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Despite the proven efficacy of pre-exposure prophylaxis (PrEP) in preventing HIV acquisition, PrEP is underutilized by sexual and gender minority young adults in the 13 states in the United States “South.” In this paper, we describe the process we used to develop a digital campaign to promote awareness and engagement of sexual and gender minority young adults in the Louisiana Department of Health’s TelePrEP Program and provide campaign performance metrics. In Phase 1, we conducted formative research that informed campaign development and strategy. In total, 109 sexual and gender minority young adults completed a survey of PrEP constructs (e.g., facilitators, barriers). We also conducted three, sequential focus groups to iteratively generate, revise and refine the digital material. In collaboration with our strategic marketing partner (SMP), we developed 3 different ads and 1 video ad to promote on web and mobile-in app display, as well as Facebook, Instagram, and YouTube. Phase 2 focused on campaign implementation and evaluation (e.g., number of impressions, user activities on LA TelePrEP landing page). In the first few weeks of the campaign, data from tracking pixels indicated minimal activities on the landing page. We paused to revamp the campaign. Our SMP determined that a more young adult-focused landing page could bolster engagement. We created a new landing page and reran the campaign for 33 days. We saw substantially more user activities on the new landing page (n = 382) compared to the LA TelePrEP landing page (n = 185). Overall, we had 730,665 impressions and 475 link clicks. By collaborating with our SMP, we effectively and efficiently translated our community-engaged formative research into relevant and engaging digital content. This pilot study is one of the first to demonstrate the importance of using tracking pixels to monitor real-time user data to optimize performance of a digital PrEP campaign.

Objectives. To evaluate the effectiveness of an evidence-based, parent-centered intervention, Familias Unidas, delivered by nonresearch personnel, in preventing substance use (alcohol, illicit drugs) and sex without a condom among Hispanic adolescents. Methods. A randomized controlled trial (n = 746) evaluated the effectiveness of Familias Unidas among Hispanic eighth graders (age range = 12–16 years), relative to prevention as usual, within a public school system. School personnel, including social workers and mental health counselors, were trained to deliver the evidence-based intervention. Participant recruitment, intervention delivery, and follow-up ran from September 2010 through June 2014 in Miami–Dade County, Florida. Results. Familias Unidas was effective in preventing drug use from increasing and prevented greater increases in sex without a condom 30 months after baseline, relative to prevention as usual. Familias Unidas also had a positive impact on family functioning and parental monitoring of peers at 6 months after baseline. Conclusions. This study demonstrated the effectiveness of a parent-centered preventive intervention program in preventing risky behaviors among Hispanic youths. Findings highlight the feasibility of training nonresearch personnel on effectively delivering a manualized intervention in a real-world setting.

Despite the availability of efficacious and effective family-based interventions, such interventions are scarce for sexual minority adolescents, particularly among ethnic/racial minorities. Prior to creating an entirely new intervention, a prudent first step may be to determine if existing interventions are efficacious in reducing risk behaviors in sexual minority adolescents. This study assesses the relative efficacy of a general, family-based intervention (Familias Unidas) on improving substance and condom use outcomes among Hispanic adolescents with same gender sexual behaviors (HASGB). Data across five distinct trials of Familias Unidas were synthesized. HASGB were randomized either to an intervention (n = 94) or control condition (n = 100). Mediation analyses tested for intervention efficacy on past 90-day substance (cigarette/alcohol/illicit drug) use and condomless sex at last intercourse in HASGB participants and whether family functioning indicators—parent–adolescent communication, positive parenting, and parental monitoring of peers—mediated the effects. Post hoc analyses explored the moderating role of study target population based on prior risk. Familias Unidas did not impact substance use but significantly reduced condomless sex postintervention relative to the control condition. Hypothesized mediators did not explain this effect. Post hoc analyses indicated that the effect was significant in studies that recruited based on prior risk but not studies that recruited universal samples. Our results suggest that a general, family-based intervention may have positive effects on condom use in HASGB, particularly those with prior indicated risk. Identifying intervention components that drive this effect in addition to developing tailored content for HASGB is needed.

