Text Messaging to Improve Linkage, Retention, and Health Outcomes Among HIV-Positive Young Transgender Women: Protocol for a Randomized Controlled Trial (Text Me, Girl!).

Anne E Fehrenbacher,Cathy J Reback,Kimberly Kisler,Jesse B Fletcher

doi:10.2196/12837

Abstract

BackgroundTransgender women in the United States experience numerous risk factors for HIV acquisition and transmission, including increased rates of homelessness, alcohol and drug use, sex work, and nonprescribed hormone and soft tissue–filler injections. In addition, transgender women face discrimination and social/economic marginalization more intense and deleterious than that experienced by lesbian, gay, or bisexual individuals, further worsening health outcomes. Although little research has been done specifically with young transgender women aged 35 years and younger, existing evidence suggests even further elevated rates of homelessness, substance use, and engagement in HIV transmission risk behaviors relative to their older transgender women and nontransgender young adult counterparts. Young transgender women living with HIV experience a range of barriers that challenge their ability to be successfully linked and retained in HIV care.ObjectiveThe aim of this randomized controlled trial, Text Me, Girl!, is to assess the impact of a 90-day, theory-based, transgender-specific, text-messaging intervention designed to improve HIV-related health outcomes along the HIV care continuum among young (aged 18-34 years) transgender women (N=130) living with HIV/AIDS.MethodsParticipants were randomized into either Group A (immediate text message intervention delivery; n=61) or Group B (delayed text message intervention delivery whereby participants were delivered the text-messaging intervention after a 90-day delay period; n=69). Over the course of the 90-day intervention, participants received 270 theory-based text messages that were targeted, tailored, and personalized specifically for young transgender women living with HIV. Participants received 3 messages per day in real time within a 10-hour gradual and automated delivery system. The text-message content was scripted along the HIV care continuum and based on social support theory, social cognitive theory, and health belief model. The desired outcome of Text Me, Girl! was virological suppression.ResultsRecruitment began on November 18, 2016, and the first participant was enrolled on December 16, 2016; enrollment closed on May 31, 2018. Intervention delivery ended on November 30, 2018, and follow-up evaluations will conclude on August 31, 2019. Primary outcome analyses will begin immediately following the conclusion of the follow-up evaluations.ConclusionsText messaging is a communication platform well suited for engaging young transgender women in HIV care because it is easily accessible and widely used, as well as private, portable, and inexpensive. Text Me, Girl! aimed to improve HIV care continuum outcomes among young transgender women by providing culturally responsive text messages to promote linkage, retention, and adherence, with the ultimate goal of achieving viral suppression. The Text Me, Girl! text message library is readily scalable and can be adapted for other hard-to-reach populations.International Registered Report Identifier (IRRID)DERR1-10.2196/12837

Highlights

Criterion 1: NEED Strength: The applicant organization provides a thorough introduction to the proposed social media intervention to improve linkage and retention in HIV care
The application clearly explains the specific needs of the target population, HIV-positive young transgender women, linking data to a model of HIV care continuum and the potential impact social media has on this group
Weakness: The application does not adequately detail how the intervention will be sustained beyond the funding period, given that the text messaging program is run by a subcontractor, and there is a financial cost to continuing the program

Summary

Introduction

HAB: Use of Social Media along the HIV Care Continuum Demonstration Sites Criterion 1: NEED Strength: The applicant organization provides a thorough introduction to the proposed social media intervention to improve linkage and retention in HIV care. The applicant organization demonstrates extensive knowledge of the literature regarding problems along the HIV Care Continuum specific to transgender women and social media concepts.

Results

Conclusion