Strategies to Facilitate Service Utilization Among Youth at Risk for HIV: A Randomized Controlled Trial (ATN 149).
Dallas Swendeman, Mary Jane Rotheram-Borus, Elizabeth Mayfield Arnold, Maria Isabel Fern��ndez, W Scott Comulada, Kelsey Ishimoto, William Gertsch, Debra A Murphy, Manuel Ocasio, Sung-Jae Lee, Katherine A Lewis, Adolescent HIV Medicine Trials Network (ATN) CARES Team
Author Information
Dallas Swendeman: Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza, Suite 37-360A, Los Angeles, CA, 90024, USA. DSwendeman@mednet.ucla.edu. ORCID
Mary Jane Rotheram-Borus: Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza, Suite 37-360A, Los Angeles, CA, 90024, USA.
Elizabeth Mayfield Arnold: Department of Psychiatry, University of Kentucky, Lexington, USA.
Maria Isabel Fern��ndez: College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA.
W Scott Comulada: Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza, Suite 37-360A, Los Angeles, CA, 90024, USA.
Kelsey Ishimoto: Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza, Suite 37-360A, Los Angeles, CA, 90024, USA.
William Gertsch: Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza, Suite 37-360A, Los Angeles, CA, 90024, USA.
Debra A Murphy: Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza, Suite 37-360A, Los Angeles, CA, 90024, USA.
Manuel Ocasio: Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA.
Sung-Jae Lee: Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza, Suite 37-360A, Los Angeles, CA, 90024, USA.
Katherine A Lewis: Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza, Suite 37-360A, Los Angeles, CA, 90024, USA.
Sexual and gender minority youth (SGMY) are vulnerable to acquiring HIV and need HIV prevention and health services, but may have competing needs. A prior analysis found that PrEP use reports increased in a combination intervention study arm with coaching, peer support, and automated text-messages. This paper examines ancillary support and healthcare services utilization as secondary intervention objectives. SGMY (N���=���895, 40% Black, 29% Latino) in Los Angeles and New Orleans were recruited from May, 2017 to August, 2019 and randomized to four intervention conditions: (a) automated text-messaging and monitoring intervention (AMMI), (b) AMMI plus peer support online (AMMI+PS), (c) AMMI plus strengths-based coaching by near-peer paraprofessionals (AMMI+C), or (d) all three (AMMI+PS+C). Intent-to-treat multivariate regression analyses evaluated the interventions' efficacy on past 4-month reports of ancillary support services use, having a regular healthcare provider, receiving care from doctor's office or clinic and mental health specialists, and participation in mental health support groups and HIV prevention programs. Ancillary services utilization reports declined from 40% of youth reporting an average of 4.4 services at baseline to 22.6% reporting 2.5 services by 24 months. Food, housing, transportation, and other basic services were utilized most frequently. Youth in the two coaching interventions maintained higher reports of services use over time compared to AMMI-only (both OR���1.23, 95%CI���1.12-1.35) and to AMMI+PS (both OR���1.20 95%CI 1.08-1.33). Our coaching intervention may support SGMY to stay engaged in support services. Results may be limited by self-report biases. It is unclear if these services are related to better long-term outcomes.
