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

Project Summary

Adolescent sexual minority males, transgender girls, and gender diverse teens (ASMM/TGD; ages 13-18) are

disproportionately affected by HIV, accounting for 79% of new infections among this age group. Although CDC

and USPTF recommend HIV screening among teens, testing rates among ASMM/TGD are very low (1 in 4

ASMM; 3x more likely to report being tested for HIV at follow-up versus those in the

control arm, even though only a minority of messages focused on testing. We propose to update G2G with the

latest HIV prevention and testing science, make content inclusive of TGD, and test its effectiveness on the

outcome of validated HIV testing (e.g., photo of test result). Moreover, widespread adoption of digital HIV

prevention programs has lagged due to lack of attention to implementation throughout software development,

intervention design, and testing. For instance, who should implement digital HIV prevention/testing interventions

for teens (e.g., direct-to-consumer, clinics) remains an open question, and involving potential implementers in

the development process can ensure intervention success; best practices for updating content and technology

for digital HIV prevention/testing programs to prevent their obsolescence are lacking; and there is a lack of

consensus on how best to reach SGM adolescents for such programs. We propose a Hybrid Type 1 trial that will

establish G2G effectiveness and identify best practices for implementing digital HIV prevention/testing for teens

via three specific aims. In Aim 1 we will collaborate with a youth advisory council to add content reflecting our

increased emphasis on HIV testing and update gender inclusivity and cultural relevance of existing content. With

prospective implementers’ input, we will also modernize the G2G software platform with an eye toward

implementation. In Aim 2 we will test G2G effectiveness on HIV testing in a nationwide randomized controlled

trial with 360 ASMM/TGD aged 13-18. Finally, Aim 3 will convene a experts in ASMM/TGD youth research and

service provision to identify and achieve consensus in processes of, requirements for, and barriers/facilitators to

reaching and engaging ASMM/TGD for HIV testing/prevention. The goal of Aim 3 is to inform, develop, and

disseminate concrete tools to ensure HIV prevention programs reach ASMM/TGD. The panel will also

recommend potential implementation models and adaptations needed to scale up G2G in real world settings.