Background Adolescents are disproportionately affected by sexually transmitted infections (STIs), including HIV. Many youths with asymptomatic STI or related symptoms do not seek treatment and may not be screened if accessing the health care system for other reasons. Objective We examined intervention completion and changes in the number of new patients, the number of STI or HIV tests, and the sexual risk profile of patients over time to determine the feasibility and acceptability of a peer-driven text messaging strategy to connect youth to STI and HIV services. Methods The intervention enlisted consecutive patients at an adolescent medicine clinic to send a text message to 5 peers they believed were sexually active and lived in the clinic’s service area. The intervention was evaluated using an interrupted time-series design in which baseline clinic service levels were documented during a 35-week lead-in period, followed by a 20-week intervention implementation period, and a 16-week period of continued clinic observation. Clinic and patient data were obtained through chart abstraction from intake forms that occurred during the entire study period. Analyses conducted in 2015 used a generalized linear mixed model. Results Of the 153 patients approached to participate, 100 agreed to send SMS text messages. Most (n=55, 55%) reported no concerns with sending the text message. No adverse events or negative outcomes were reported. Adolescent STI testing, positive test results, and reported risk behavior increased post intervention, although this was not statistically significant, likely because of the small sample size. Conclusions Given low youth uptake of health care services, and STI/HIV screening, in particular, new strategies are needed to address access barriers. Common approaches for reaching youth are resource-intensive and often miss those not connected to school or community programs. The peer-based text messaging strategy showed promise for both increasing the number of youths accessing health services and finding youths engaging in sexual risk behaviors and most in need of sexual health screening and services.
BACKGROUND To understand the types of messages youth believe were motivating and persuasive when asked to text friends to encourage them to seek HIV/STI testing services at a neighborhood clinic. OBJECTIVE To understand the types of messages youth believe are motivating and persuasive when asked to text friends to encourage them to seek HIV/STI testing services at a neighborhood clinic. METHODS We implemented an adolescent peer-based text messaging intervention to encourage clinic attendance and increase STI and HIV testing among youth (n= 100) at an adolescent clinic in San Francisco, California. Participants were asked to send a text message to five friends they believed were sexually active to encourage their friends to visit the clinic and receive STI/HIV screening. Thematic analysis was employed to analyze the content of the text messages sent and received during the clinic visit. Member checking and consensus coding was used to ensure interrater reliability and significance of themes. RESULTS We identified 4 themes in the messages sent by participants: i) calls to action to encourage peers to get tested, ii) personalized messages with sender-specific information, iii) clinic information such as location and hours, and iv) self-disclosure of personal clinic experience. We found that nearly all text messages included some combination of 2 or more of these broad themes. We also found that youth were inclined to send messages they created themselves, as opposed to sending the same message to each peer, which they tailored to each individual to whom they were sent. Many (40%) received an immediate response to their message and most participants reported receiving at least one positive response, while few reported that they had received at least one negative response. There were some differences in responses by the type of message sent. CONCLUSIONS Given the high rates of STI and HIV and low rates of testing among adolescents, peer-driven text messaging interventions to encourage accessing care may be successful at reaching this population. This study suggests that youth are willing to text message their friends and there are clear types of messages they developed and utilized. Future research should employ these methods with a large, more diverse sample of youth and young adults for long-term evaluation of care seeking and care retention outcomes to make progress in reducing HIV/STI among adolescents and young adults.
UNSTRUCTURED Adolescents are disproportionately affected by sexually transmitted infections (STI), including HIV. Many youth with asymptomatic STI or related symptoms do not seek treatment and may not be screened if accessing the healthcare system for other reasons. We examined the feasibility and acceptability of a peer-driven, text messaging strategy to connect youth to STI and HIV services. Using an interrupted time series design consecutive patients at an adolescent medicine clinic were enlisted to send five text messages to peers they believed were sexually active and lived in the clinic's service area. Analyses conducted in 2015 used a generalized linear mixed model. Data were collected from 2013-2014. Of 153 patients approached to participate, 100 agreed to send text messages. Most (55%) reported no concerns with sending the text message. No adverse events or negative outcomes were reported. Adolescent STI testing, positive test results and reported risk behavior increased post intervention, although not statistically significant, likely because of the small sample size. Given low youth uptake of healthcare services and STI/HIV screening, in particular, new strategies are needed to address access barriers. Common approaches for reaching youth are resource-intensive and often miss youth not connected to school or community programs. The peer-based, text messaging strategy showed promise for both increasing the number of youth accessing health services and finding youth engaging in sexual risk behaviors and most in need of sexual health screening and services.
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