The acceptability and feasibility of a pilot study examining the impact of a mobile technology-based intervention informed by behavioral economics to improve HIV knowledge and testing frequency among Latinx sexual minority men and transgender women

Sarah MacCarthy, Alexandra Mendoza-Graf, Zachary Wagner, Joanna L Barreras, Alice Kim, Rebecca Giguere, Alex Carballo-Dieguez, Sebastian Linnemayr, Sarah MacCarthy, Alexandra Mendoza-Graf, Zachary Wagner, Joanna L Barreras, Alice Kim, Rebecca Giguere, Alex Carballo-Dieguez, Sebastian Linnemayr

Abstract

Background: We developed a novel intervention that uses behavioral economics incentives and mobile-health text messages to increase HIV knowledge and testing frequency among Latinx sexual minority men and Latinx transgender women. Here we provide a theoretically-grounded assessment regarding the intervention's acceptability and feasibility.

Methods: We conducted 30-min exit interviews with a stratified sample of participants (n = 26 Latinx sexual minority men, 15 Latinx transgender women), supplemented with insights from study staff (n = 6). All interviews were recorded, transcribed, and translated for a content analysis using Dedoose. Cohen's Kappa was 89.4% across coded excerpts. We evaluated acceptability based on how participants cognitively and emotionally reacted to the intervention and whether they considered it to be appropriate. We measured feasibility based on resource, scientific and process assessments (e.g., functionality of text messaging service, feedback on study recruitment procedures and surveys).

Results: Regarding acceptability, most participants clearly understood the intervention as a program to receive information about HIV prevention methods through text messages. Participants who did not complete the intervention shared they did not fully understand what it entailed at their initial enrollment, and thought it was a one-time engagement and not an ongoing program. Though some participants with a higher level of education felt the information was simplistic, most appreciated moving beyond a narrow focus on HIV to include general information on sexually transmitted infections; drug use and impaired sexual decision-making; and differential risks associated with sexual positions and practices. Latinx transgender women in particular appreciated receiving information about Pre-Exposure Prophylaxis. While participants didn't fully understand the exact chances of winning a prize in the quiz component, most enjoyed the quizzes and chance of winning a prize. Participants appreciated that the intervention required a minimal time investment. Participants shared that the intervention was generally culturally appropriate. Regarding feasibility, most participants reported the text message platform worked well though inactive participants consistently said technical difficulties led to their disengagement. Staff shared that clients had varying reactions to being approached while being tested for HIV, with some unwilling to enroll and others being very open and curious about the program. Both staff and participants relayed concerns regarding the length of the recruitment process and study surveys.

Conclusions: Our theoretically-grounded assessment shows the intervention is both acceptable and feasible.

Trial registration: The trial was registered on May 5, 2017 with the ClinicalTrials.gov registry [ NCT03144336 ].

Keywords: Acceptability; Behavioral economics; Feasibility; HIV prevention; Latinx; Sexual minority men; Transgender women.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Exit Interview Sampling. Figure provides a detailed breakdown of the sampling frame for the exit interviews

