positive youth aware of their serostatus. We conducted a systematic review to assess the utility of technology-based interventions to increase point-of-care youth HIV testing and linkage to care. We searched PubMed, Embase, CINAHL, and Cochrane CENTRAL for randomized controlled trials of technology-based interventions aimed at increasing point-of-care youth HIV testing, published between 2008 and 2020. All identified citations were independently screened for inclusion by two authors, and the Cochrane Risk of Bias Tool for Randomized Controlled Trials was used to assess the quality of included studies. Three studies met all inclusion criteria. Two interventions were effective in increasing HIV testing, while one was effective at linkage to care. Technology-based interventions have the potential to increase youth HIV testing in clinical settings and facilitate linkage to care, possibly reducing undiagnosed HIV among adolescents and emerging adults.
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19
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Threats M, Bond K. HIV Information Acquisition and Use Among Young Black Men Who Have Sex With Men Who Use the Internet: Mixed Methods Study. J Med Internet Res 2021; 23:e22986. [PMID: 33960953 PMCID: PMC8140385 DOI: 10.2196/22986] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/31/2020] [Accepted: 01/16/2021] [Indexed: 12/31/2022] Open
Abstract
Background HIV disproportionately affects young Black men who have sex with men (YBMSM) in the United States. eHealth holds potential for supporting linkage and engagement in HIV prevention and care and the delivery of HIV information to YBMSM. Objective This study aims to investigate HIV information acquisition and use among YBMSM who use the internet. Methods A web-based self-administered survey and semistructured interviews were conducted. The survey findings informed the development of the interview guide. Descriptive statistics were used to characterize the survey sample, and interview data were analyzed thematically using modified grounded theory methodologies. Results Among the internet sample (N=83), the average age was 29.2 (SD 3.5) years, 41% (n=34) of participants self-reported living with HIV, 43% (n=36) were HIV-negative, and 15% (n=13) were unsure of their HIV status. Most participants (n=79, 95%) acquired HIV information through the internet while using a mobile phone. Web-based HIV information was intentionally sought from consumer health information websites (n=31, 37%), government health information websites (n=25, 30%), and social media (n=14, 17%). Most men incidentally acquired HIV information via advertisements on social media sites and geospatial dating apps (n=54, 65%), posts on social media sites from their web-based social ties (n=44, 53%), and advertisements while browsing the internet (n=40, 48%). Although the internet is the top source of HIV information, health care providers were the most preferred (n=42, 50%) and trusted (n=80, 96%) source of HIV information. HIV information was used to facilitate the use of HIV prevention and care services. The qualitative sample included YBMSM across a range of ages and at different points of engagement in HIV prevention and care. Qualitative findings included the importance of the internet as a primary source of HIV information. The internet was used because of its ease of accessibility, because of its ability to maintain anonymity while searching for sensitive information, and to mitigate intersecting stigmas in health care settings. Participants used HIV information to assess their risk for HIV and AIDS, support their skill building for HIV prevention, inform patient–doctor communication, and learn about HIV prevention and treatment options. Men expressed concerns about their diminishing access to online spaces for HIV information exchange among YBMSM because of censorship policies on social media sites and the stigmatizing framing and tone of mass media HIV-prevention advertisements encountered while using the internet. Conclusions YBMSM in this sample had high utilization of eHealth for HIV information acquisition and use but diminished access to their preferred and most trusted source of HIV information: health care providers. Future eHealth-based HIV interventions culturally tailored for YBMSM should aim to reduce intersectional stigma at the point of care and support patient–provider communication. The findings demonstrate the need for community-informed, culturally tailored HIV messaging and online spaces for informational support exchange among YBMSM.
