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Try out PMC Labs and tell us what you think. Learn More. Guy2Guy G2G is the first comprehensive HIV prevention program developed for sexual minority males as young as 14 years old and is delivered nationally via text messaging.

Here, we report the of the pilot randomized control trial. Both programs lasted 5 weeks and delivered 5 to 10 text messages daily. A 1-week booster was delivered 6 weeks subsequently. Youth were recruited across the United States via Facebook and enrolled by telephone from October to April We also examined these outcomes at intervention end and stratified them by sexual experience.

At 90 days postintervention, there were no ificant differences in CSAs or abstinence noted. G2G appears promising in increasing adolescent HIV testing rates. Additional content or features may be needed to invigorate condom use. The burden of HIV infection falls disproportionately on adolescent gay and bisexual men. Nonetheless, there is a concerning paucity of culturally relevant, validated HIV prevention programs available. We report pilot randomized controlled trial findings for Guy2Guy, the first national, mobile health HIV prevention program for sexual minority youth as young as 14 years of age, including those who are sexually inexperienced.

Although preliminary, our findings show promise for similar efforts in the future. HIV infection among young people occurs disproportionately through male-to-male sexual contact in the United States, 1 yet few validated prevention programs exist for adolescent gay and bisexual men AGBM.

In developing an intervention, determining population-specific needs and corresponding solutions to be integrated into the program is critical.

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Thus, text messaging may be a compelling intervention delivery mechanism for youth. Condom use at first sex is a crucial factor influencing current condom use, 6 — 10 yet few HIV prevention programs include sexually inexperienced youth.

To maximize opportunities to improve lifelong HIV preventive behavior, HIV interventions need to include adolescents before their sexual debut.

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Intervention content must go beyond issues surrounding the use of condoms as well. Formative development activities are reported elsewhere. As the first text messaging—based HIV prevention program developed and pilot tested nationally in a diverse sample of AGBM as young as 14 years old, the findings have the potential to build knowledge about feasible and acceptable strategies to reach and engage this important population in HIV prevention programming.

Chesapeake and Northwestern University institutional review boards approved the protocol and granted a waiver of parental permission. Eligible participants were the sole owners of a cell phone with unlimited text messaging who intended to keep their current for 6 months and had at least 6 months of text messaging experience.

The technology-related criteria helped ensure the intervention was tested among youth similar to those most likely to use the intervention if it were publicly available. Exclusion criteria included knowing another person enrolled in the program and participating in a study Free phone sex ads in Phillips eg, focus groups.

Participants were recruited through online advertisements on Facebook between June 20 and October 31, The advertisement linked interested youth to the online screener form. Completed screeners were ed to the project coordinator.

Project staff then contacted the eligible candidates and scheduled a phone appointment to confirm eligibility, to complete a self-safety assessment, 19 and to obtain informed consent. Participants were then ed a survey link to the baseline survey. After survey completion, youth were randomly ased and began receiving text messages. With no published interventions for AGBM as young as 14 years of age, we based power analyses on findings from an HIV prevention program for sexual-minority men 18 to 24 years old.

Participants were not incentivized to complete the baseline survey. Incentives were issued as Amazon. The main intervention content, delivered over 5 weeks, was based on the Information-Motivation-Behavior Model of HIV preventive behavior. Additional topics covered the importance of HIV testing, healthy and unhealthy relationships, coming out, and bullying.

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The booster, delivered 6 weeks postintervention, reinforced this content Fig 1. Both sexually experienced and inexperienced intervention youth were encouraged to first buy condoms Badge 1 and carry condoms with them Badge 2. Youth who were sexually experienced at baseline were then encouraged to use condoms if they were currently having sex Badge 3.

They also were encouraged to get tested for HIV Badge 4. Participants were given up to three chances to earn a badge. At the outset, participants were not notified of the total of badges or the activities that would earn badges. However, as the program progressed, they received text messages asking whether they had achieved a particular badge activity. Intervention participants were also paired to a text buddy. Text buddies were matched on sexual experience, time zone ie, within 1 zoneand distance at least miles apart to prevent meeting each otherwhen possible.

The control group participants received a text messaging program matched on the of days in the intervention content. Messages focused on general health topics eg, self-esteem, Table 1. Over 5 weeks, intervention participants in the inexperienced group received an average of 8. The control participants received 7. These differences reflect additional features for intervention participants and tailored content by sexual experience within the intervention arm.

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Participants in both arms completed a comprehensive baseline and day assessment online. At the end of the 5-week main intervention, outcome measures were collected via a brief text messaging—based assessment. To maximize response, youth who had not completed the online assessment at day follow-up received an abbreviated text messaging—based survey that queried only the outcome measures.

They could subsequently complete the full online survey if they chose, but for those who completed both, answers to the abbreviated survey were included in analysis because they were provided by the participants first. Note the follow-up period is approximate and depends on when participants completed the assessment eg, the same day the invitation was sent, a week later, etc and how quickly intervention youth responded to bidirectional messages eg, level-up, badge messages.

