Special Projects of National Significance Social Media Initiative: Improving Health Outcomes Along the HIV Care Continuum in Youth and Young Adults Living With HIV

BACKGROUND In the United States, disparities in the rates of HIV care among youth and young adults result from the intersections of factors that include stigma, substance use, homelessness or marginal housing, institutional neglect, and mental health issues. Novel interventions are needed that are geared to youth and young adults. OBJECTIVE In this paper, we aim to describe the interventions used by participating sites for Using Social Media initiative, the process for classifying the intervention components, and the methods for conducting a comprehensive evaluation of the interventions. METHODS In 2015, the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau, Special Projects of National Significance (SPNS) funded the Evaluation and Technical Assistance Center (ETAC) at the University of California, Los Angeles and 10 demonstration projects at sites across the United States that incorporated innovative approaches using a variety of social media and mobile technology strategies designed specifically for youth and young adults living with HIV. The ETAC developed a typology, or a classification system, that systematically summarizes the principal components of the interventions into broader groups and developed a multisite, mixed-methods approach to evaluate them based on the Department of Health and Human Services HIV health outcomes along the HIV care continuum. The mixed-methods approach is key to remove potential biases in assessing the effectiveness of demonstration projects. RESULTS This SPNS project was funded in September 2015, and enrollment was completed on May 31, 2018. A total of 984 participants have been enrolled in the multisite evaluation. Data collection will continue until August 2019. However, data analysis is currently underway, and the first results are expected to be submitted for publication in 2019. CONCLUSIONS This HRSA-funded initiative seeks to increase engagement in HIV medical care, improve health outcomes for people living with HIV, and reduce HIV-related health disparities and health inequities that affect HIV-positive youth and young adults. INTERNATIONAL REGISTERED REPORT RR1-10.2196/10681

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Text Messaging to Improve Linkage, Retention, and Health Outcomes among HIV-positive Young Transgender Women: Protocol for a Randomized Controlled Trial (Text Me, Girl!) (Preprint)

10.2196/preprints.12837 ◽

2018 ◽

Author(s):

Cathy J. Reback ◽

Jesse B. Fletcher ◽

Anne E. Fehrenbacher ◽

Kimberly Kisler

Keyword(s):

Health Outcomes ◽

Text Messaging ◽

Text Message ◽

Transgender Women ◽

Hiv Care ◽

Hiv Care Continuum ◽

Care Continuum ◽

Intervention Delivery ◽

Trans Women ◽

Living With Hiv

BACKGROUND Many transgender women in the U.S. experience numerous cofactors for HIV acquisition and transmission, including increased rates of homelessness, alcohol and drug use, high rates of sex work, as well as non-prescribed hormone injections and/or medically unsupervised soft-tissue filler injections, HIV risk factors specific to this population. In addition, trans women face discrimination and social/economic marginalization more intense and deleterious than that experienced by lesbian, gay, or bisexual individuals, further worsening health outcomes. Although little research has been done specifically on young trans women under the age of 35 years old, existing evidence suggests even further elevated rates of homelessness, substance use, and engagement in HIV transmission risk behaviors relative to their older trans women and non-trans young adult counterparts. Young trans women living with HIV experience a range of barriers that challenge their ability to be successfully linked and retained in HIV care. OBJECTIVE Text Me, Girl! was a randomized controlled trial to assess the impact of a 90-day, theory-based, transgender-specific, text-messaging intervention designed to improve HIV-related health outcomes along the HIV Care Continuum among young (18 to 34 years) transgender women (N=130) living with HIV/AIDS. METHODS Participants were randomized into either Group A) Immediate Text Message Intervention Delivery (ID: n=61); or, Group B) Delayed Text Message Intervention Delivery (DD: n=69) whereby participants were delivered the text-messaging intervention after a 90-day delay period. Over the course of the 90-day intervention, participants received 270 theory-based text messages that were targeted, tailored, and personalized specifically for young transgender women living with HIV. Participants received three messages per day in real-time within a 10-hour gradual and automated delivery system. The text-message content was scripted along the HIV Care Continuum and based on Social Support Theory, Social Cognitive Theory, and Health Belief Model. The desired outcome of Text Me, Girl! was virological suppression. RESULTS Recruitment began on November 18, 2016 and the first participant was enrolled on December 16, 2016; enrollment closed on May 31, 2018. Intervention delivery ended on November 30, 2018, and follow-up evaluations concluded on August 31, 2019. Primary outcome analyses began immediately following the conclusion of the follow-up evaluations. CONCLUSIONS Text messaging is the ideal communication platform for engaging young trans women in HIV care because it is easily accessible, private, portable, and inexpensive. Text Me, Girl! aimed to improve HIV Care Continuum outcomes among young trans women by providing culturally responsive text messages to promote linkage, retention, and adherence with the ultimate goal of achieving viral suppression. The Text Me, Girl! text message library is readily scalable and can be adapted for other hard-to-reach populations.