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Affiliation(s)
- Megan Threats
- School of Communication and Information, Rutgers University, New Brunswick, NJ, United States.,Yale School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, CT, United States
| | - Keosha Bond
- Yale School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, CT, United States.,Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, United States
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20
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Jackman KMP, Kane J, Kharrazi H, Johnson RM, Latkin C. Using the Patient Portal Sexual Health Instrument in Surveys and Patient Questionnaires Among Sexual Minority Men in the United States: Cross-sectional Psychometric Validation Study. J Med Internet Res 2021; 23:e18750. [PMID: 33565987 PMCID: PMC7935249 DOI: 10.2196/18750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/24/2020] [Accepted: 10/26/2020] [Indexed: 01/01/2023] Open
Abstract
Background Patient portal modules, including electronic personal health records, health education, and prescription refill ordering, may be leveraged to address the sexually transmitted infection (STI) burden, including HIV, among gay, bisexual, and other sexual minority men (SMM). Theoretical frameworks in the implementation sciences highlight examining constructs of innovation attributes and performance expectations as key determinants of behavioral intentions and the use of new web-based health technologies. However, behavioral intentions to use patient portals for HIV and other STI prevention and care among SMM is understudied. Objective The aim of this study is to develop a brief instrument for measuring attitudes focused on using patient portals for STI prevention and care among a nationwide sample of SMM. Methods A total of 12 items of the American Men’s Internet Survey-Patient Portal Sexual Health Instrument (AMIS-PPSHI) were adapted from a previous study. Psychometric analyses of the AMIS-PPSHI items were conducted among a randomized subset of 2018 AMIS participants reporting web-based access to their health records (N=1375). Parallel analysis and inspection of eigenvalues in a principal component analysis (PCA) informed factor retention in exploratory factor analysis (EFA). After EFA, Cronbach α was used to examine the internal consistency of the scale and its subscales. Confirmatory factor analysis (CFA) was used to assess the goodness of fit of the final factor structure. We calculated the total AMIS-PPSHI scale scores for comparisons within group categories, including age, STI diagnosis history, recency of testing, serious mental illness, and anticipated health care stigma. Results The AMIS-PPSHI scale resulting from EFA consisted of 12 items and had good internal consistency (α=.84). The EFA suggested 3 subscales: sexual health engagement and awareness (α=.87), enhancing dyadic communication (α=.87), and managing sexual health care (α=.79). CFA demonstrated good fit in the 3-factor PPSHI structure: root mean square error of approximation=0.061, comparative fit index=0.964, Tucker-Lewis index=0.953, and standardized root mean square residual=0.041. The most notable differences were lower scores on the enhanced dyadic communication subscale among people living with HIV. Conclusions PPSHI is a brief instrument with strong psychometric properties that may be adapted for use in large surveys and patient questionnaires in other settings. Scores demonstrate that patient portals are favorable web-based solutions to deliver health services focused on STI prevention and care among SMM in the United States. More attention is needed to address the privacy implications of interpersonal use of patient portals outside of traditional health settings among persons with HIV.
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Affiliation(s)
- Kevon-Mark P Jackman
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jeremy Kane
- Department of Epidemiology, Columbia University Mailman School of Public Health, NY, NY, United States
| | - Hadi Kharrazi
- Department of Health Policy and Management, Center for Population Health IT, Johns Hopkins Bloomberg School of Public Health, Batimore, MD, United States
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins Blooomberg School of Public Health, Baltimore, MD, United States
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21
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Fernandez MI, Harper GW, Hightow-Weidman LB, Kapogiannis BG, Mayer KH, Parsons JT, Rotheram-Borus MJ, Seña AC, Sullivan PS. Research Priorities to End the Adolescent HIV Epidemic in the United States: Viewpoint. JMIR Res Protoc 2021; 10:e22279. [PMID: 33393918 PMCID: PMC7813632 DOI: 10.2196/22279] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022] Open
Abstract
Youth represent 21% of new HIV diagnoses in the United States. Gay, bisexual, and transgender (GBT) youth, particularly those from communities of color, and youth who are homeless, incarcerated, in institutional settings, or engaging in transactional sex are most greatly impacted. Compared with adults, youth have lower levels of HIV serostatus awareness, uptake of antiretroviral therapy (ART), and adherence. Widespread availability of ART has revolutionized prevention and treatment for both youth at high risk for HIV acquisition and youth living with HIV, increasing the need to integrate behavioral interventions with biomedical strategies. The investigators of the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) completed a research prioritization process in 2019, focusing on research gaps to be addressed to effectively control HIV spread among American youth. The investigators prioritized research in the following areas: (1) innovative interventions for youth to increase screening, uptake, engagement, and retention in HIV prevention (eg, pre-exposure prophylaxis) and treatment services; (2) structural changes in health systems to facilitate routine delivery of HIV services; (3) biomedical strategies to increase ART impact, prevent HIV transmission, and cure HIV; (4) mobile technologies to reduce implementation costs and increase acceptability of HIV interventions; and (5) data-informed policies to reduce HIV-related disparities and increase support and services for GBT youth and youth living with HIV. ATN’s research priorities provide a roadmap for addressing the HIV epidemic among youth. To reach this goal, researchers, policy makers, and health care providers must work together to develop, test, and disseminate novel biobehavioral interventions for youth.
