Engagement in Coaching for Youth at Risk for HIV

Introduction: Mobile health (mHealth) interventions are an important part of the lives of youth in today’s society. Youth use mobile technologies to connect with others as an important part of their peer relationships. The use of technology to engage youth at high risk for HIV (YHR) has become part of many evidence-based interventions in the past decade focused on encouraging uptake to the HIV Prevention Continuum (i.e., uptake of repeat HIV testing, a consistent prevention strategy [pre-exposure prophylaxis [PrEP], post-exposure prophylaxis [PEP], or condom use], retention in medical care, and treatment of comorbid conditions). While specific engagement strategies are seldom described, engagement is critical to the success of these interventions.

Methods: We are delivering three mHealth interventions for YHR (n=1340) in a randomized controlled trial that is part of the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN). Our coaching intervention, delivered by paraprofessional peers, is based on a strengths-based model that focuses on establishing a positive, empowering relationship with YHR by first assessing their strengths in a variety of life domains. YHR then identify personalized, measurable treatment goals that are addressed with coaching in-person and via text messaging and phone sessions over 24 months. Coaching sessions use skills common to existing evidence-based interventions, such as problem-solving, role playing, relaxation, and cognitive skills. YHR can also reach out via text messaging or phone calls as needed for support outside of coaching sessions.

Results: Engaging youth in mHealth interventions can be challenging, especially getting youth to initiate involvement given the other competing demands in their lives and the lack of consistent and reliable methods of communication. Many YHR are dealing with multiple life stressors and change locations and contact information frequently. For coaching engagement, actively reaching out to youth via a variety of methods to initiate coaching, helping youth accomplish goals early into the coaching intervention, maintaining ongoing contact, and promoting availability of support when real-time needs arise, can help engagement and retention. Youth can interact with coaches in their natural environments at the times when they need the intervention, which allows for flexibility that is not always present in HIV interventions.

Conclusions: There are specific strategies that can improve engagement in mHealth coaching interventions that rely on continued assessment of impact and adaption when needed. Successful engagement and retention must focus on ways to maintain contact with a population that can be difficult to track over time.