Background : Rates of HIV infection among transgender youth, including trans feminine, trans masculine and gender non-binary youth (hereafter: trans), are extremely high, particularly among trans women and trans men who have sex with men. Additionally, engagement in routine health care is sub-optimal due to structural barriers, provider attitudes, and perceived or actual experiences of stigma and discrimination. To address the disparities experienced by trans youth, the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) is conducting TechStep, a technology-facilitated stepped-care intervention to decrease sexual risks and increase PrEP uptake among HIV-negative trans youth in five US cities.
Methods : Trans youth, 15-24 years, will be randomized into one of three groups (N=250; ~n=83/group). Group 1: a text messaging intervention; Group 2: a WebApp intervention; Group 3: a website with basic information on trans health, HIV/STIs and community referrals. After the initial 3-month intervention period, participants in groups 1 and 2 who do not lower their sexual risks or do not initiate PrEP will be re-randomized to either continue with their original assigned intervention or to be stepped up by adding e-coaching to their original assigned intervention (i.e., text + e-coaching or WedApp + e-coaching). Assessments will occur at 3-month intervals for 9 months. Primary outcomes include sexual risk reduction and PrEP uptake.
Results : TechStep utilized a community-informed intervention development approach. Two trans-specific youth advisory boards (YABs) were formed, one in-person and one virtual. In Fall 2019, eight focus groups were conducted in Houston, Los Angeles, New York, and Philadelphia. Focus groups were stratified by age to gain perspectives of younger (15-20 years old) and older (21-24 years old) youth. Multiple text and WebApp intervention reiterations were made following the YAB meetings and focus groups.
Conclusions : Feedback from trans youth through multiple sources was critical in the development of the technology-facilitated interventions. Engagement of trans youth in the design and conduct of interventions tailored to their needs is a necessary component to address HIV risk in this vulnerable population. Lessons learned from this community-informed approach will describe how the feedback from trans youth translated into specific design and content.