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Affiliation(s)
- M Isabel Fernandez
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Gary W Harper
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Lisa B Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Bill G Kapogiannis
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, United States
| | | | | | - Arlene C Seña
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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22
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Zlotorzynska M, Bauermeister JA, Golinkoff JM, Lin W, Sanchez TH, Hightow-Weidman L. Online recruitment of youth for mHealth studies. Mhealth 2021; 7:27. [PMID: 33898596 PMCID: PMC8063013 DOI: 10.21037/mhealth-20-64] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/12/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Social networking sites and apps have emerged as an opportunity to engage in research young men who have sex with men (YMSM) at risk of HIV infection who may not be otherwise reached by in-person recruitment efforts. This paper highlights lessons learned, best practices and on-going recruitment challenges in the iTech network of the NIH Adolescent Trials Network for HIV Interventions. METHODS Recruitment was conducted for four randomized controlled trials (RCTs) of mHealth HIV prevention interventions for YMSM living in 10 US cities. Advertising was purchased on Facebook, Instagram, Snapchat, Twitter and Grindr. Users who clicked on banner ads were taken directly to a study-specific eligibility screener and if eligible, were asked to provide contact information for follow-up by respective study site staff. Ad and screening metrics (impressions, clicks, cost per click (CPC), click-through rate (CTR), number screened, number eligible, number who provided contact information and cost per eligible contact) were compared across platforms, studies and geographic areas (where available). Screening metrics were also calculated for in-person recruitment efforts. RESULTS Grindr and Snapchat ads produced the highest CTRs as compared to Facebook ads. However, these ads had the lowest proportions of users who initiated eligibility screeners and ultimately Facebook ads yielded the lowest cost per eligible contact across studies. Instagram ads yielded the highest proportions of eligible contacts who were racial/ethnic minorities and under the age of 18. Geographic variability in cost per eligible contact was observed for studies with identical eligibility criteria running concurrently in different regions, driven by both advertising costs and the screening and eligibility rates. Despite lower eligibility rates, the total numbers of eligible contacts were higher for online advertising campaigns, as compared to other recruitment efforts, for all studies except P3. Ads recruiting for P3 had the highest cost per eligible contact, likely due to this study having the most stringent eligibility criteria of the studies described. CONCLUSIONS We implemented a successful online advertising strategy to recruit YMSM at high risk for HIV infection into four RCTs of mHealth interventions. This report provides a framework for evaluation of data from future online recruitment efforts across platforms and geographic areas, regardless of inevitable changes in the digital marketing space.
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Affiliation(s)
| | - José A Bauermeister
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, USA
| | - Jesse M Golinkoff
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, USA
| | - Willey Lin
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, USA
| | - Travis H Sanchez
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lisa Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC, USA
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23
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Sullivan PS, Hightow-Weidman L. Mobile apps for HIV prevention: how do they contribute to our epidemic response for adolescents and young adults? Mhealth 2021; 7:36. [PMID: 33898605 PMCID: PMC8063022 DOI: 10.21037/mhealth-20-71] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/05/2020] [Indexed: 11/06/2022] Open
Abstract
Mobile health (mHealth) tools to address the HIV epidemic have proliferated in recent years. Yet when applied to the United States (US) epidemic, which is driven by new HIV infections among men who have sex with men (MSM), it is not clear how mHealth tools fit in the overall portfolio of biobehavioral prevention interventions and clinical services proven to be efficacious. Adolescent and young adult MSM are particularly vulnerable and reducing HIV incidence among this priority population will require substantial levels of uptake of multiple prevention strategies (i.e., HIV testing, condom use, sexually transmitted infection (STI) testing, pre-exposure prophylaxis (PrEP), and treatment for those with HIV infection). Starting from the premise that adolescents are avid consumers of technology, this paper considers the particular strengths and opportunities of mHealth tools to address HIV prevention and provides examples of mHealth approaches that have been tested or are in development in these areas. Even after mHealth interventions are proven effective, there will be important intervening steps before such tools can be deployed and integrated into existing prevention programs given the diverse landscape of prevention service delivery. We anticipate some of the likely barriers to broad implementation of proven mHealth interventions in the context of the US public health funding and service delivery infrastructure and provide recommendations to increase efforts for future scale-up and dissemination.
