Efficacy of MyPEEPS Mobile, an HIV Prevention Intervention Using Mobile Technology, on Reducing Sexual Risk Among Same-Sex Attracted Adolescent Males: A Randomized Clinical Trial

Rebecca Schnall, Lisa M Kuhns, Cynthia Pearson, D Scott Batey, Josh Bruce, Marco A Hidalgo, Sabina Hirshfield, Patrick Janulis, Haomiao Jia, Asa Radix, Uri Belkind, Rafael Garibay Rodriguez, Robert Garofalo, Rebecca Schnall, Lisa M Kuhns, Cynthia Pearson, D Scott Batey, Josh Bruce, Marco A Hidalgo, Sabina Hirshfield, Patrick Janulis, Haomiao Jia, Asa Radix, Uri Belkind, Rafael Garibay Rodriguez, Robert Garofalo

Abstract

Importance: HIV transmission rates in the United States have increased among men who have sex with men. However, there are no published randomized trials examining interventions to reduce sexual risk for HIV acquisition in males younger than 18 years.

Objective: To determine the efficacy of MyPEEPS Mobile, a mobile-delivered HIV prevention intervention, to reduce sexual risk behavior in same-sex attracted young males.

Design, setting, and participants: This was a national randomized clinical trial of the efficacy MyPEEPS Mobile vs a delayed intervention among males aged 13 to 18 years to prevent or reduce sexual risk for HIV acquisition. Study activities were completed through 4 study sites in Birmingham, Alabama; New York, New York; Seattle, Washington; and Chicago, Illinois. Study staff at each site met with participants in person or via video conferencing. Data were collected from June 1, 2018, to April 7, 2020, and analyzed from July to October 2021.

Interventions: The MyPEEPS Mobile intervention contains 21 online psychoeducational and skill-building modules, which participants completed over a 3-month period. Participants randomized to the intervention group received access to MyPEEPS Mobile for the first 3 months, while those randomized to the delayed intervention group received access at their 9-month visit after data for the primary efficacy analysis had been collected.

Main outcomes and measures: The self-reported primary outcome was change in the number of condomless anal sex acts between study conditions. Secondary outcomes were change in the number of sex partners, number of condomless anal sex partners, the number of sex acts while under the influence of substances, preexposure prophylactic uptake, nonoccupational postexposure prophylaxis use, and HIV and sexually transmitted infection testing.

Results: In the analytic sample of 763 racially and ethnically diverse study participants, the mean (SD) age was 16.2 (1.4) years; 736 participants (97%) were male, 13 (2%) nonbinary; and 6 (1%) genderqueer; 158 (21%) were Black or African American, 311 (41%) were Hispanic or Latino, and 284 (37%) were White. Overall, 382 were randomized to the intervention group and 381 to the delayed intervention group. At 3-month follow-up, there was a significant reduction in the number of condomless anal sex acts in the intervention group compared with the delayed intervention group (incidence rate ratio [IRR], 0.56; 95% CI, 0.32-0.99); however, there was no significant difference between groups at 6 or 9 months. In subgroup analyses, the intervention effect was pronounced among Black non-Hispanic participants at 3-month follow-up (IRR, 0.19; 95% CI, 0.04-0.94) and 6-month follow-up (IRR, 0.15; 95% CI, 0.03-0.78) compared with the delayed intervention group. There were no significant differences in the change in the number of sex partners, number of condomless anal sex partners, the number of sex acts while under the influence of substances, preexposure prophylactic uptake, nonoccupational postexposure prophylaxis use, and HIV and sexually transmitted infection testing between the intervention and delayed intervention groups.

Conclusions and relevance: In this study, the MyPEEPS Mobile intervention demonstrated a 44% overall reduction in condomless anal sex at 3-month follow-up compared with the delayed intervention group, but not at 6 or 9 months. To our knowledge, MyPEEPS Mobile is the first intervention to demonstrate evidence of short-term efficacy for reducing sexual risk among same-sex attracted young males.

Trial registration: ClinicalTrials.gov Identifier: NCT03167606.

Conflict of interest statement

Conflict of Interest Disclosures: Drs Kuhns and Schnall reported receiving grants from the National Institutes of Health, the US Centers for Disease Control and Prevention, and various entities under federal research subcontracts outside the submitted work. Dr Batey reported grants from Columbia University during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.. Study Flow Diagram
Figure 1.. Study Flow Diagram
Figure 2.. Mean Number of Condomless Sex…
Figure 2.. Mean Number of Condomless Sex Acts
Whiskers indicate SDs.