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Effects of a Peer-Led Intervention on HIV Care Continuum Outcomes Among Contacts of Children, Adolescents, and Young Adults Living With HIV in Zimbabwe

Global Health Science and Practice ◽

10.9745/ghsp-d-19-00210 ◽

2019 ◽

Vol 7 (4) ◽

pp. 575-584 ◽

Cited By ~ 1

Author(s):

Talent Tapera ◽

Nicola Willis ◽

Kudakwashe Madzeke ◽

Tanyaradzwa Napei ◽

Mather Mawodzeke ◽

...

Keyword(s):

Young Adults ◽

Adolescents And Young Adults ◽

Hiv Care ◽

Hiv Care Continuum ◽

Care Continuum ◽

Living With Hiv

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Qualitative Evaluation of Social Media and Mobile Technology Interventions Designed to Improve HIV Health Outcomes for Youth and Young Adults Living With HIV: A HRSA SPNS Initiative

Health Promotion Practice ◽

10.1177/1524839920938704 ◽

2020 ◽

Vol 21 (5) ◽

pp. 693-704

Author(s):

Ronald A. Brooks ◽

Omar Nieto ◽

Dallas Swendeman ◽

Janet Myers ◽

Ricardo Mendoza Lepe ◽

...

Keyword(s):

Social Media ◽

Young Adults ◽

Mobile Technology ◽

Viral Suppression ◽

Medical Information ◽

Qualitative Evaluation ◽

The United States ◽

Hiv Care ◽

Youth And Young Adults ◽

Living With Hiv

Youth and young adults living with HIV (YYALH) are less likely to be engaged in HIV care, adhere to their medications, and achieve viral suppression compared to older adult populations. In the United States, the majority of YYALH belong to racial/ethnic, sexual, and gender minority groups. HIV care interventions are needed that specifically target YYALH and that exploit the use of social media and mobile technology (SMMT) platforms, where youth and young adults have a ubiquitous presence. We conducted a qualitative evaluation of SMMT interventions included in a Health Resources and Services Administration Special Projects of National Significance initiative designed to improve medical care engagement, retention, and medication adherence to achieve viral suppression among YYALH. However, in this study, only young adults living with HIV (YALH) ages 18 to 34 years participated. A total of 48 YALH were interviewed. The data were analyzed using thematic analysis and revealed three main themes supporting the usefulness of the SMMT interventions, which included (1) acceptability of SMMT interventions in managing HIV care with subthemes of medical information accessibility, reminders, and self-efficacy; (2) feelings of support and personal connection afforded by SMMT interventions; and (3) SMMT interventions help to alleviate negative feelings about status and mitigate HIV-related stigma. A few participants identified problems with using their respective intervention, primarily related to the functionality of the technologies. Overall, findings from our qualitative evaluation suggest that SMMT-based interventions have the potential to increase engagement and retention in care, support YALH in adhering to medication, and help them adjust to their diagnosis.

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Text Messaging to Improve Linkage, Retention, and Health Outcomes Among HIV-Positive Young Transgender Women: Protocol for a Randomized Controlled Trial (Text Me, Girl!)

JMIR Research Protocols ◽

10.2196/12837 ◽

2019 ◽

Vol 8 (7) ◽

pp. e12837 ◽

Cited By ~ 2

Author(s):

Cathy J Reback ◽

Jesse B Fletcher ◽

Anne E Fehrenbacher ◽

Kimberly Kisler

Keyword(s):

