Use of Behavior Change Techniques in Digital HIV Prevention Programs for Adolescents and Young People: Systematic Review.

BACKGROUND

HIV infections have caused severe public health and economic burdens to the world. Adolescents and young people continue to constitute a large proportion of newly diagnosed HIV cases. Digital health interventions have been increasingly used to prevent the rising HIV epidemic. Behavior change techniques (BCTs) are intervention components designed to modify the underlying processes that regulate behavior. The BCT taxonomy offers a systematic approach to identifying, extracting, and coding these components, providing valuable insights into effective intervention strategies. However, few reviews have comprehensively identified the use of BCTs in digital HIV interventions among adolescents and young people.

OBJECTIVE

This study aimed to synthesize existing evidence on the commonly used BCTs in effective digital HIV prevention programs targeting adolescents and young people.

METHODS

In total, 4 databases (PubMed, Embase, Cochrane Library, and APA PsycINFO) were searched, and studies from January 2008 to November 2024 were screened. Reference lists of relevant review studies were reviewed to identify any additional sources. Eligible randomized controlled trials with 1 of 3 HIV prevention outcomes (ie, HIV knowledge, condom-use self-efficacy, and condom use) were included. Basic study characteristics, intervention strategies, and study results were extracted and compared for data analysis. For the included interventions, BCTs were identified according to the BCT taxonomy proposed by Abraham and Michie in 2008, and the frequencies of BCTs used in these interventions were counted.

RESULTS

Searches yielded 383 studies after duplicates were removed, with 34 (8.9%) publications finally included in this review. The most frequently used BCTs included prompting intention formation (34/34, 100%), providing information about behavior-health link (33/34, 97%), providing information on consequences (33/34, 97%), and providing instruction (33/34, 97%). Interventions with significant improvements in HIV knowledge (11/34, 32%) more frequently used BCTs with a provision nature, such as providing information about behavior-health link (11/11, 100%), information on consequences (11/11, 100%), encouragement (10/11, 91%), and instruction (10/11, 91%). Those with significant increases in condom-use self-efficacy (7/34, 20%) used BCTs toward initiating actions, such as prompts for intention formation (7/7, 100%), barrier identification (7/7, 100%), and practice (5/7, 71%). In addition, studies showing significant improvements in condom use (14/34, 41%) included BCTs focused not only on provision and initiation but also on behavioral management and maintenance, such as use follow-up prompts (5/14, 36%), relapse prevention (4/14, 29%), prompt self-monitoring of behavior (3/14, 21%), and prompt review of behavioral goals (3/14, 21%).

CONCLUSIONS

This is the first systematic review that examined the use of BCTs in digital HIV prevention interventions for adolescents and young adults. The identified BCTs offer important reference for developing more effective digital interventions, with implications for enhancing their HIV knowledge, condom-use self-efficacy, and condom use in youth.