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Randomized Controlled Trial
. 2021 Oct;25(10):3437-3448.
doi: 10.1007/s10461-021-03237-5. Epub 2021 May 7.

A Pilot RCT Evaluating InThistoGether, an mHealth HIV Prevention Program for Ugandan Youth

Michele L Ybarra  1 , Edgar Agaba  2 , Novatus Nyemara  2   3
Affiliations
Randomized Controlled Trial

A Pilot RCT Evaluating InThistoGether, an mHealth HIV Prevention Program for Ugandan Youth

Michele L Ybarra et al. AIDS Behav. 2021 Oct.

Abstract
in English, Spanish

Despite data suggesting that older adolescence is an important period of risk for HIV acquisition in Uganda, tailored HIV prevention programming is lacking. To address this gap, we developed and tested nationally, InThistoGether (ITG), a text messaging-based HIV prevention program for 18-22 year-old Ugandan youth. To assess feasibility and acceptability, and preliminary indications of behavior change, a randomized controlled trial was conducted with 202 youth. Participants were assigned either to ITG or an attention-matched control group that promoted general health (e.g., self-esteem). They were recruited between December 2017 and April 2018 on Facebook and Instagram, and enrolled over the telephone. Between 5-10 text messages were sent daily for seven weeks. Twelve weeks later, the intervention ended with a one-week 'booster' that reviewed the main program topics. Measures were assessed at baseline and intervention end, 5 months post-randomization. Results suggest that ITG is feasible: The retention rate was 83%. Ratings for the content and program features met acceptability thresholds; program experience ratings were mixed. ITG also was associated with significantly higher rates of condom-protected sex (aIRR = 1.68, p < 0.001) and odds of HIV testing (aOR = 2.41, p = 0.03) compared to the control group. The odds of abstinence were similar by experimental arm however (aOR = 1.08, p = 0.86). Together, these data suggest reason for optimism that older adolescent Ugandans are willing to engage in an intensive, text messaging-based HIV prevention programming. Given its wide reach and low cost, text messaging should be better utilized as an intervention delivery tool in low-income settings like Uganda. Findings also suggest that ITG may be associated with behavior change in the short-term. (Trial registration: ClinicalTrials.gov ID# NCT02729337).

A pesar de que los datos sugieren que la adolescencia mayor es un período importante de riesgo de contraer el VIH en Uganda, hace falta una programación de prevención del VIH personalizados. Para abordar esta brecha, desarrollamos y probamos a nivel nacional, InThistoGether (ITG), un programa de prevención del VIH basado en mensajes de texto para jóvenes ugandeses de 18 a 22 años. Para evaluar la viabilidad y aceptabilidad, y las indicaciones preliminares del cambio de comportamiento, se realizó un ensayo controlado aleatorio con 202 jóvenes. Los participantes fueron asignados a ITG o a un grupo de control de atención que promovía la salud general (p.ej., la autoestima). Fueron reclutados entre diciembre de 2017 y abril de 2018 en Facebook e Instagram y se inscribieron por teléfono. Se enviaron entre 5 y 10 mensajes de texto diariamente durante siete semanas. Doce semanas después, la intervención terminó con un "refuerzo" de una semana que repasó los principales temas del programa. Las medidas se evaluaron al inicio y al final de la intervención, 5 meses después de la aleatorización. Los resultados sugieren que ITG es factible: la tasa de retención fue 83%. Las calificaciones del contenido y las características del programa alcanzaron los umbrales de aceptabilidad; las calificaciones de experiencia del programa fueron mixtas. La ITG también se asoció con tasas significativamente más altas de relaciones sexuales protegidas con condón (aIRR = 1.68, p < 0.001) y probabilidades de pruebas de VIH (aOR = 2.41, p = 0.03) en comparación con el grupo de control. Sin embargo, las probabilidades de abstinencia fueron similares en el grupo experimental (ORa = 1,08, p = 0,86). Juntos, estos datos sugieren razones para el optimismo de que los adolescentes ugandeses mayores están dispuestos a participar en un programa intensivo de prevención del VIH basado en mensajes de texto. Dado su amplio alcance y bajo costo, los mensajes de texto deberían utilizarse como una herramienta de entrega de intervenciones en lugares de bajos ingresos como Uganda. Los hallazgos también sugieren que ITG puede estar asociada con cambios de comportamiento a corto plazo.

Keywords: Adolescents; HIV prevention; MHealth; Uganda.

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Conflict of interest statement

Conflict of interest The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
CONSORT diagram for InThistoGether (ITG) Pilot RCT
See this image and copyright information in PMC

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