References

    1. CDC . CDC - Statistics Overview - Statistics Center - HIV/AIDS. 2013.
    1. Fauci AS, et al. Ending the HIV epidemic: a plan for the United States. JAMA. 2019;321(9):844–845. doi: 10.1001/jama.2019.1343.
    1. Division of HIV and STD Programs et al. Los Angeles County Five - Year Comprehensive HIV Plan (2013–2017) 2013.
    1. Division of HIV and STD Programs and Los Angeles County Department of Public Health . Transgender Population Estimates 2–12-13 pub (Read-Only) - Transgender Population Estimates 2–12-13 pub.pdf. 2013.
    1. CDC . HIV Continuum of Care, US, 2014 Overall by Age, Race/Ethnicity, Transmission Route and Sex. 2017.
    1. Li Z, et al. Vital signs: HIV transmission along the continuum of care—United States, 2016. MMWR Morb Mortal Wkly Rep. 2019;68(11):267. doi: 10.15585/mmwr.mm6811e1.
    1. CDC . Recommendations for HIV Screening of Gay, Bisexual, and Other Men who have Sex with Men - United States, 2017. 2017.
    1. Barreras J, Linnemayr S, MacCarthy S. “We have a stronger survival mode”: exploring knowledge gaps and culturally sensitive messaging of PrEP among Latino men who have sex with men and Latina transgender women in Los Angeles, CA. AIDS Care. 2019;31(10):1221–1227. doi: 10.1080/09540121.2019.1601669.
    1. Brown JL, Sales JM, DiClemente RJ. Combination HIV prevention interventions: the potential of integrated behavioral and biomedical approaches. Curr HIV/AIDS Rep. 2014;11(4):363–375. doi: 10.1007/s11904-014-0228-6.
    1. Galindo GR, et al. Community member perspectives from transgender women and men who have sex with men on pre-exposure prophylaxis as an HIV prevention strategy: implications for implementation. Implement Sci. 2012;7(1):116. doi: 10.1186/1748-5908-7-116.
    1. Mantell JE, et al. Knowledge and attitudes about preexposure prophylaxis (PrEP) among sexually active men who have sex with men and who participate in New York City Gay Pride events. LGBT Health. 2014;1(2):93–97. doi: 10.1089/lgbt.2013.0047.
    1. Krakower DS, et al. Limited awareness and low immediate uptake of pre-exposure prophylaxis among men who have sex with men using an internet social networking site. PLoS One. 2012;7(3):e33119. doi: 10.1371/journal.pone.0033119.
    1. Bauermeister JA, et al. PrEP awareness and perceived barriers among single young men who have sex with men in the United States. Curr HIV Res. 2013;11(7):520. doi: 10.2174/1570162X12666140129100411.
    1. Jaiswal J, et al. Structural barriers to pre-exposure prophylaxis use among young sexual minority men: The P18 Cohort Study. Curr HIV Res. 2018;16(3):237–249. doi: 10.2174/1570162X16666180730144455.
    1. Lelutiu-Weinberger C, Golub SA. Enhancing PrEP access for Black and Latino men who have sex with men. J Acquir Immune Defic Syndr. 2016;73(5):547. doi: 10.1097/QAI.0000000000001140.
    1. Brooks R, et al. Experiences of anticipated and enacted Pre-Exposure Prophylaxis (PrEP) stigma among Latino MSM in Los Angeles. AIDS Behav. 2019;23(7):1964–1973. doi: 10.1007/s10461-019-02397-9.
    1. Brooks RA, et al. Persistent stigmatizing and negative perceptions of pre-exposure prophylaxis (PrEP) users: implications for PrEP adoption among Latino men who have sex with men. AIDS Care. 2019;31(4):427–435. doi: 10.1080/09540121.2018.1499864.
    1. Pew Research Center . ICE arrests went up in 2017, with biggest increases in Florida, northern Texas, Oklahoma. 2018.
    1. Ortega AN, et al. Health care access, use of services, and experiences among undocumented Mexicans and other Latinos. Arch Int Med. 2007;167(21):2354–2360. doi: 10.1001/archinte.167.21.2354.
    1. Lim MSC, et al. SMS STI: a review of the uses of mobile phone text messaging in sexual health. Int J STD AIDS. 2008;19:287. doi: 10.1258/ijsa.2007.007264.
    1. Sun CJ, et al. Acceptability and feasibility of using established geosocial and sexual networking mobile applications to promote HIV and STD testing among men who have sex with men. AIDS Behav. 2015;19(3):543–552. doi: 10.1007/s10461-014-0942-5.
    1. Newell A. A mobile phone text message and Trichomonas vaginalis. Sex Transm Infect. 2001;77:225. doi: 10.1136/sti.77.3.225.
    1. Gabarron E, et al. Mobile phone applications for the care and prevention of HIV and other sexually transmitted diseases: a review. J Med Internet Res. 2013;15:e1. doi: 10.2196/jmir.2301.
    1. Sullivan PS, Grey JA, Rosser BRS. Emerging technologies for HIV prevention for MSM: What we’ve learned, and ways forward. J Acquir Immune Defic Syndr. 2013;63(0 1):S102–S107. doi: 10.1097/QAI.0b013e3182949e85.
    1. Dhar J, Leggat C, Bonas S. Texting – a revolution in sexual health communication. Int J STD AIDS. 2006;17:375. doi: 10.1258/095646206777323463.
    1. Druce KL, Dixon WG, McBeth J. Maximizing engagement in mobile health studies: lessons learned and future directions. Rheum Dis Clin North Am. 2019;45(2):159–172. doi: 10.1016/j.rdc.2019.01.004.
    1. CDC Prevalence and awareness of HIV infection among men who have sex with men--21 cities, United States, 2008. MMWR Morb Mortal Wkly Rep. 2010;59(37):1201–1207.
    1. Pop-Eleches C, et al. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS. 2011;25(6):825–834. doi: 10.1097/QAD.0b013e32834380c1.
