Efficacy of a Just-in-Time Adaptive Intervention to Promote HIV Risk Reduction Behaviors Among Young Adults Experiencing Homelessness: Pilot Randomized Controlled Trial.

Diane Santa Maria,Nikhil Padhye,Alexis Sims,Jennifer Jones,Yijiong Yang,Michael Businelle,Marguerita Lightfoot

doi:10.2196/26704

Abstract

BackgroundPeople experiencing homelessness have higher rates of HIV than those who are stably housed. Mental health needs, substance use problems, and issues unique to homelessness such as lack of shelter and transiency need to be considered with regard to HIV prevention. To date, HIV prevention interventions for young adults experiencing homelessness have not specifically addressed modifiable real-time factors such as stress, sexual or drug use urge, or substance use, or been delivered at the time of heightened risk. Real-time, personalized HIV prevention messages may reduce HIV risk behaviors.ObjectiveThis pilot study tested the initial efficacy of an innovative, smartphone-based, just-in-time adaptive intervention that assessed predictors of HIV risk behaviors in real time and automatically provided behavioral feedback and goal attainment information.MethodsA randomized attention control design was used among young adults experiencing homelessness, aged 18-25 years, recruited from shelters and drop-in centers in May 2019. Participants were randomized to either a control or an intervention group. The intervention (called MY-RID [Motivating Youth to Reduce Infection and Disconnection]) consisted of brief messages delivered via smartphone over 6 weeks in response to preidentified predictors that were assessed using ecological momentary assessments. Bayesian hierarchical regression models were used to assess intervention effects on sexual activity, drug use, alcohol use, and their corresponding urges.ResultsParticipants (N=97) were predominantly youth (mean age 21.2, SD 2.1 years) who identified as heterosexual (n=51, 52%), male (n=56, 57%), and African American (n=56, 57%). Reports of sexual activity, drug use, alcohol use, stress, and all urges (ie, sexual, drug, alcohol) reduced over time in both groups. Daily drug use reduced by a factor of 13.8 times over 6 weeks in the intervention group relative to the control group (Multimedia Appendix 4). Lower urges for sex were found in the intervention group relative to the control group over the duration of the study. Finally, there was a statistically significant reduction in reports of feeling stressed the day before between the intervention and control conditions (P=.03).ConclusionsFindings indicate promising intervention effects on drug use, stress, and urges for sex in a hard-to-reach, high-risk population. The MY-RID intervention should be further tested in a larger randomized controlled trial to further investigate its efficacy and impact on sexual risk behaviors.Trial RegistrationClinicalTrials.gov NCT03911024; https://clinicaltrials.gov/ct2/show/NCT03911024

Highlights

BackgroundYoung adult homelessness continues to be a major public health problem with 1 in 10 young adults aged 18 to 25 years experiencing homelessness over the course of a year [1] and an estimated 1.7 to 2.5 million youth under 25 years experiencing homelessness each year in the United States [2]
The intervention consisted of brief messages delivered via smartphone over 6 weeks in response to preidentified predictors that were assessed using ecological momentary assessments
Participants (N=97) were predominantly youth who identified as heterosexual (n=51, 52%), male (n=56, 57%), and African American (n=56, 57%)

Summary

Introduction

BackgroundYoung adult homelessness continues to be a major public health problem with 1 in 10 young adults aged 18 to 25 years experiencing homelessness over the course of a year [1] and an estimated 1.7 to 2.5 million youth under 25 years experiencing homelessness each year in the United States [2]. The implications of mental health needs, substance use problems, and issues unique to YEH such as the lack of stable sheltering options need to be considered with regard to HIV prevention. This is salient as people experiencing homelessness have higher rates of HIV than those who are stably housed [8]. Substance use problems, and issues unique to homelessness such as lack of shelter and transiency need to be considered with regard to HIV prevention. Real-time, personalized HIV prevention messages may reduce HIV risk behaviors

Methods

Results

Conclusion