Text Messaging to Improve Linkage, Retention, and Health Outcomes Among HIV-Positive Young Transgender Women: Protocol for a Randomized Controlled Trial (Text Me, Girl!)

Abstract

Background Transgender women in the United States experience numerous risk factors for HIV acquisition and transmission, including increased rates of homelessness, alcohol and drug use, sex work, and nonprescribed hormone and soft tissue–filler injections. In addition, transgender women face discrimination and social/economic marginalization more intense and deleterious than that experienced by lesbian, gay, or bisexual individuals, further worsening health outcomes. Although little research has been done specifically with young transgender women aged 35 years and younger, existing evidence suggests even further elevated rates of homelessness, substance use, and engagement in HIV transmission risk behaviors relative to their older transgender women and nontransgender young adult counterparts. Young transgender women living with HIV experience a range of barriers that challenge their ability to be successfully linked and retained in HIV care. Objective The aim of this randomized controlled trial, Text Me, Girl!, is to assess the impact of a 90-day, theory-based, transgender-specific, text-messaging intervention designed to improve HIV-related health outcomes along the HIV care continuum among young (aged 18-34 years) transgender women (N=130) living with HIV/AIDS. Methods Participants were randomized into either Group A (immediate text message intervention delivery; n=61) or Group B (delayed text message intervention delivery whereby participants were delivered the text-messaging intervention after a 90-day delay period; n=69). Over the course of the 90-day intervention, participants received 270 theory-based text messages that were targeted, tailored, and personalized specifically for young transgender women living with HIV. Participants received 3 messages per day in real time within a 10-hour gradual and automated delivery system. The text-message content was scripted along the HIV care continuum and based on social support theory, social cognitive theory, and health belief model. The desired outcome of Text Me, Girl! was virological suppression. Results Recruitment began on November 18, 2016, and the first participant was enrolled on December 16, 2016; enrollment closed on May 31, 2018. Intervention delivery ended on November 30, 2018, and follow-up evaluations will conclude on August 31, 2019. Primary outcome analyses will begin immediately following the conclusion of the follow-up evaluations. Conclusions Text messaging is a communication platform well suited for engaging young transgender women in HIV care because it is easily accessible and widely used, as well as private, portable, and inexpensive. Text Me, Girl! aimed to improve HIV care continuum outcomes among young transgender women by providing culturally responsive text messages to promote linkage, retention, and adherence, with the ultimate goal of achieving viral suppression. The Text Me, Girl! text message library is readily scalable and can be adapted for other hard-to-reach populations. International Registered Report Identifier (IRRID) DERR1-10.2196/12837

Technology-Based Stepped Care to Stem Transgender Adolescent Risk Transmission: Protocol for a Randomized Controlled Trial (TechStep)

“…Thus, participants will receive a text message approximately every 5 hours starting at either 9:00 AM or noon local time (eg, at noon, at 5:00 PM, and at 10:00 PM). Timing was determined based on findings from the 3 previous text messaging studies conducted by the Protocol Co-Chair [ 30 - 32 ] and supported by feedback from focus group participants. Participants will select whether to start receiving messages in the morning, starting at 9:00 AM, or in the afternoon, starting at noon.…”

Information and communication technology-based health interventions for transgender people: A scoping review

“…For example, the interventions iTab [80], Text Me, Girl! [74], TechStep [57] and CARE+ SMS [81] sent pre-developed daily motivational text messages to participants in order to encourage adherence to PrEP or HIV treatment, and to promote emotional health. Some interventions, such as the PrEPmate study [42], utilised a bidirectional automated response system which required participants to respond to 'check in' messages asking about their PrEP use.…”

Transgender Individuals and Digital Health

“…Project Moxie used a remote video-chat counseling intervention to facilitate HIV self-testing that was found to be highly acceptable to participants and increased willingness to use PrEP [ 83 ]. Text Me, Girl!, an RCT, which provided trans-feminine young adults (ages 18–34) living with HIV with supportive text messages, demonstrated significant outcomes for increased antiretroviral treatment (ART) uptake, engagement in care, excellent ART adherence, and viral suppression by the 18-month follow-up [ 84 ]. A third study, Trans Women Connected, showed preliminary usability and acceptability of the mobile phone app as well preliminary effects in self-efficacy seeking transgender and queer-friendly health services, intentions to find online support, and knowledge of pre-exposure prophylaxes (PrEP) as HIV prevention [ 85 ].…”