Using Mobile Technology and Incentives With Men Who Have Sex With Men and Transgender Women for HIV Prevention (MOTIVES)

This project entails a 3-phase mobile technology based and behavioral economics supported HIV prevention intervention - called Mobile Technology and Incentives (MOTIVES) - to increase engagement with HIV prevention information and improve testing frequency among Latino men who have sex with men (MSM) and transgender women (TGW). The study is conducted in collaboration with Bienestar Human Services, Inc. (Bienestar); a non-profit community-based service organization established in 1989 with sites located across Los Angeles County that primarily serves Latino populations. Specific Aim 1 included focus groups with MSM and TGW to finalize the planned intervention based on the insights from a preliminary study. Specific Aim 2 will enroll 200 HIV-negative MSM and TGW in a 12-month, two-arm randomized controlled trial (RCT). Those in the intervention group will receive weekly text messages with HIV prevention information and can win reward points for correctly answering weekly quizzes to keep them engaged and improve their retention of the HIV prevention information. Those who continue to test negative for HIV at least once every three months can enter a prize drawing to win prizes, with larger chances for those correctly answering the weekly quizzes. The control group will receive the same HIV prevention information but without the incentives. The secondary outcomes include sexual risk behaviors and HIV infection. Specific Aim 3 includes 6 exit focus groups (with 5-8 participants per group) to evaluate areas for study improvement and estimate parameters for future scale up. The Specific Aims are to 1) develop MOTIVES and finalize the weekly text message information content and the types of incentives; 2) implement and evaluate the impact of MOTIVES; and 3) evaluate areas of improvement for MOTIVES through focus groups and estimate mission-critical design parameters with point and confidence interval estimates for a subsequent, fully-powered R01 application.

SUMMARY OF PHASE 1 Phase 1 developed the intervention parameters to inform the implementation of MOTIVES. The focus groups built on the preliminary study information and gathered data regarding specific barriers to receiving HIV prevention information, frequent testing, type of information, incentive and prize drawing parameters from MSM and TGW clients. The focus groups took between 60 to 90 minutes and were conducted by Dr. MacCarthy and Study Coordinator, Joanna Barreras in English or Spanish as preferred by the participants. Clients were provided a copy of the informed consent and received an overview of the study, the purpose of Phase 1, procedures, potential risks and discomforts, anticipated benefits, alternatives to participation, payment for participation, privacy and confidentiality. All focus groups were digitally recorded and translated into English when needed. All focus groups content was synthesized to produce summary memos on specific topics describing each theme, presenting segments of text as exemplars.

SUMMARY OF PHASE 2 Phase 2 will conduct a small RCT among 200 Bienestar clients that will be piloted with five participants. Quantitative data on primary (e.g., HIV knowledge and frequency of testing behavior) and secondary outcomes (e.g., self-reported sexual risk behavior - to determine how well participants translated their HIV prevention knowledge into behavior over the study period, and HIV status) will be collected.

Clients who express interest and are eligible will undergo the consent process. At enrollment, several steps will be taken to increase the confidentiality of participants related to text message communication. For example, HIV testers will instruct participants how to maintain privacy on their device, and delete SMS messages from their mobile device. At recruitment, HIV testers will ask the participant to save the number from which the messages will be sentas 'MOTIVES' so that the respondent easily recognizes the sender without increasing the chance of accidental disclosure of study participation. Further, participants will be reminded that they will receive texts on the same day every week (e.g., Wednesday and Friday) and at the same times of the week (e.g., 2 pm PST) to help them anticipate the arrival of study-related communication. The text message database will be secured by password protection, anonymized data, and managed onsite. The participant will then participate the baseline survey (details of the survey described later). The participant will then be randomized into either intervention or control group. The randomization of TGW will be performed separately from MSM to ensure equal distribution of TGW in both arms (approximately 90 MSM and 10 TGW in each arm). This is important because our pilot data suggests TGW experience much higher levels of risk and vulnerability to HIV compared to MSM and will represent a smaller percentage of the overall study population.

Follow-up surveys at 6 months and 12 months after enrollment: Our pilot data suggests that most participants will have access to the Internet and accommodations will be made for participants who are not able to access the Internet. The month 12 follow-up survey will have a reduced number of questions to complete. Participants will be asked to complete their final survey 12 months after enrollment. Thus the final survey will be conducted when the intervention period has ended and therefore completing the questions at a Bienestar testing location will not confound the outcome of interest. Those who do not complete their HIV test for that period can complete the final survey at Bienestar. The survey measures used have been successfully applied in our prior research among MSM and TGW. All measures described below will be assessed at baseline and 12 months, whereas a select few will be assessed at month six to keep the survey burden of the online surveys at the interim month survey low.