References

    1. Giroir BP. The time is now to end the HIV epidemic. Am J Public Health. 2020;110(1):22-24. doi:10.2105/AJPH.2019.305380
    1. US Centers for Disease Control and Prevention . HIV among gay and bisexual men. Reviewed June 28, 2022. Accessed August 17, 2022.
    1. Bosh KA, Hall HI, Eastham L, Daskalakis DC, Mermin JH. Estimated annual number of HIV infections—United States, 1981-2019. MMWR Morb Mortal Wkly Rep. 2021;70(22):801-806. doi:10.15585/mmwr.mm7022a1
    1. US Department of Health & Human Services . US statistics: fast facts. Accessed August 17, 2022.
    1. US Centers for Disease Control and Prevention . CDC Fact Sheet: HIV among gay and bisexual men. Accessed August 17, 2022.
    1. US Centers for Disease Control and Prevention . HIV surveillance report. Accessed August 17, 2022.
    1. Stephenson J. HIV and youth. JAMA. 2006;296(7):759.
    1. National Institutes of Health. NIH strategic plan for HIV and HIV-related research FY 2019/2020. Accessed August 17, 2022.
    1. Sullivan PS, Jones J, Kishore N, Stephenson R. The roles of technology in primary HIV prevention for men who have sex with men. Curr HIV/AIDS Rep. 2015;12(4):481-488. doi:10.1007/s11904-015-0293-5
    1. Kirk GD, Himelhoch SS, Westergaard RP, Beckwith CG. Using mobile health technology to improve HIV care for persons living with HIV and substance abuse. AIDS Res Treat. 2013;2013:194613. doi:10.1155/2013/194613
    1. CTIA . The wireless industry: industry data. Accessed August 30,2022.
    1. Pew Research Center. Internet and technology. Accessed August 22, 2022.
    1. Cole-Lewis H, Kershaw T. Text messaging as a tool for behavior change in disease prevention and management. Epidemiol Rev. 2010;32(1):56-69. doi:10.1093/epirev/mxq004
    1. Guse K, Levine D, Martins S, et al. . Interventions using new digital media to improve adolescent sexual health: a systematic review. J Adolesc Health. 2012;51(6):535-543. doi:10.1016/j.jadohealth.2012.03.014
    1. Córdova D, Mendoza Lua F, Ovadje L, Hong E, Castillo B, Salas-Wright CP. Randomized controlled trials of technology-based HIV/STI and drug abuse preventive interventions for African American and Hispanic Youth: systematic review. JMIR Public Health Surveill. 2017;3(4):e96-e96. doi:10.2196/publichealth.7129
    1. Hightow-Weidman LB, Muessig KE, Bauermeister JA, LeGrand S, Fiellin LE. The future of digital games for HIV prevention and care. Curr Opin HIV AIDS. 2017;12(5):501-507. doi:10.1097/COH.0000000000000399
    1. Schnall R, Travers J, Rojas M, Carballo-Diéguez A. eHealth interventions for HIV prevention in high-risk men who have sex with men: a systematic review. J Med internet Res. 2014;16(5):e134-e134. doi:10.2196/jmir.3393
    1. Bull S, Pratte K, Whitesell N, Rietmeijer C, McFarlane M. Effects of an internet-based intervention for HIV prevention: the Youthnet trials. AIDS Behav. 2009;13(3):474-487. doi:10.1007/s10461-008-9487-9
    1. Markham CM, Shegog R, Leonard AD, Bui TC, Paul ME. +CLICK: harnessing web-based training to reduce secondary transmission among HIV-positive youth. AIDS Care. 2009;21(5):622-631. doi:10.1080/09540120802385637
    1. Guse K, Levine D, Martins S, et al. . Interventions using new digital media to improve adolescent sexual health: a systematic review. J Adolesc Health. 2012;51(6):535-543. doi:10.1016/j.jadohealth.2012.03.014
    1. Bird JD, LaSala MC, Hidalgo MA, Kuhns LM, Garofalo R. “I had to go to the streets to get love”: pathways from parental rejection to HIV risk among young gay and bisexual men. J Homosex. 2017;64(3):321-342. doi:10.1080/00918369.2016.1179039
    1. Hidalgo MA, Cotten C, Johnson AK, Kuhns LM, Garofalo R. ‘Yes, I am more than just that’: gay/bisexual young men residing in the United States discuss the influence of minority stress on their sexual risk behavior prior to HIV infection. Int J Sex Health. 2013;25(4):291-304. doi:10.1080/19317611.2013.818086
