Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States.
TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
J Med Internet Res. 2021 Jul 6;23(7):e26704. doi: 10.2196/26704.
People 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.
This 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.
A 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.
Participants (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).
Findings 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.
ClinicalTrials.gov NCT03911024; https://clinicaltrials.gov/ct2/show/NCT03911024.
无家可归者的 HIV 感染率高于稳定住房者。在预防 HIV 时，需要考虑心理健康需求、药物使用问题以及无家可归者特有的问题，如缺乏住所和短暂性。迄今为止，针对无家可归的年轻成年人的 HIV 预防干预措施并未特别针对压力、性冲动或药物使用冲动等可改变的实时因素，也未在高危时提供。实时、个性化的 HIV 预防信息可能会减少 HIV 风险行为。
本试点研究测试了一种创新的、基于智能手机的、即时自适应干预措施的初步疗效，该措施实时评估 HIV 风险行为的预测因素，并自动提供行为反馈和目标实现信息。
2019 年 5 月，从收容所和临时收容中心招募了 18-25 岁的无家可归的年轻成年人，他们被随机分为对照组或干预组，采用随机对照设计。干预措施（称为 MY-RID [激励年轻人减少感染和脱节]）包括在 6 周内通过智能手机发送的简短信息，以响应使用生态瞬时评估预先确定的预测因素。贝叶斯分层回归模型用于评估性活动、药物使用、酒精使用及其相应冲动的干预效果。
参与者（N=97）主要是年轻人（平均年龄 21.2 岁，标准差 2.1 岁），他们自认为是异性恋者（n=51，52%）、男性（n=56，57%）和非裔美国人（n=56，57%）。在两组中，性活动、药物使用、酒精使用和压力报告均随时间减少。与对照组相比，干预组在 6 周内每日药物使用减少了 13.8 倍（多媒体附录 4）。在研究期间，干预组的性冲动降低。最后，干预组和对照组相比，前一天感到压力的报告有统计学意义上的减少（P=.03）。
研究结果表明，该干预措施对难以接触的高风险人群的药物使用、压力和性冲动具有良好的干预效果。应在更大规模的随机对照试验中进一步测试 MY-RID 干预措施，以进一步研究其对性行为风险的疗效和影响。
ClinicalTrials.gov NCT03911024；https://clinicaltrials.gov/ct2/show/NCT03911024。