Our primary outcome measures were the of condomless sex acts CSAs and abstinence at days postintervention. Secondary Free phone sex ads in Phillips measures included HIV testing among sexually experienced youth, the of CSAs, and whether youth had been abstinent in the 90 days since the intervention end, which were stratified by baseline sexual experience. We examined relative difference in CSAs and abstinence at intervention end for all youth and stratified them by baseline sexual experience.

Those reporting at least 1 sex partner were asked the of times they had vaginal, insertive anal, and receptive anal sex with each of their 3 most recent partners. CSAs were calculated as the sum of times they did not use a condom across partners and types of sex.

Abstinence was indicated if they reported no sex partners. Those who reported having sex at least once were asked the of times they did not use a condom. Again, CSAs were calculated as the of times the youth did not use a condom; abstinence was indicated for youth who reported no sex acts during the observation period.

Youth self-reported whether they were tested for HIV at these intervals: ever, at baseline, at the start of G2G, at intervention end, and since the end of the program at day follow-up. Analyses were intent-to-treat and complete case ie, those who responded to the outcome Free phone sex ads in Phillips were included in analyses.

Statistically ificant characteristics were included in multivariate models. Because of skew, negative binomial regression was used to estimate the incident rate ratio IRR of the count of CSAs for the intervention versus control groups.

Logistic regression assessed the relative odds of abstinence and HIV testing for the 2 experimental arms. Postintervention assessments were gathered between July and Decemberand day postintervention assessments were gathered between October and April See Fig 2 for Consolidated Standards of Reporting Trials flow. Five intervention participants actively withdrew from the program. No control participants withdrew and no harms were reported.

M, mean. Each point estimate represents a single model, which is adjusted for age and baseline indicator of the outcome measure. HIV testing was only a tested outcome for sexually experienced youth. Sexual experience is based on a baseline report.

At days postintervention, no ificant differences in CSAs or abstinence were noted Table 3. This effect was no longer statistically ificant when age was added to the model Table 3. Age differed by arm when treated categorically Table 2but age was equivalent by arm when assessed by using a dichotomous definition to reflect recruitment bins ie, 14—15 years of age versus 16—18 years of age.

Together, these data suggest that the outcome was vulnerable to the operationalization of age in analyses but not in an interpretable way: when the outcome was examined within each age group eg, 17 year oldspatterns were not apparent. No other secondary outcomes at intervention end or day follow-up were statistically ificantly different, although findings suggested that abstinence may have been higher at intervention end among baseline-abstinent intervention youth than control youth Table 3.

This does not appear to persist over time. Regular HIV testing is a cornerstone of HIV prevention with a demonstrated impact on subsequent HIV risk behaviors among those testing positive, 30 which highlights the potential public health impact of this finding.

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Moreover, G2G delivers automated and standardized content, representing a program uniquely positioned for cost-effective and time-efficient scale and dissemination. Neither main outcome measure, CSAs nor abstinence, was ificantly different for participants in G2G versus the attention-matched control group at days postintervention. Testing may be easier to affect than condom use because the barriers may be easier to overcome.

Testing is a singular behavior affected every 3 to 6 months, whereas condom use requires action every time one has sex. Moreover, one can get tested individually, whereas condom use is necessarily a dyadic behavior. Although consistent condom use is the most desired HIV prevention outcome for sexually active AGBM, 3132 a pragmatic approach valuing additional prevention behaviors, including testing, is useful. Fears about anal sex that AGBM voiced during focus groups eg, pain 33 motivated purposively sex-positive G2G content development eg, tips for pleasurable, safe sex.

Admittedly, some may see this finding as concerning. We believe from a public health perspective however, this is neutral in its implications because the s of CSAs were unchanged across arms or within the intervention arm between baseline and follow-up. That said, certainly a more positive outcome would have been to observe the decreases in CSAs among intervention youth versus control youth. Age appears to be a confounder of the intervention effect. This is unexpected given that more general indicators of age 14—15 vs 16—18 years suggest the arms are balanced on this factor.

Age also introduced model instability in 4 of the secondary outcome models Table 3 footnotes. Thus, it may be that age is reducing model power without adding any explanatory value. That a reduction in CSAs is noted provides additional optimism for the intervention. Power estimates were based on sexually active to year-old sexual Free phone sex ads in Phillips men. The current study was underpowered in part because AGBM have sex and therefore, condomless sex less often than to year-olds. Power was additionally limited by the inclusion of sexually inexperienced youth at study outset.

Although focusing squarely on AGBM who were sexually experienced would have increased our power, we emphasize the value in exposing sexually inexperienced youth to messages making HIV preventive behavior, including testing, normative. Our point estimates can inform more accurate power estimates for future studies including younger AGBM.

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