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Intervention IP-106: A Randomized Trial of an Online Risk Reduction Intervention for Young Black Men Who Have Sex with Men (MSM)

Summary

Young Black men who have sex with men (BMSM) bear a disproportionate burden of the HIV epidemic. HealthMpowerment.org (HMP), is a mobile optimized, online intervention to reduce sexual risk behaviors among young BMSM by providing information and resources, fostering social support, and including game-based elements. In a randomized controlled trial with 474 young BMSM, self-reported condomless anal intercourse at 3-months was 32% lower among those receiving HMP than those exposed to an information-only website (IRR 0.68, 95% CI: 0.43, 0.93); however, this effect was not sustained at 12 months.

Overview

Purpose of Intervention:

To reduce riskier sexual behaviors and build community among HIV-positive and negative young Black men who have sex with men and trans women through a mobile phone-optimized online intervention that utilizes behavior change and gaming theories

Intervention Type:

Research-Tested — Interventions with strong methodological rigor that have demonstrated short-term or long-term positive effects on one or more targeted health outcomes to improve minority health and/or health disparities through quantitative measures; Studies have a control or comparison group and are published in a peer-review journal; No pilot, demonstration or feasibility studies.

Intervention Details

Intervention was Primarily Driven, Led, or Managed by:

Academic/Clinical Researchers Only

Citations:

  • Hightow-Weidman LB, LeGrand S, Muessig KE, Simmons RA, Soni K, Choi SK, Kirschke-Schwartz H, Egger JR. A Randomized Trial of an Online Risk Reduction Intervention for Young Black MSM. AIDS and behavior. 2019 May;23(5):1166-1177. PubMedExternal Web Site Policy PubMed CentralExternal Web Site Policy DOIExternal Web Site Policy
    Relevance: Main Intervention
  • Muessig KE, Baltierra NB, Pike EC, LeGrand S, Hightow-Weidman LB. Achieving HIV risk reduction through HealthMpowerment.org, a user-driven eHealth intervention for young Black men who have sex with men and transgender women who have sex with men. Digital culture & education. 2014;6(3):164-182. PubMedExternal Web Site Policy PubMed CentralExternal Web Site Policy
    Relevance: Evaluations and Assessments
Adaptation of Another Research-based Intervention:

No

Contact Information

Primary Contact Name:

Lisa Hightow-Weidman

Primary Contact Affiliation:

Florida State University Institute on Digital Health and Innovation

Intervention URL:

https://healthmpowerment.org/

Primary Contact Email:

lhightowweidman@fsu.edu

Primary Contact Phone Number:

850-644-3296

Results

Intentions

Improve minority health or the health of other populations with health disparities (e.g. rural populations, populations with low SES, and sexual and gender minorities)

Intervention Primary Outcome:

Relative rate of self-reported condomless anal sex (CAI)

Intervention Secondary Outcome:

Efficacy of the intervention

Key Findings:

The rate of self-reported condomless anal intercourse (CAI) at 3-months was 32% lower in the intervention group compared to the control group (IRR 0.68, 95% CI 0.43, 0.93), however this effect was not sustained at 12 months. When adjusted for loss-to-follow-up, the rate of CAI at 3-months post-randomization was 26% lower in the intervention group compared to the control group (incidence rate ratio = 0.74, 95% CI: 0.46-0.99). At 3-months post randomization, the rate of CAI was 82% lower among HIV-positive participants with detectable viral loads in the intervention group compared to the control group (incidence rate ratio = 0.18, 95% CI: 0.04-0.32). When adjusted for loss-to-follow-up, the rate of CAI at 3-months post-randomization was 50% lower among HIV-positive participants with detectable viral loads in the intervention group compared to the control group (incidence rate ratio = 0.50, 95% CI: 0.12-0.89).

Statistical Method Used:

A generalized linear mixed modeling framework was used to estimate the effect of the HMP intervention on the change in the rate of CAI from baseline. A secondary analysis, the same models were fitted to data with acts of condomless serodiscordant anal intercourse as the outcome. To further investigate the efficacy of the HMP intervention among only those participants who complied with the intervention, we estimated the complier averaged causal effect (CACE).

