Young people of color bear a disproportionate burden of HIV/AIDS in the US. Despite disproportionate risk, testing among young people of color is not common. Though HIV testing is recommended for all young people 13 and older, many do not seek available services and face barriers to accessing healthcare. Young people of color from the poorest communities in metropolitan New York City have among the highest rates of HIV/AIDS and sexually transmitted infections (STI) in the US. Rates of STI are even higher among HIV+ young people, increasing vulnerability to infection with other STI as well as transmission of HIV. Project STAY (Services to Assist Youth), a collaboration between the Harlem Health Promotion Center, Mailman School of Public Health at Columbia University and New York Presbyterian Hospital, offers an innovative outreach solution for connecting underserved young people with sexual health education and HIV/STI services. Project STAY has been successful at reaching target young people with prevention education through community-based workshops. Yet, there is currently no mechanism for ongoing contact with participants to promote screening and reinforce workshop material. An efficient way to maintain contact with participants to disseminate ongoing prevention information could improve linkages to care by overcoming the logistic and motivational barriers to service access. Mobile and Internet technologies are ideal for contact continuity. We propose to conduct formative work to develop and evaluate feasibility and acceptance of an innovative intervention that integrates mobile, Internet, and Short Text Messaging (SMS) technologies to improve linkages to care and promote HIV risk reduction behaviors for Project STAY participants aged 18 to 24. We will conduct elicitation research with target end-users and clinic stakeholders to ensure that the intervention addresses the needs of the target audience and is compatible with clinic infrastructure. The intervention will then be piloted with 90 participants in a two-group design to examine feasibility of assessment and intervention implementation, outcome and process trends, and end-user acceptance of the intervention. Results of this formative study will inform refinement of the intervention and research design planning for a larger R01 evaluation. A successful SMS text message intervention that improves links to HIV health services for underserved minority young people will have high public health impact and will serve as a model for integrating community prevention outreach with direct care more broadly. This proposal is well aligned with the current strategic goals of the Office of National AIDS Policy and with the mission of R34 PAR-09-173, Pilot Intervention and Services Research.
A successful integrated SMS text message intervention that increases linkages to HIV health services and continuity of care for underserved at risk minority young people will have high public health impact - there are approximately one million young people in the target audience in NYC alone. The focus on screening, treatment and prevention aligns with the mission of the Office of National AIDS Policy;the project will also provide a model for integrating community prevention outreach with direct care to promote prevention and health care utilization among young people more broadly. Finally, the project will fill an important gap in the research literature regarding SMS text message interventions targeted to HIV/STI service utilization and prevention.
