Abstract
BackgroundDespite successes in preventing and treating HIV, Indigenous people in Canada continue to face disproportionately high rates of HIV infection. Programs that support healing from lifetime trauma, support connection to culture, and reduce drug-related harms are critical to preventing HIV among young Indigenous people who use drugs. The Cedar Project WelTel mHealth intervention proposed here is a structured mobile-phone initiative to connect young Indigenous people who use drugs with Cedar Case Managers in a community-based setting. The intervention consists of a package of supports, including a mobile phone and cellular plan, weekly two-way text messaging, and support from Cedar Case Managers.MethodsThe Cedar Project WelTel mHealth study is a multi-site Zelen pre-randomized trial to measure the effect of a two-way supportive text-message intervention to reduce HIV vulnerability among young Indigenous people who use illicit drugs in two Canadian cities. The trial is nested within the Cedar Project, an ongoing cohort study addressing HIV and hepatitis C vulnerability among young Indigenous people who use drugs in Vancouver and Prince George, British Columbia. The Cedar Project Partnership, an independent body of Indigenous Elders, leaders, and health/social service experts, governs all aspects of the study. Two hundred participants will be followed over a 16-month period, with HIV propensity score at 6 months as the primary outcome. Secondary outcomes include HIV propensity at 1 year, HIV risk, resilience, psychological distress, access to drug-related services, and connection to culture measured at 6 months and 1 year. Primary analysis is by intention to treat.DiscussionCulturally safe interventions that address barriers to HIV prevention while supporting the strength of young Indigenous people who use drugs are urgently needed. Despite presenting a tremendous opportunity to connect young, highly transient Indigenous people who use drugs to prevention services, supportive two-way mHealth programs have yet to be tested for HIV prevention in a community-based setting with this population.Trial registrationClinicalTrials.gov NCT02437123 https://clinicaltrials.gov/show/NCT02437123 (registered 4 May 2015). Protocol version: 24 July 2015.
Highlights
Despite successes in preventing and treating HIV, Indigenous people in Canada continue to face disproportionately high rates of HIV infection
To minimize the risk of bias introduced in our modified intention to treat (ITT) analysis, we propose to use complier average causal effect (CACE) analysis [45]
Innovative, culturally safe interventions that address the barriers to HIV prevention while supporting the strength of young Indigenous people who use drugs are urgently needed
Summary
Despite successes in preventing and treating HIV, Indigenous people in Canada continue to face disproportionately high rates of HIV infection. Programs that support healing from lifetime trauma, support connection to culture, and reduce drug-related harms are critical to preventing HIV among young Indigenous people who use drugs. In a study of young Indigenous people who use drugs in British Columbia (BC), 65 % had been removed from their biological parents and placed into care [11]. Those who had been in care were 2.1 times more likely to have a parent who attended residential school and 2.6 times more likely to have been sexually abused. Acknowledging the profound effect of intergenerational and lifetime trauma, and subsequent reliance on the powerful numbing effect of drugs, is critical to understanding HIV vulnerability among young Indigenous people who use drugs [4, 7, 12,13,14,15]
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