The COVID-19 pandemic illuminated the benefits of telemedicine. Self-collected specimens are a promising alternative to clinician-collected specimens when in-person testing is not feasible. In this study, we assessed the adequacy of self-collected pharyngeal and rectal specimens for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae among individuals undergoing chlamydia and gonorrhea screening. We used data from a large cohort study that included male and female adolescents between the ages of 12-24 years. We considered self-collected specimens adequate for clinical use if the human synthase gene (a control target of the assay) was detected in the specimen. In total, 2,458 specimens were included in the analysis. The human synthase gene was detected in 99.2% (2,439/2,458) of all self-collected specimens, 99.5% (1,108/1,114) of the pharyngeal specimens, and 99.0% (1,331/1,344) of the rectal specimens. Self-collected pharyngeal and rectal specimens demonstrated a very high proportion of human gene presence, suggesting that self-collection was accurate. A limitation of this study is that the sample adequacy control detects the presence or absence of the human hydroxymethylbilane synthase gene, but it does not indicate the specific anatomic origin of the human hydroxymethylbilane synthase gene. Self-collected specimens may be an appropriate alternative to clinician-collected specimens.

Sexual and gender minority (SGM) adolescents and young adults (AYAs) are at increased risk of HIV infection, particularly in the Southern United States. Despite the availability of effective biomedical prevention strategies, such as pre-exposure prophylaxis (PrEP), access and uptake remain low among SGM AYAs. In response, the Louisiana Department of Health initiated the LA TelePrEP Program, which leverages the power of telemedicine to connect Louisiana residents to PrEP. A virtual TelePrEP Navigator guides users through the enrollment process, answers questions, schedules appointments, and facilitates lab testing and medication delivery. To increase the participation of SGM AYAs in the program, the TelePrEP program partnered with researchers to develop a chatbot that would facilitate access to the program and support navigator functions. Chatbots are capable of carrying out many functions that reduce employee workload, and despite their successful use in health care and public health, they are relatively new to HIV prevention. In this paper, we describe the iterative and community-engaged process that we used to develop an SMS text messaging-based chatbot tailored to SGM AYAs that would support navigator functions and disseminate PrEP-related information. Our process was comprised of 2 phases: conceptualization and development. In the conceptualization phase, aspects of navigator responsibilities, program logistics, and user interactions to prioritize in chatbot programming (eg, scheduling appointments and answering questions) were identified. We also selected a commercially available chatbot platform that could execute these functions and could be programmed with minimal coding experience. In the development phase, we engaged Department of Health staff and SGM AYAs within our professional and personal networks. Five different rounds of testing were conducted with various groups to evaluate each iteration of the chatbot. After each iteration of the testing process, the research team met to discuss feedback, guide the programmer on incorporating modifications, and re-evaluate the chatbot's functionality. Through our highly collaborative and community-engaged process, a rule-based chatbot with artificial intelligence components was successfully created. We gained important knowledge that could advance future chatbot development efforts for HIV prevention. Key to the PrEPBot's success was resolving issues that hampered the user experience, like asking unnecessary questions, responding too quickly, and misunderstanding user input. HIV prevention researchers can feasibly and efficiently program a rule-based chatbot with the assistance of commercially available tools. Our iterative process of engaging researchers, program personnel, and different subgroups of SGM AYAs to obtain input was key to successful chatbot development. If the results of this pilot trial show that the chatbot is feasible and acceptable to SGM AYAs, future HIV researchers and practitioners could consider incorporating chatbots as part of their programs. PRR1-10.2196/42983.

Measures of sexual orientation and family functioning are widely used among sexual minority populations. However, data on whether these measures are culturally syntonic and responsive to the needs of a particular population, such as Hispanic sexual minority youth (HSMY), are lacking. Therefore, this study assessed whether HSMY understand measures of sexual orientation and family functioning as intended. Authors conducted individual interviews with five HSMY to evaluate the face validity of a measure of sexual orientation (i.e., Klein Sexual Orientation Grid) and measures of family functioning (i.e., Parent–Adolescent Communication Scale, Parenting Practices Scale, Parental Monitoring of Peers). Data were analyzed using a general inductive approach. For the sexual orientation measure, five themes were identified related to the: (1) clarity of questions, (2) challenging nature of questions, (3) difficulty of responses, (4) suggestions to improve response options, and (5) need for questions to include gender identity. For family functioning, three themes were identified: (1) relevance of the measures to sexual minority youth, (2) the importance of understanding family history and cultural context, and (3) capturing the context of how sexual minority status and disclosure impact family functioning. HSMY had generally positive feedback regarding these measures; however, they also suggested specific changes associated with wording and specificity of the measures to make them more relevant to HSMY’s unique needs.