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Affiliation(s)
- Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30329, USA
| | - Lisa Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
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24
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Hightow-Weidman LB, Horvath KJ, Scott H, Hill-Rorie J, Bauermeister JA. Engaging youth in mHealth: what works and how can we be sure? Mhealth 2021; 7:23. [PMID: 33898592 PMCID: PMC8063019 DOI: 10.21037/mhealth-20-48] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/12/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Youth participating in mobile health (mHealth) intervention trials often engage with the technologies [e.g., applications (app) or mobile-optimized websites] only partially, often prematurely discontinuing use altogether. Limited engagement can impact the interventions effect on behavior change and compromise researchers' ability to test and estimate the true efficacy of their interventions. While mHealth interventions have been shown to be feasible and acceptable to youth, across diverse health conditions, strategies to increase engagement have been less well studied. Specifically, within HIV prevention and care mHealth interventions, there is not consensus as to which components represent the "key ingredients" to support maximal engagement of youth. Further, successful intervention evaluation requires the ability to systematically track users' engagement with intervention components (i.e., paradata) to evaluate its effects on behavior change. METHODS As part of the Adolescent Medicine Trials Network UNC/Emory Center for Innovative Technology (iTech) portfolio of HIV/AIDS Interventions, we present diverse strategies used across five mHealth protocols seeking to promote youth engagement, track and measure engagement through paradata, and incorporate these components into mHealth intervention evaluations. RESULTS We describe the importance of defining and measuring engagement using case studies from iTech to illustrate how different research teams select mHealth features to promote youth engagement over time, taking into account features embedded in the technology design, key mechanisms of change and trial outcomes (e.g., HIV testing, pre-exposure prophylaxis uptake and adherence, HIV treatment adherence). Finally, we discuss how the research teams plan to evaluate engagement's role on their intervention's outcomes. CONCLUSIONS Based on this synthesis, we discuss strategies to enhance mHealth engagement during intervention development and design, ensure its monitoring and reporting throughout the trial, and evaluate its impact on trial outcomes.
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Affiliation(s)
- Lisa B. Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Keith J. Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Hyman Scott
- University of California, San Francisco, CA, USA
- Department of Public Health, Bridge HIV, San Francisco, CA, USA
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25
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Gilbey D, Morgan H, Lin A, Perry Y. Effectiveness, Acceptability, and Feasibility of Digital Health Interventions for LGBTIQ+ Young People: Systematic Review. J Med Internet Res 2020; 22:e20158. [PMID: 33270039 PMCID: PMC7746499 DOI: 10.2196/20158] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/30/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Young people (aged 12-25 years) with diverse sexuality, gender, or bodily characteristics, such as those who identify as lesbian, gay, bisexual, transgender, intersex, or queer (LGBTIQ+), are at substantially greater risk of a range of mental, physical, and sexual health difficulties compared with their peers. Digital health interventions have been identified as a potential way to reduce these health disparities. OBJECTIVE This review aims to summarize the characteristics of existing evidence-based digital health interventions for LGBTIQ+ young people and to describe the evidence for their effectiveness, acceptability, and feasibility. METHODS A systematic literature search was conducted using internet databases and gray literature sources, and the results were screened for inclusion. The included studies were synthesized qualitatively. RESULTS The search identified 38 studies of 24 unique interventions seeking to address mental, physical, or sexual health-related concerns in LGBTIQ+ young people. Substantially more evidence-based interventions existed for gay and bisexual men than for any other population group, and there were more interventions related to risk reduction of sexually transmitted infections than to any other health concern. There was some evidence for the effectiveness, feasibility, and acceptability of these interventions overall; however, the quality of evidence is often lacking. CONCLUSIONS There is sufficient evidence to suggest that targeted digital health interventions are an important focus for future research aimed at addressing health difficulties in LGBTIQ+ young people. Additional digital health interventions are needed for a wider range of health difficulties, particularly in terms of mental and physical health concerns, as well as more targeted interventions for same gender-attracted women, trans and gender-diverse people, and people with intersex variations. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020128164; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=128164.
