Background : Young adult trans women experience a number of psychosocial barriers that stand as obstacles to linkage and retention in HIV care and ART medication adherence. Due to these challenges, a text-messaging intervention that is easily accessible, culturally responsive, private, and portable is a particularly salient method for engaging and retaining young adult trans women in HIV care. The Text Me, Girl! project utilized a theory-based text-messaging intervention to increase HIV care outcomes and promote physical health, with the desired outcome of virological suppression, among trans women, aged 18-34.
Methods : From December 2016 to May 2018, 130 trans women enrolled in the study. Over the course of the 90-day intervention, participants received 270 theory-based text messages that were targeted, tailored, and personalized for young adult trans women living with HIV; participants received three messages/day within a 10-hour unidirectional and automated delivery system. The text-message content was scripted along the HIV Care Continuum and based on theories of behavior change. Self-reported ACASI assessments were conducted at baseline and 3-, 6-, 12-, and 18-months post-enrollment.
Results : Most (89%) participants were trans women of color. The mean age was 29.5 years (SD=3.8); 41% had less than a high school diploma/GED; 44% were experiencing housing instability. From baseline to 6-month follow-up evaluation, engagement in HIV care, operationalized as a HIV care visit in the past 6 months, increased from 62% to 76% (χ2(1)=3.9, p=.047). The proportion of participants who were currently taking ART increased from 48% to 66% (χ2(1)=5.8, p=.016). Of those who reported ART uptake at baseline only 5% described their medication adherence as “excellent;” whereas, at 6-month follow-up 38% described their medication adherence as “excellent” (χ2(1)=19.6, p
Conclusions : Preliminary data indicates that the trans women in this sample responded well to the unidirectional text-message intervention. Advancement along the HIV Care Continuum was evidenced by improved engagement in HIV care, ART uptake and adherence, and viral suppression, all of which significantly increased at the 6-month follow-up evaluation. Longitudinal medical chart data will provide further indication of whether this innovative text-messaging intervention can produce sustained virological suppression and improve the health outcomes among young adult trans women living with HIV.