    1. Free C, et al. Txt2stop: a pilot randomised controlled trial of mobile phone-based smoking cessation support. Tob Control. 2009;18(2):88–91. doi: 10.1136/tc.2008.026146.
    1. Bramley D, et al. Smoking cessation using mobile phone text messaging is as effective in Maori as non-Maori. N Z Med J. 2005;118(1216):U1494.
    1. Linnemayr S, et al. Behavioral economics-based incentives supported by mobile technology on HIV knowledge and testing frequency among Latino/a men who have sex with men and transgender women: Protocol for a randomized pilot study to test intervention feasibility and acceptability. Trials. 2018;19(1):540. doi: 10.1186/s13063-018-2867-1.
    1. Linnemayr S, et al. Using behavioral economics to promote HIV prevention for key populations. J AIDS Clin Res. 2018;9(11):780. doi: 10.4172/2155-6113.1000780.
    1. MacCarthy S, et al. Strategies for improving mobile-technology-based HIV prevention interventions with Latino men who have sex with men and Latina transgender women. AIDS Educ Prev. 2019;31(5):407–420. doi: 10.1521/aeap.2019.31.5.407.
    1. Maccarthy S, et al. Using behavioral economics to increase HIV knowledge and testing among Latinx sexual minority men and transgender women: A quasi-experimental pilot study. JAIDS J Acquir Immune Defic Syndr. 2020;85:189. doi: 10.1097/QAI.0000000000002433.
    1. Centers for Disease Control and Prevention. Pre-Exposure Prophylaxis (PrEP). 2020 May 13, 2020 [cited 2020 October 9, 2020]; Available from: .
    1. Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017;17(1):88. doi: 10.1186/s12913-017-2031-8.
    1. Tickle-Degnen L. Nuts and bolts of conducting feasibility studies. Am J Occup Ther. 2013;67(2):171–176. doi: 10.5014/ajot.2013.006270.
    1. Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–1288. doi: 10.1177/1049732305276687.
    1. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Measurement. 1960;20(1):37–46. doi: 10.1177/001316446002000104.
    1. Brown BJ, Sugarman J. Why ethics guidance needs to be updated for contemporary HIV prevention research. J Int AIDS Soc. 2020;23(5):e25500. doi: 10.1002/jia2.25500.
    1. Blankenship KM, et al. Structural interventions: concepts, challenges and opportunities for research. J Urban Health. 2006;83(1):59–72. doi: 10.1007/s11524-005-9007-4.
    1. Truong M, Paradies Y, Priest N. Interventions to improve cultural competency in healthcare: a systematic review of reviews. BMC Health Serv Res. 2014;14(1):99. doi: 10.1186/1472-6963-14-99.
    1. Butler M, et al. Improving cultural competence to reduce health disparities. 2016.
    1. Agency for Healthcare Research and Quality, Evidence-based Practice Center Systematic Review Protocol: Improving Cultural Competence to Reduce Health Disparities for Priority Populations 2014, AHRQ. .
    1. Hashemian TS, Kritz-Silverstein D, Baker R. T ext2 F loss: the feasibility and acceptability of a text messaging intervention to improve oral health behavior and knowledge. J Public Health Dentistry. 2015;75(1):34–41. doi: 10.1111/jphd.12068.
    1. MacCarthy S, et al. A randomized controlled trial study of the acceptability, feasibility, and preliminary impact of SITA (SMS as an Incentive To Adhere): a mobile technology-based intervention informed by behavioral economics to improve ART adherence among youth in Uganda. BMC Infect Dis. 2020;20(1):1–10. doi: 10.1186/s12879-020-4896-0.
    1. Le D, et al. Feasibility and acceptability of SMS text messaging in a prostate cancer educational intervention for African American men. Health Informatics J. 2016;22(4):932–947. doi: 10.1177/1460458215598636.
    1. Reback CJ, et al. Text messaging reduces HIV risk behaviors among methamphetamine-using men who have sex with men. AIDS Behav. 2012;16(7):1993–2002. doi: 10.1007/s10461-012-0200-7.
    1. Senn TE, et al. Development and preliminary pilot testing of a peer support text messaging intervention for HIV-infected black men who have sex with men. J Acquir Immune Defic Syndr (1999) 2017;74(Suppl 2):S121. doi: 10.1097/QAI.0000000000001241.
    1. Ober AJ, et al. An organizational readiness intervention and randomized controlled trial to test strategies for implementing substance use disorder treatment into primary care: SUMMIT study protocol. Implementation Sci. 2015;10(1):66. doi: 10.1186/s13012-015-0256-7.
    1. Ober AJ, et al. Assessing and improving organizational readiness to implement substance use disorder treatment in primary care: findings from the SUMMIT study. BMC Family Pract. 2017;18(1):107. doi: 10.1186/s12875-017-0673-6.
    1. Aarons GA. Mental health provider attitudes toward adoption of evidence-based practice: The Evidence-Based Practice Attitude Scale (EBPAS) Mental Health Serv Res. 2004;6(2):61–74. doi: 10.1023/B:MHSR.0000024351.12294.65.
    1. Weiner BJ, Amick H, Lee S-YD. Conceptualization and measurement of organizational readiness for change: a review of the literature in health services research and other fields. Med Care Res Rev. 2008;65(4):379–436. doi: 10.1177/1077558708317802.
    1. Fernandez ME, et al. Developing measures to assess constructs from the inner setting domain of the consolidated framework for implementation research. Implementation Sci. 2018;13(1):52. doi: 10.1186/s13012-018-0736-7.

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