Session: Moving Toward a Cure: Strategies to Treat and Prevent HIV in the United States for Adolescents and Young Adults (Society for Prevention Research 27th Annual Meeting)

Global donors have set the goal of “Getting to Zero HIV infections” because of the ability of antiretroviral medications (ARV) to both prevent HIV and to reduce transmission from infected persons and to increase the length and quality of their life. Yet, HIV among adolescents has remained a significant challenge, especially domestically, where youth reflect over 20% of the HIV diagnoses. Youth have the lowest rates of uptake and adherence to ARV and are least aware of their HIV status. Therefore, we have designed a randomized controlled trial (RCT) to examine three interventions, varying in intensity and cost, to promote prevention among uninfected youth at high risk (YHR). Seronegative youth with multiple, overlapping risks are being recruited from 13 community-based organizations, clinics, drop-in centers, and shelters in Los Angeles and New Orleans (N=903): gay, bisexual, and transgender youth (GBTY, 60%), homeless youth (62%), substance-abusing youth (73%), youth with criminal justice contact (37%), and youth with inpatient mental health treatment (40%), particularly those who are Black and Latino (84%). YHR are randomized to one four conditions: 1) an automated messaging and weekly monitoring program (AMMI) delivered via text messages; 2) a peer support intervention delivered via social media forums; 3) coaching, delivered via text-message, phone, in-person, or telehealth contacts; or 4) a combined intervention with all interventions. The primary outcomes are assessing youths’ uptake, retention, and adherence in the HIV Prevention Continua (engaging and being retained in medical care; getting repeatedly tested for HIV quarterly, using ARV as pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), or consistent condom use; and getting tested and treated for sexually transmitted infections. Repeat assessments are conducted every four months over 24 months to evaluate the interventions. This symposium will have four presentations: there will be three presentations, one for each intervention modality, on the engagement, uptake, and the qualitative responses of YHR to each of the intervention conditions. For example, the AMMI intervention has about a 40% response rate to the weekly monitoring, a rate similar to studies with adults at high risk of HIV. Engagement in coaching slowly increases over time from a texting relationship, to an in-person contact, which then cements the relationship over time. The final presentation will summarize the outcomes over 12 months for the first 350 youth recruited into the program. The discussant will examine the implications of this study for urban communities nationally, as well as how the demographic differences between New Orleans and Los Angeles required adaptation to the program, as well as comparing this RCT to a parallel study with youth living with HIV.