A Nurse Case Management HIV Prevention Intervention (Come As You Are) for Youth Experiencing Homelessness: Protocol for a Randomized Wait-list Controlled Trial.

Diane Santa Maria,Adey Nyamathi,Nikhil Padhye,Jennifer Jones,Mary Paul,Yasmeen Quadri,Margarita Calvo Armijo,Marguerita Lightfoot,Michael Businelle

doi:10.2196/26716

Abstract

BackgroundYouth experiencing homelessness are more likely than housed youth to experience premature death, suicide, drug overdose, pregnancy, substance use, and mental illness. Yet while youth experiencing homelessness are 6 to 12 times more likely to become infected with HIV than housed youth, with HIV prevalence as high as 16%, many do not access the prevention services they need. Despite adversities, youth experiencing homelessness are interested in health promotion programs, can be recruited and retained in interventions and research studies, and demonstrate improved outcomes when programs are tailored and relevant to them.ObjectiveThe study aims to compare the efficacy of a nurse case management HIV prevention and care intervention, titled Come As You Are, with that of usual care among youth experiencing homelessness aged 16 to 25 years.MethodsThe study is designed as a 2-armed randomized wait-list controlled trial. Participants (n=450) will be recruited and followed up for 9 months after the intervention for a total study period of 12 months. Come As You Are combines nurse case management with a smartphone-based daily ecological momentary assessment to develop participant-driven HIV prevention behavioral goals that can be monitored in real-time. Youth in the city of Houston, Texas will be recruited from drop-in centers, shelters, street outreach programs, youth-serving organizations, and clinics.ResultsInstitutional review board approval (Committee for the Protection of Human Subjects, University of Texas Health Science Center at Houston) was obtained in November 2018. The first participant was enrolled in November 2019. Data collection is ongoing. To date, 123 participants have consented to participate in the study, 89 have been enrolled, and 15 have completed their final follow-up.ConclusionsThere is a paucity of HIV prevention research regarding youth experiencing homelessness. Novel and scalable interventions that address the full continuum of behavioral and biomedical HIV prevention are needed. This study will determine whether a personalized and mobile HIV prevention approach can reduce HIV risk among a hard-to-reach, transient population of youth at high risk.International Registered Report Identifier (IRRID)DERR1-10.2196/26716

Highlights

human immunodeficiency virus LGBTQ (HIV) Risks Among Youth Experiencing HomelessnessA number of systemic barriers and risk behaviors drive high HIV infection rates among youth experiencing homelessness
Come As You Are combines nurse case management with a smartphone-based daily ecological momentary assessment to develop participant-driven HIV prevention behavioral goals that can be monitored in real-time
The first participant was enrolled in November 2019

Summary

Introduction

HIV Risks Among Youth Experiencing HomelessnessA number of systemic barriers and risk behaviors drive high HIV infection rates among youth experiencing homelessness. Youth experiencing homelessness have earlier sexual debuts; are more likely to have multiple sexual partners; and trade sex for food, shelter, money, drugs, or alcohol [1,2] They are more likely to use substances before sex, are less likely to use condoms, and are overrepresented by youth who identify as men who have sex with men; each of these characteristics increase risk for HIV [3,4], and those who trade sex are at high risk for HIV infection as they are rarely able to negotiate condom use due to the power dynamics [5] and often lack knowledge about biomedical advances in HIV prevention such as preexposure prophylaxis and nonoccupational postexposure prophylaxis [6]. Addressing facilita- Perceived behavior adher- Review goals and action plan; use motivational interview- Revise/reinforce HIV pretors and barriers ence and coping effective- ing to discuss personal HIV prevention behavior change vention goals and action ness facilitators and barriers; evoke change talk plan to increase facilitators. Youth experiencing homelessness are interested in health promotion programs, can be recruited and retained in interventions and research studies, and demonstrate improved outcomes when programs are tailored and relevant to them

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