Sexual and gender minority (SGM) and racial or ethnic minority youth at-risk for or living with HIV may have higher risk of SARS-CoV-2 infection. However, there are few data on vaccine hesitancy/acceptance and COVID-19 self-protective behaviors among this population. Youth aged 15–24 years (n = 440), predominantly African American and Latine (73%, n = 320) SGM, from Los Angeles and New Orleans reported their vaccine attitudes and COVID-19 and HIV preventive behaviors in October 2020. Latent class analyses categorized individuals into groups based on their vaccine attitudes and preventive behaviors. Relationships between these groups and other factors were analyzed using Fisher’s exact tests, ANOVA, and logistic regression. Most youth had accepting vaccine attitudes (70.2%, n = 309), with 20.7% hesitant (n = 91), and 9.1% resistant (n = 40). SGM and African Americans were significantly less accepting than their cis-gender and heterosexual peers. About two-thirds (63.2%, n = 278) of the respondents reported consistent COVID-19 self-protective behaviors. Youth with pro-vaccine attitudes were most consistently self-protective; however, only 54.4% (n= 168/309) intended to take a COVID-19 vaccine. Homelessness history, race, and sexual orientation were associated with vaccine attitudes. Accepting vaccine attitudes and consistent COVID-19 self-protective behaviors were closely related. COVID-19 attitudes/behaviors were not associated with HIV risk and only loosely associated with SARS-CoV-2 vaccine intentions.

Compared to non-Hispanic whites, Hispanic adolescents in the U.S. report higher rates of several mental, emotional, and behavioral problems such as substance use, sexual risk behaviors, and internalizing and externalizing problems. There is evidence of common pathways in the development of mental, emotional, and behavioral problems with certain subgroups of Hispanic adolescents being at greater risk. In the present article, we report analysis of baseline data for 959 Hispanic adolescents who participated in one of two randomized controlled trials evaluating a family-based preventive intervention. Utilizing latent class analysis, we identified subgroups of Hispanic adolescents based on socio-ecological risk and protective factors (e.g., parent–adolescent communication, parental involvement in school). Three distinct socio-ecological risk subgroups (high, medium, and low risk) were identified and exhibited significant differences from each other across a majority of socio-ecological risk and protective factors. Adolescents in higher socio-ecological risk subgroups reported greater mental, emotional, and behavioral problems across all outcomes. Individual comparisons revealed significant differences between the low socio-ecological risk group and both the medium and high socio-ecological risk group in lifetime alcohol use, smoking, and sex, as well as internalizing and externalizing problems. Implications for intervention include focusing on specific risk subgroups and targeting shared risk and protective factors rather than specific mental, emotional, and behavioral outcomes.

The substance use, violence, and AIDS (SAVA) syndemic framework is used to study risk for HIV/AIDS. As a secondary analysis from a large HIV/AIDS prevention study, we categorized participants into having from zero to three SAVA conditions based on the presence or absence of self-reported substance use in the past 4 months, history of lifetime sexual abuse, and intimate partner violence. We used Poisson regression models to examine the association between the number of SAVA conditions and sexual risk behavior. Among all participants (n = 195, median age, 20), 37.9%, 19.5%, and 6.7% reported occurrence of one, two, and all three SAVA conditions, respectively. We found that more than one SAVA condition experienced by women was significantly associated with having more than one sex partner (adjusted prevalence ratio [aPR] = 1.88; 95% confidence interval [CI] = 1.28, 2.76) and with substance use before sex (aPR = 1.61 95% CI = 1.06, 2.45).

In response to the COVID-19 pandemic, our team adjusted study procedures to support research staff wellbeing. ATN CARES is a community-based, adolescent-focused HIV research program. Our participants and frontline staff alike are predominantly Black or Latinx sexual and gender minorities. Senior researchers and staff collaborated to refine our procedures, anticipating stay-at-home orders in March 2020. Transition to virtual space appeared seamless; however, we did not foresee that staff would have the additional role of providing COVID-19-related informational and emotional support to participants. This and the added strain of working remotely were increasing staff stress and in general negatively affecting staff wellbeing. Leveraging staff interests and skills, staff and senior researchers developed purposeful ways to stay connected and alleviate these strains, including exercise sessions; professional development workshops; motivational messages; and games. These proved beneficial and serve as a reminder that wellbeing of staff—our frontline heroes—is vital to a successful research project.