Abstract
Background: Adolescent men who have sex with men (AMSM), aged 13 to 18 years, account for more than 80% of teen HIV occurrences. Despite this disproportionate burden, there is a conspicuous lack of evidence-based HIV prevention programs. Implementation issues are critical as traditional HIV prevention delivery channels (eg, community-based organizations, schools) have significant access limitations for AMSM. As such, eHealth interventions, such as our proposed SMART program, represent an excellent modality for delivering AMSM-specific intervention material where youth are. Objective: This randomized trial aimed to test the effectiveness of the SMART program in reducing condom-less anal sex and increasing condom self-efficacy, condom use intentions, and HIV testing for AMSM. We also plan to test whether SMART has differential effectiveness across important subgroups of AMSM based on race and ethnicity, urban versus rural residence, age, socioeconomic status, and participation in an English versus a Spanish version of SMART. Methods: Using a sequential multiple assignment randomized trial design, we will evaluate the impact of a stepped-care package of increasingly intensive eHealth interventions (ie, the universal, information-based SMART Sex Ed; the more intensive, selective SMART Squad; and a higher cost, indicated SMART Sessions). All intervention content is available in English and Spanish. Participants are recruited primarily from social media sources using paid and unpaid advertisements. Results: The trial has enrolled 1285 AMSM aged 13 to 18 years, with a target enrollment of 1878. Recruitment concluded in June 2020. Participants were recruited from 49 US states as well as Puerto Rico and the District of Columbia. Assessments of intervention outcomes at 3, 6, 9, and 12 months are ongoing. Conclusions: SMART is the first web-based program for AMSM to take a stepped-care approach to sexual education and HIV prevention. This design indicates that SMART delivers resources to all adolescents, but more costly treatments (eg, video chat counseling in SMART Sessions) are conserved for individuals who need them the most.
| Original language | English (US) |
|---|---|
| Article number | e19701 |
| Journal | JMIR Research Protocols |
| Volume | 9 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 2020 |
Funding
This work was supported by a grant from the National Institute on Minority Health and Health Disparities (U01MD011281; principal investigator: BM). REDCap is supported at the Feinberg School of Medicine by the Northwestern University Clinical and Translational Science Institute, which is supported by a grant from the NIH’s National Center for Advancing Translational Sciences (UL1TR001422; principal investigator: D Lloyd-Jones). The sponsor had no involvement in conducting the research or preparing of the paper for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The authors would like to thank the study staff for their contributions, including (to-date) Andres Carrion, Melissa Mongrella, Erin Dominici, Luis Morales, Leishla Pérez-Cardona, Yamari Lewis, Kai Korpak, Andrés Alvarado Avila, Manuel Hurtado, Jr, Allie Chinander, Rana Saber, and the entire Research Application Design and Development team. The authors would like to thank all the staff across the other SMART study sites: University of Puerto Rico, Hunter College of the City University of New York, North Carolina State University, and the University of Hawai’i at Hilo for their hard work. Finally, the authors would like to thank the SMART Youth Advisory Council and the study participants for their time.
Keywords
- Adolescents
- EHealth
- HIV prevention
- Implementation science
- Men who have sex with men
- Mobile phone
ASJC Scopus subject areas
- General Medicine