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Affiliation(s)
- Dylan Gilbey
- Telethon Kids Institute, Perth, Australia.,School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Helen Morgan
- Telethon Kids Institute, Perth, Australia.,Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, Perth, Australia.,Centre for Child Health Research, The University of Western Australia, Perth, Australia
| | - Yael Perry
- Telethon Kids Institute, Perth, Australia.,Centre for Child Health Research, The University of Western Australia, Perth, Australia
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26
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Hightow-Weidman L, Muessig K, Claude K, Roberts J, Zlotorzynska M, Sanchez T. Maximizing Digital Interventions for Youth in the Midst of Covid-19: Lessons from the Adolescent Trials Network for HIV Interventions. AIDS Behav 2020; 24:2239-2243. [PMID: 32306214 PMCID: PMC7166094 DOI: 10.1007/s10461-020-02870-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Lisa Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA.
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA.
- Behavior and Technology Lab (BATLab), Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Kate Muessig
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Behavior and Technology Lab (BATLab), Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Kristina Claude
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Behavior and Technology Lab (BATLab), Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Jessica Roberts
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Behavior and Technology Lab (BATLab), Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | - Travis Sanchez
- Rollins School of Public Health, Emory University, Atlanta, USA
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27
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Harnessing digital data and data science to achieve 90-90-90 goals to end the HIV epidemic. Curr Opin HIV AIDS 2020; 14:481-485. [PMID: 31449089 DOI: 10.1097/coh.0000000000000584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Effective public health interventions depend on timely, accurate surveillance. Harnessing digital data (including internet searches, social media, and online media) and data science is an emerging approach to complement traditional surveillance in public health but has been underutilized in HIV prevention and treatment. RECENT FINDINGS We highlight recent examples that illustrate how social media data can be applied to HIV surveillance and prevention interventions. SUMMARY To achieve 90-90-90 goals to end the HIV epidemic, we encourage traditional public health researchers to partner with data scientists to supplement HIV surveillance programs with social media analytics to refine estimates of HIV infections and key populations at risk and to identify subgroups and regions where prevention and treatment efforts need to be bolstered. We also encourage interdisciplinary teams to design interventions to promote HIV prevention and linkage to care by leveraging digital media, such as search engines and social media, that have the potential to reach millions of people instantaneously.
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28
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Testing the Testers: Are Young Men Who Have Sex With Men Receiving Adequate HIV Testing and Counseling Services? J Acquir Immune Defic Syndr 2020; 82 Suppl 2:S133-S141. [PMID: 31658201 PMCID: PMC6820705 DOI: 10.1097/qai.0000000000002173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The United States Centers for Disease Control and Prevention promote HIV testing every 6 months among young men who have sex with men (YMSM) to facilitate entry into the HIV prevention and care continuum. Willingness to be tested may be influenced by testing services' quality. Using a novel mystery shopper methodology, we assessed YMSM's testing experiences in 3 cities and recommend service delivery improvements.
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29
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Horvath KJ, Lammert S, Danh T, Mitchell JW. The Feasibility, Acceptability and Preliminary Impact of Mobile Application to Increase Repeat HIV Testing Among Sexual Minority Men. AIDS Behav 2020; 24:1835-1850. [PMID: 31823111 DOI: 10.1007/s10461-019-02755-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We pilot tested the Status Update Project (SUP) mobile app intervention to promote repeat HIV testing among HIV-negative US MSM. Participants (Mean age = 29 years; 51% racial/ethnic minority; 63% single) who were eligible and enrolled were randomized to either the SUP mobile app or a no-treatment condition, with assessments at baseline and month 4 and 8. Eighty-three percent of men were retained at the 8-month follow up. Among men randomized to the SUP arm, the app's ease and simplicity, health information, HIV testing locator, and HIV test reminders were most liked. At month 4, men randomized to the SUP arm were more likely to be repeat testers compared to those in the control arm (RR = 4.4; 95% CI 0.9, 19.9), although differences diminished by month 8 (RR = 1.2; 95% CI 0.8, 2.0). These findings add to our understanding of how mHealth interventions may play an important role in encouraging repeat HIV testing among MSM.
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Affiliation(s)
- Keith J Horvath
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, Department of Psychology, San Diego State University, 6363 Alvarado Court, San Diego, CA, 92120, USA.