    1. Lyons T, Johnson AK, Garofalo R. “What could have been different”: a qualitative study of syndemic theory and HIV prevention among young men who have sex with men. J HIV AIDS Soc Serv. 2013;12(3-4):368-383. doi:10.1080/15381501.2013.816211
    1. Hidalgo MA, Kuhns LM, Hotton AL, Johnson AK, Mustanski B, Garofalo R. The MyPEEPS randomized controlled trial: a pilot of preliminary efficacy, feasibility, and acceptability of a group-level, HIV risk reduction intervention for young men who have sex with men. Arch Sex Behav. 2015;44(2):475-485. doi:10.1007/s10508-014-0347-6
    1. Cho H, Porras T, Baik D, Beauchemin M, Schnall R. Understanding the predisposing, enabling, and reinforcing factors influencing the use of a mobile-based HIV management app: a real-world usability evaluation. Int J Med Inform. 2018;117:88-95. doi:10.1016/j.ijmedinf.2018.06.007
    1. Ignacio M, Garofalo R, Pearson C, et al. . Pilot feasibility trial of the MyPEEPS mobile app to reduce sexual risk among young men in 4 cities. JAMIA Open. 2019;2(2):272-279. doi:10.1093/jamiaopen/ooz008
    1. Schnall R, Kuhns L, Hidalgo M, et al. . Development of MyPEEPS Mobile: a behavioral health intervention for young men. Stud Health Technol Inform. 2018;250:31-31. doi:10.3233/978-1-61499-872-3-31
    1. Schnall R, Kuhns LM, Hidalgo MA, et al. . Adaptation of a group-based HIV RISK reduction intervention to a mobile app for young sexual minority men. AIDS Educ Prev. 2018;30(6):449-462. doi:10.1521/aeap.2018.30.6.449
    1. Kuhns LM, Garofalo R, Hidalgo M, et al. . A randomized controlled efficacy trial of an mHealth HIV prevention intervention for sexual minority young men: MyPEEPS mobile study protocol. BMC Public Health. 2020;20(1):65-65. doi:10.1186/s12889-020-8180-4
    1. Donenberg GR, Pao M. Youths and HIV/AIDS: psychiatry’s role in a changing epidemic. J Am Acad Child Adolesc Psychiatry. 2005;44(8):728-747. doi:10.1097/01.chi.0000166381.68392.02
    1. Bandura A, Walters RH. Social Learning Theory. Vol 1. Prentice-hall Englewood Cliffs; 1977.
    1. Bruce D, Harper GW, Bauermeister JA. Minority stress, positive identity development, and depressive symptoms: implications for resilience among sexual minority male youth. Psychol Sex Orientat Gend Divers. 2015;2(3):287-296. doi:10.1037/sgd0000128
    1. Donenberg GR, Emerson E, Bryant FB, Wilson H, Weber-Shifrin E. Understanding AIDS-risk behavior among adolescents in psychiatric care: links to psychopathology and peer relationships. J Am Acad Child Adolesc Psychiatry. 2001;40(6):642-653. doi:10.1097/00004583-200106000-00008
    1. Larsen DL, Attkisson CC, Hargreaves WA, Nguyen TD. Assessment of client/patient satisfaction: development of a general scale. Eval Program Plann. 1979;2(3):197-207. doi:10.1016/0149-7189(79)90094-6
    1. Kuhns LM, Garofalo R, Hidalgo M, et al. . A randomized controlled efficacy trial of an mHealth HIV prevention intervention for sexual minority young men: MyPEEPS mobile study protocol. BMC Public Health. 2020;20(1):65. doi:10.1186/s12889-020-8180-4
    1. McCulloch CE, Searle SR. Generalized, Linear, and Mixed Models. John Wiley & Sons; 2004.
    1. US Centers for Disease Control and Prevention . Lifetime Risk of HIV Diagnosis. Updated February 23, 2018. Accessed April 23, 2018,
    1. US Centers for Disease Control and Prevention . High impact HIV/AIDS prevention project. Accessed August 17, 2022.
    1. US Centers for Disease Control and Prevention . Compendium of evidence-based interventions and best practices for HIV prevention. Accessed June 1, 2017.
    1. Mustanski B, Parsons JT, Sullivan PS, Madkins K, Rosenberg E, Swann G. Biomedical and behavioral outcomes of Keep It Up!: an eHealth HIV prevention program RCT. Am J Prev Med. 2018;55(2):151-158. doi:10.1016/j.amepre.2018.04.026

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다