Mobile screening to identify and follow-up with high Risk, HIV negative youth

Abstract

Background HIV prevalence remains disproportionately high among youth, especially among young men who have sex with men, young people with substance use disorders, and recently incarcerated youth. However, youth may not report behavioral risks because they fear stigma or legal consequences. While routine HIV screening programs have increased testing, current programs are not designed to identify, or provide prevention services to, high-risk patients who test HIV negative. Aims To examine the feasibility and preliminary efficacy of: a tablet-based screening designed to facilitate HIV risk reporting and testing among a sample of young urban emergency department (ED) patients; and a text message-based follow up protocol for patients who test HIV-negative and report increased behavioral risk. Methods 100 ED patients aged 18 – 24, who declined HIV tests offered at triage, completed a tablet-based intervention that included a risk screening, an educational video, and offered participants HIV tests. If patients accepted testing and reported increased risk, the tablets offered follow-up text messages. Results 30 participants accepted HIV tests following the intervention and 21 participants, identified by custom software as high-risk, agreed to receive text messages. Two thirds (66.7%) of text recipients responded to questions at week 6, more than half (57.1%) responded at week 8, one (4.76%) re-tested after week 12. Conclusion Results indicate our intervention provides a feasible way to facilitate risk reporting, increase HIV testing, and maintain ongoing contact with hard-to-reach youth via tablet computers and text messages.

Screening for HIV and linkage to care in adolescents: insights from a systematic review of recent interventions in high- versus low- and middle-income settings

“…The interventions were organized into six categories as defined in Table 3. The interventions to increase HIV testing among adolescents and young adults consisted of behavioral/educational interventions (N=4)29,30,55,56, alternate venue/self-testing (N=11),31–34,42–45,50,57,58 youth-friendly services (N=2),59,60 technology/mobile health (N=9),16,35–39,49,51,61 incentives (N=3),53,54,62 and peer/community-based interventions (N=7) 40,41,46–48,52,63. The median sample size was 613 individuals (inter-quartile range=261–2,169).…”

“…The median sample size was 613 individuals (inter-quartile range=261–2,169). The types of studies included RCTs (N=13),29,31,36,38,39,42,45,47,49,51,55,60,62 observational studies (N=15),16,32–35,41,44,58,61 and quasi-experimental/pre–post evaluations (N=8) 30,37,40,46,52,54,56,59…”

“…Of the 36 studies included in our review, 13 were RCTs and 23 were observational studies 16,30,32–35,37,40,41,44,46,52,54,56,58,59,61. Three of the RCTs39,42,62 and five of the observational studies43,44,52,54,61 were presented in abstracts; these studies were excluded from the risk of bias assessment due to insufficient information.…”

“…In the US, there were six technology or mobile health interventions16,35–39 with three RCTs 36,38,39. Ybarra et al randomized 302 MSM aged 14–18 years to receive a self-esteem control versus Guy2Guy program that involved daily text messaging for 5 weeks providing HIV information, motivation and behavioral skills, the importance of HIV testing, and healthy relationships.…”

“…Neither study reported the number of new HIV infections or linkage to care. Aronson et al conducted a tablet-based intervention for 100 young adults aged 18–24 presenting an emergency department who had declined HIV testing 35. After the intervention, 30% of youth tested and 70% agreed to participate in a 12-week program of weekly text messages.…”