+CLICK: harnessing web-based training to reduce secondary transmission among HIV-positive youth

Abstract

Adolescents and young adults account for over 10 million HIV infections worldwide. Prevention of secondary transmission is a major concern as many HIV-positive youth continue to engage in risky sexual behavior. This study pilot-tested "+CLICK", an innovative, web-based, sexual risk reduction intervention for HIV-positive youth as an adjunct to traditional clinic-based, self-management education. The theory-based application, developed for perinatally and behaviorally infected youth 13-24 years of age, provides tailored activities addressing attitudes, knowledge, skills, and selfefficacy related to sexual risk reduction. HIV-positive youth (N = 32) pilot-tested "+CLICK" to assess usability (ease of use, credibility, understandability, acceptability, motivation) and short-term psychosocial outcomes (importance and self-efficacy related to abstinence and condom use) using a single group, pre-/post-test study design in a hospital-based pediatric clinic and community locations. A subsample of participants (n = 20) assessed feasibility for clinic use. Participants were 62.5% female, 68.8% Black, and 28.1% Hispanic. Mean age was 17.8 years (SD = 2.55), 43.8% were infected behaviorally, 56.2% perinatally, and 68.8% were sexually experienced. Usability ratings were high: 84.4% rated the application very easy to use; 93.8% perceived content as trustworthy; 87.5% agreed most words were understandable; 87.5% would use the application again. Short-term psychosocial outcomes indicate a significant increase in condom use self-efficacy (p = 0.008) and positive trends toward importance (p = 0.067) and self-efficacy (p = 0.071) for waiting before having sex. Regarding feasibility, participants accessed "+CLICK" during waiting periods (average time, 15 minutes) in their routine clinic visit. Clinic staff rated "+CLICK" highly in providing consistent, confidential, and motivational sexual health education without significant disruption to clinic flow. Results suggest that the application is a feasible tool for use in the clinic and has the potential to affect psychological antecedents to sexual behavior change. Further research on long-term and behavioral effects is indicated prior to broader dissemination into clinical practice.

Self-management interventions for people living with human immunodeficiency virus: A scoping review

“…Benefits of this method of service delivery include confidentiality and self-directed learning pace (Markham et al, 2009;Shegog et al, 2012). However, technology-based interventions may be inaccessible to PHAs from marginalized groups, who may be unfamiliar with, or not have access to, different forms of technology.…”

Providing Effective Medical and Case Management Services to HIV-Infected Youth Preparing to Transition to Adult Care

“…For example, a computer-based individualized prevention program called 1 Click can be completed during waiting times at medical appointments (Markham, Shegog, Leonard, Bui, & Paul, 2009). Small group interaction through the Be Healthy/Act Safe Program has also been shown to reduce risk behaviors in HIV-infected youth (Rotheram-Borus et al, 2001) and can be implemented in a variety of settings.…”

Sexual health promotion for young people delivered via digital media: a scoping review

“…Targeting populations with particular conditions in the clinical setting means that interventions reach them when they are a captive audience. 118,128 Particular settings may favour the particular sociodemographic groups of interest, for example sexual health clinics can provide easy access to high numbers of young people at relatively high risk, but, again, the advantages may be offset by excluding a proportion of those not in touch with services and who may have the greatest needs. Assessing service-use characteristics of the target population is an essential part of intervention development, as reaching them in a clinical setting is a potentially quick, cheap and easy way to ensure that they are preferentially accessed.…”

“…67,68,[110][111][112][113][114][115] Interventions that mainly target prevention of unintended pregnancy were identified less frequently, even in examples of interventions in which the target population was female. 67,68,113,116 However, there are good examples of IDIs that take a combined approach to STIs/HIV and pregnancy prevention, 109,117,118 in keeping with integration as a sexual health policy and practice priority throughout the UK. 4,57 Integrated sexual health provision remains poorly defined in both policy and practice.…”

“…113,127,143,144,208 Locations that are frequently accessed by the target population can be identified to maximise reach, using face-to-face methods. 118,127,153,209 This approach provides straightforward and quantifiable access where coverage and fidelity to the intervention (such as number of visits to the site and dosage) are generally higher and can be more easily measured. Nonetheless, sexual health clinic attendees also often attend on a once-only basis, limiting the opportunity for follow-up access and requiring either that interventions have impact in a single use or that ongoing online interaction is maintained.…”