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
| | - Sara Lammert
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Thu Danh
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Jason W Mitchell
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI, USA
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30
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Gannon B, Davis R, Kuhns LM, Rodriguez RG, Garofalo R, Schnall R. A Mobile Sexual Health App on Empowerment, Education, and Prevention for Young Adult Men (MyPEEPS Mobile): Acceptability and Usability Evaluation. JMIR Form Res 2020; 4:e17901. [PMID: 32254043 PMCID: PMC7175191 DOI: 10.2196/17901] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/20/2020] [Accepted: 02/29/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND HIV incidence among young adult men who have sex with men (MSM), particularly among black and Latino men, continues to rise. As such, continued HIV prevention interventions for young MSM of color are of utmost importance. Male Youth Pursuing Empowerment, Education and Prevention around Sexuality (MyPEEPS) Mobile is a comprehensive HIV prevention and sexual health education smartphone app initially created to promote sexual health and HIV prevention among adolescent sexual minority young men aged 13 to 18 years. OBJECTIVE The objective of this study was to critically appraise the acceptability and usability of MyPEEPS Mobile for young adult MSM aged 19 to 25 years. METHODS Study participants used the mobile app, completed usability questionnaires and in-depth interviews, and reported their experience using the app. Analysis of interview data was guided by the Unified Theory of Acceptance and Use of Technology (UTAUT) to better understand the usability and acceptability of this intervention for young adults. Interview data were coded using the following constructs from the UTAUT model: performance expectancy, effort expectancy, and social influence. RESULTS A total of 20 young adult MSM (n=10 in Chicago, Illinois, and n=10 in New York, New York) were enrolled in the study. Participants reported that MyPEEPS Mobile was free of functional problems (Health Information Technology Usability Evaluation Scale scores and Post-Study System Usability Questionnaire scores consistent with high usability), easy to use, and useful, with an engaging approach that increased acceptability, including the use of avatars and animation, and inclusive representation of the diverse identities by race and ethnicity, gender identity, and sexual orientation. Recommended areas for improving MyPEEPS Mobile for the target demographic included more adult-oriented graphics, advanced educational content, scenarios for youth with more sexual experience, and search function to increase accessibility of key content. CONCLUSIONS Overall, young adult MSM aged 19 to 25 years described the MyPEEPS Mobile as educational, informative, and usable for their sexual health education and HIV prevention needs, and they provided actionable recommendations to optimize its use and applicability for this age group.
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Affiliation(s)
- Brittany Gannon
- School of Nursing, Columbia University, New York, NY, United States
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York City, NY, United States
| | - Rindcy Davis
- Gertrude H Sergievsky Center, Columbia University, New York, NY, United States
| | - Lisa M Kuhns
- Lurie Children's Hospital, Chicago, IL, United States
- Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IN, United States
| | | | - Robert Garofalo
- Lurie Children's Hospital, Chicago, IL, United States
- Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IN, United States
| | - Rebecca Schnall
- School of Nursing, Columbia University, New York, NY, United States
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Hightow-Weidman LB, Bauermeister JA. Engagement in mHealth behavioral interventions for HIV prevention and care: making sense of the metrics. Mhealth 2020; 6:7. [PMID: 32190618 PMCID: PMC7063263 DOI: 10.21037/mhealth.2019.10.01] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/12/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Engagement is the primary metric by which researchers can assess whether participants in a mHealth intervention used and interacted with the intervention's content as intended over a pre-specified period to result in behavior change. Paradata, defined as the process data documenting users' access, participation, and navigation through a mHealth intervention, have been associated with differential treatment outcomes in mHealth interventions. Within behavioral mHealth interventions, there has been an increase in the number of studies addressing the HIV prevention and care continuum in recent years, yet few have presented engagement metrics or examined how these data could inform design modifications, promote continued engagement, and supplement primary intervention efficacy and scale-up efforts. METHODS We review common paradata metrics in mHealth interventions (e.g., amount, frequency, duration and depth of use), using case studies from four technology-driven HIV interventions to illustrate their utility in evaluating mHealth behavioral interventions for HIV prevention and care. Across the four case studies, participants' ages ranged between 15 and 30 years and included a racially and ethnically diverse sample of youth. The four case studies had different approaches for engaging young men who have sex with men: a tailored brief intervention, an interactive modular program, a daily tool to monitor and self-regulate treatment adherence, and an online platform promoting social engagement and social support. Each focused on key outcomes across the HIV prevention and care continuum [e.g., safer sex behaviors, HIV testing, antiretroviral therapy (ART) adherence] and collected paradata metrics systematically. RESULTS Across the four interventions, paradata was utilized to identify patterns of use, create user profiles, and determine a minimum engagement threshold for future randomized trials based on initial pilot trial data. Evidence of treatment differences based on paradata analyses were also observed in between-arm and within-arm analyses, indicating that intervention exposure and dosage might influence the strength of the observed intervention effects. Paradata reflecting participants' engagement with intervention content was used to suggest modifications to intervention design and navigation, to understand what theoretically-driven content participants chose to engage with in an intervention, and to illustrate how engagement was linked to HIV-related outcomes. CONCLUSIONS Paradata monitoring and reporting can enhance the rigor of mHealth trials. Metrics of engagement must be systematically collected, analyzed and interpreted to meaningfully understand a mHealth intervention's efficacy. Future mHealth trials should work to identify suitable engagement metrics during intervention development, ensure their collection throughout the trial, and evaluate their impact on trial outcomes.