Health Outcomes ◽

Text Messaging ◽

Text Message ◽

Transgender Women ◽

Text Messages ◽

Hiv Care ◽

Hiv Care Continuum ◽

Care Continuum ◽

Intervention Delivery ◽

Living With Hiv

Background Transgender women in the United States experience numerous risk factors for HIV acquisition and transmission, including increased rates of homelessness, alcohol and drug use, sex work, and nonprescribed hormone and soft tissue–filler injections. In addition, transgender women face discrimination and social/economic marginalization more intense and deleterious than that experienced by lesbian, gay, or bisexual individuals, further worsening health outcomes. Although little research has been done specifically with young transgender women aged 35 years and younger, existing evidence suggests even further elevated rates of homelessness, substance use, and engagement in HIV transmission risk behaviors relative to their older transgender women and nontransgender young adult counterparts. Young transgender women living with HIV experience a range of barriers that challenge their ability to be successfully linked and retained in HIV care. Objective The aim of this randomized controlled trial, Text Me, Girl!, is to assess the impact of a 90-day, theory-based, transgender-specific, text-messaging intervention designed to improve HIV-related health outcomes along the HIV care continuum among young (aged 18-34 years) transgender women (N=130) living with HIV/AIDS. Methods Participants were randomized into either Group A (immediate text message intervention delivery; n=61) or Group B (delayed text message intervention delivery whereby participants were delivered the text-messaging intervention after a 90-day delay period; n=69). Over the course of the 90-day intervention, participants received 270 theory-based text messages that were targeted, tailored, and personalized specifically for young transgender women living with HIV. Participants received 3 messages per day in real time within a 10-hour gradual and automated delivery system. The text-message content was scripted along the HIV care continuum and based on social support theory, social cognitive theory, and health belief model. The desired outcome of Text Me, Girl! was virological suppression. Results Recruitment began on November 18, 2016, and the first participant was enrolled on December 16, 2016; enrollment closed on May 31, 2018. Intervention delivery ended on November 30, 2018, and follow-up evaluations will conclude on August 31, 2019. Primary outcome analyses will begin immediately following the conclusion of the follow-up evaluations. Conclusions Text messaging is a communication platform well suited for engaging young transgender women in HIV care because it is easily accessible and widely used, as well as private, portable, and inexpensive. Text Me, Girl! aimed to improve HIV care continuum outcomes among young transgender women by providing culturally responsive text messages to promote linkage, retention, and adherence, with the ultimate goal of achieving viral suppression. The Text Me, Girl! text message library is readily scalable and can be adapted for other hard-to-reach populations. International Registered Report Identifier (IRRID) DERR1-10.2196/12837

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Authorship Correction: Promising Approaches for Engaging Youth and Young Adults Living with HIV in HIV Primary Care Using Social Media and Mobile Technology Interventions: Protocol for the SPNS Social Media Initiative (Preprint)

10.2196/preprints.15660 ◽

2019 ◽

Author(s):

Melissa Medich ◽

Dallas T Swendeman ◽

W Scott Comulada ◽

Uyen H Kao ◽

Janet J Myers ◽

...

Keyword(s):

Primary Care ◽

Social Media ◽

Young Adults ◽

Mobile Technology ◽

Hiv Primary Care ◽

Youth And Young Adults ◽

Living With Hiv

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Influence of Material Deprivation on Clinical Outcomes Among People Living with HIV in High-Income Countries: A Systematic Review and Meta-analysis

AIDS and Behavior ◽

10.1007/s10461-021-03551-y ◽

2021 ◽

Author(s):

Vasiliki Papageorgiou ◽

Bethan Davies ◽

Emily Cooper ◽

Ariana Singer ◽

Helen Ward

Keyword(s):

Systematic Review ◽

Social Determinants ◽

Meta Analysis ◽

Hiv Treatment ◽

Material Deprivation ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Care Continuum ◽

Care Continuum ◽

Living With Hiv

AbstractDespite developments in HIV treatment and care, disparities persist with some not fully benefiting from improvements in the HIV care continuum. We conducted a systematic review to explore associations between social determinants and HIV treatment outcomes (viral suppression and treatment adherence) in high-income countries. A random effects meta-analysis was performed where there were consistent measurements of exposures. We identified 83 observational studies eligible for inclusion. Social determinants linked to material deprivation were identified as education, employment, food security, housing, income, poverty/deprivation, socioeconomic status/position, and social class; however, their measurement and definition varied across studies. Our review suggests a social gradient of health persists in the HIV care continuum; people living with HIV who reported material deprivation were less likely to be virologically suppressed or adherent to antiretrovirals. Future research should use an ecosocial approach to explore these interactions across the lifecourse to help propose a causal pathway.

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Motivational Interviewing and the Adolescent/Young Adult HIV Care Continuum

Motivational Interviewing in HIV Care ◽

10.1093/med/9780190619954.003.0005 ◽

2019 ◽

pp. 37-46

Author(s):

Sylvie Naar ◽

Maurice Bulls

Keyword(s):

Young Adult ◽

Motivational Interviewing ◽

Behavioral Therapy ◽

Hiv Care ◽

Behavior Changes ◽

Hiv Care Continuum ◽

Care Continuum ◽

Future Direction ◽

Youth Living With Hiv ◽

Living With Hiv

This chapter explores the HIV care continuum specifically with youth living with HIV (YLH). The authors review relevant HIV statistics, including the trends in YLH. The authors then examine the fit of motivational interviewing (MI) with adolescent development, arguing that it is an excellent strategy to include in promoting self-management of HIV. Multiple examples are also provided for programs and interventions using MI with youth. This chapter provides specific details on how MI can be leveraged in working with YLH, although many of these insights can generalize to adult populations. In the final section, the authors examine the future direction of MI in the care of YLH. They argue that once MI has helped to motivate YLH toward change, the substitution for or addition of cognitive-behavioral therapy (CBT) may be warranted. In this way, the more action-oriented strategies of CBT strengthen the behavior changes that MI has helped to put in motion.

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