Evaluations and Assessments

Were Any of the Following Assessments Conducted (Economic Evaluation, Needs Assessment, Process Evaluation)?:

No

Demographic and Implementation Description

Diseases, Disorders, or Conditions:

HIV/AIDS

Race/Ethnicity:

African American or Black

Populations with Health Disparities:

People with Lower Socioeconomic Status (SES), Racial and Ethnic Minority Populations, Sexual and Gender Minority (SGM) Groups

Age:

Young Adults (18 - 39 years)

Socio-demographics / Population Characteristics

Community Type:

Unspecified

Other Populations with Health Disparities:

People Living with HIV/AIDS

Gender Identity:

Male, Transgender

Sexual Orientation:

Bisexual, Gay, Unspecified

Geographic Location:

North Carolina

Socio-Economic Status:

Low SES

Minority Health and Health Disparities Research Framework

Levels of Influence
Individual Interpersonal Community Societal
Determinant Types Biological
Behavioral ✔ ✔
Physical / Built Environment
Sociocultural Environment ✔ ✔
Health Care System ✔ ✔

Community Involvement

The community's role in different areas of the Intervention (Choices are "No Role", "Participation", and "Leadership"):

Design:

Participation

Dissemination:

No Role

Evaluation:

No Role

Implementation:

Participation

Outreach:

Participation

Planning :

Participation

Recruitment:

Participation

Sustainability:

Participation

Characteristics and Implementation

Intervention Focus Area:

Behavior Change

Disease Continuum:

Primary Prevention, Secondary Prevention

Delivery Setting:

Online

Mode of Delivery:

Online/e-Health, m-Health (mobile)

Who delivered the Intervention?:

Healthcare Professional (Physician, Nurse, Technician), Peer(s), Researcher, software developer

Conceptual Framework

Intervention Theory:

None

Intervention Framework:

Integrated Behavior Model

Implementation

Intervention Study Design:

Individual Randomized Controlled Trial/Comparative (requires random assignment, a control/comparison group, and pre and post intervention outcome assessments)

Targeted Intervention Sample Size:

474

Actual Intervention Sample Size:

474

Start Year:

2013

End Year:

2015

Intervention Exposures

Duration of Intervention/How Long it Lasted:

1-3 months

Frequency of Intervention Delivery:

Participants could access the website as often and for as long as they wanted

Number of Sessions/Meetings/Visits/Interactions:

3-4 Sessions

Average Length of Each Session/Meeting/Visit/Interaction:

1-2 Hours

Format of Delivery:

Individual

Highest Reading Level of Intervention Materials Provided to Participants:

Grade 6-7

Impact, Lessons, Components

Produced an impact or change beyond the primary or secondary outcome:

Yes

Improved HIV-related communication (e.g., provider communication, HIV status disclosure to sexual partners) and improved HIV care outcomes (e.g., perceived barriers to treatment access, engagement in care, self reported adherence).

Essential Aspects for Success:

Digital platform free of bugs and issues with ongoing technical support from developers are essential. Super users or engagement from a youth advisory board and Subject Matter Research Consultants (SMRCs) help support conversation in forums.

Intervention Impact:

Improved HIV-related communication (e.g., provider communication, HIV status disclosure to sexual partners) and improved HIV care outcomes (e.g., perceived barriers to treatment access, engagement in care, self reported adherence).

Lessons Learned

Key Lessons Learned and/or Things That Could be Changed or Done Differently:

Bring in community/youth stakeholders to help with participant communication on the intervention for greater participant engagement.

Insights Gained During Implementation

Insight Category Insight Description
Equipment / Technologies Preferable to have a mobile app than mobile-optimized website.
Staffing Beneficial to hire youth/community advisors to help inform intervention design and implementation.
Recruitment Dating apps and social media site are very fruitful recruitment sources, and enrollment can be done 100% online.

Intervention Components

Intervention Has Multiple Components:

Yes

Assessed Each Unique Contribution:

No

Products, Materials, and Funding

Expertise, Partnerships, and Funding Sources
Used for Implementation Needed for Sustainability
Expertise

Health Education / Health Literacy

 Yes Yes

Technology

 Yes Yes
Partnerships

Mobile/Information Technology (e.g. information/mobile/electronic)

 Yes Yes
Funding Sources

Public funding (e.g., federal, state or local government)

 Yes Yes

Product/Material/Tools

Tailored For Language Language(s) if other than English Material
Outreach/Recruitment Tools

Publicity Materials (e.g. Posters, Flyers, Press Releases)

No

Attachment available for request at the bottom of the page.
Participant Educational Tools

Videos

No

 https://healthmpowerment.org/ 

Videos

No

 https://healthmpowerment.org/ 
Measurement Tools

Not available

No

No measurement tools were available.

Implementation Materials and Products

Material
Implementation/Delivery Materials
No Implementation/Delivery Materials provided.
Implementation/Output Materials
No Implementation/Output Materials provided.

Articles Related to Submitted Intervention

Article
Reports/Monographs
No Reports/Monographs provided.
Additional Articles

Evaluation

Attachment available for request at the bottom of the page.

Qualitative findings

Attachment available for request at the bottom of the page.

Development

Attachment available for request at the bottom of the page.

Materials Available for Request

  • flyer_hMp_2013_new_proof2.pdf
  • Hightow-Weidman_AIDS and Behav_2018.pdf
  • Barry_HMP Stigma_AIDSCare_2019.pdf
  • LHW_Health Educ Behav_2015.pdf