Examining recruitment strategies in the enrollment cascade of youth living with HIV: Descriptive findings from a nationwide online adherence protocol.

Abstract

Digital strategies and broadened eligibility criteria may optimize enrollment of youth living with HIV (YLH) in mobile health adaptive interventions. Prior research suggests that digital recruitment strategies are more efficient than traditional methods to overcome enrollment challenges among YLH in the United States. This paper highlights challenges and strategies that explain screening and enrollment milestones in a national online adherence protocol for YLH. Baseline data from a national online HIV adherence protocol of YLH collected from July 2018 through February 2021 were analyzed. A centralized recruitment procedure was developed which utilized (1) online recruitment via 'Online Master Screener', (2) paid online targeted advertisements on social media platforms (e.g., Facebook, Reddit) and geosocial networking dating applications (e.g., Grindr, Jack'd apps), and (3) site and provider referrals from Subject Recruitment Venues and other AIDS service organizations, website referrals, and text-in recruitment. Three distinct cohorts of YLH were identified, marked by changes in recruitment strategies. Overall, 3,270 individuals consented to screening, 2,721 completed screening, 581 were eligible, and 83 completed enrollment. We examined sociodemographic and behavioral differences in completing milestones from eligibility to full enrollment (i.e., submitting antiretroviral therapy and viral load data and completing baseline online survey). Those with most recent viral load tests more than 6 months ago were half as likely to enroll (OR 0.45, CI 0.21, 0.94). Moreover, eligible participants with self-reported antiretroviral therapy adherence (SRA) between 50% and 80% were significantly more likely to enroll than those with SRA greater than 80%. The findings add to our knowledge on the utility of digital technologies for YLH before and during the COVID-19 pandemic and provide insight into the impact of expanding eligibility criteria on enrollment. As the COVID-19 pandemic continues and usage of and engagement with social media and dating apps among YLH changes, these platforms should continue to be investigated as potential recruitment tools. Employing a wide variety of recruitment strategies such as using social media and dating apps as well as provider referral mechanisms, increasing compensation amounts, and including SRA in enrollment criteria should continue to be studied with respect to their ability to successfully recruit and enroll eligible participants. ClinicalTrials.gov (NIH U.S. National Library of Medicine) Identifier: NCT03535337; https://clinicaltrials.gov/ct2/show/NCT03535337. RR2-10.2196/11183.