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Affiliation(s)
- Lisa B. Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Maloney KM, Bratcher A, Wilkerson R, Sullivan PS. Electronic and other new media technology interventions for HIV care and prevention: a systematic review. J Int AIDS Soc 2020; 23:e25439. [PMID: 31909896 PMCID: PMC6945883 DOI: 10.1002/jia2.25439] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 11/04/2019] [Accepted: 12/04/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Electronic and other new media technologies (eHealth) can facilitate large-scale dissemination of information and effective delivery of interventions for HIV care and prevention. There is a need to both monitor a rapidly changing pipeline of technology-based care and prevention methods and to assess whether the interventions are appropriately diversified. We systematically review and critically appraise the research pipeline of eHealth interventions for HIV care and prevention, including published studies and other funded projects. METHODS Two peer-reviewed literature databases were searched for studies describing the development, trial testing or implementation of new technology interventions, published from September 2014 to September 2018. The National Institutes of Health database of grants was searched for interventions still in development. Interventions were included if eHealth was utilized and an outcome directly related to HIV treatment or prevention was targeted. We summarized each intervention including the stage of development, eHealth mode of delivery, target population and stage of the HIV care and prevention continua targeted. RESULTS AND DISCUSSION Of 2178 articles in the published literature, 113 were included with 84 unique interventions described. The interventions utilize a variety of eHealth technologies and target various points on the prevention and care continua, with greater emphasis on education, behaviour change and testing than linkage to medical care. There were a variety of interventions for HIV care support but none for PrEP care. Most interventions were developed for populations in high income countries. An additional 62 interventions with funding were found in the development pipeline, with greater emphasis on managing HIV and PrEP care. CONCLUSIONS Our systematic review found a robust collection of eHealth interventions in the published literature as well as unpublished interventions still in development. In the published literature, there is an imbalance of interventions favouring education and behaviour change over linkage to care, retention in care, and adherence, especially for PrEP. The next generation of interventions already in the pipeline might address these neglected areas of care and prevention, but the development process is slow. Researchers need new methods for more efficient and expedited intervention development so that current and future needs are addressed.
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Affiliation(s)
| | - Anna Bratcher
- Department of EpidemiologyUniversity of CaliforniaLos AngelesCAUSA
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Bonett S, Connochie D, Golinkoff JM, Horvath KJ, Bauermeister JA. Paradata Analysis of an eHealth HIV Testing Intervention for Young Men Who Have Sex With Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:434-447. [PMID: 30332307 PMCID: PMC6449689 DOI: 10.1521/aeap.2018.30.5.434] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Little is known about users' intervention engagement and use patterns within eHealth interventions. We describe these patterns among young men who have sex with men (YMSM) who participated in a brief eHealth intervention designed to increase HIV testing. We merged pilot trial participants' survey data (N = 86) with their paradata (e.g., system data recorded during interaction with the intervention). We created engagement (time spent on components) and use (interaction with features) metrics, and explored whether they differed by participant characteristics. Racial/ethnic minorities clicked on fewer features (mean = 8.30) than non-Hispanic White men (mean = 12.00). Use was associated with older age (r = .19), greater educational attainment (r = .25), and a greater number of methods to connect online (r = .38). Paradata can help researchers understand how users interact with eHealth interventions, and inform which components to retain or redesign. Efforts to systematically collect, analyze, and report paradata in eHealth HIV prevention and care interventions are warranted.
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Affiliation(s)
- Stephen Bonett
- University of Pennsylvania, School of Nursing, Philadelphia, PA, United States
| | - Daniel Connochie
- University of Pennsylvania, School of Nursing, Philadelphia, PA, United States
| | - Jesse M Golinkoff
- University of Pennsylvania, School of Nursing, Philadelphia, PA, United States
| | - Keith J Horvath
- University of Minnesota, School of Public Health, Minneapolis, MN, United States
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