Text Messaging to Improve Linkage, Retention, and Health Outcomes among HIV-positive Young Transgender Women Text Me, Girl! Friends Research Institute, Los Angeles, CA. Cathy J. Reback, Ph.D., Ray Mata June 2017

Implementation Recruitment began November 18, 2016, first participant enrolled on December 16, 2016. As of June 9, 2017, 25 participants have enrolled. Enroll through February 2018; target 3 participants/week, 12 participants/month. Current enrollment status: Inquiries: 94 Screened: 41 Screened Eligible: 26 Screened Ineligible: 15 Enrollment/Eligibility Rate: 96% (25/26) Referral Sources: Outreach: 38 FCC Internal Referral: 27 Flyer/Poster/Card: 14 Word of Mouth: 6 In-Service: 6 Text Me, Girl! Participant: 1 Internet/FB/Social Media: 0 Print Ad: 0 Other: 2

Implementation Development of text messaging intervention has been completed. 13 (52%) of the participants have been randomized into the Immediate Delivery condition and 12 (48%) into the Delayed Delivery condition. Last CAB (youth advisory group) was held on November 9, 2016, next meeting is scheduled for July 20, 2017. Staff continue to conduct in-services to local community agencies that provide services to young trans women; medical providers meetings are scheduled for this summer.

Implementation Successes and Challenges There have been no problems or challenges with the text messaging intervention, delivered through the Qualtrics platform. As the text messages are only “pushed,” i.e., sent by automation to the participant, we do not receive ongoing feedback regarding HIV medical appointments. Thus, we have added a Medical Information Form to each assessment.

Recruitment materials have been completed: Portrait and Landscape

Recruitment Six recruitment strategies will be utilized to ensure enrollment targets are met and a diversity of participants are enrolled: 1) Online Recruitment: banner ads and digital flyers 2) Print Media 3) Street- and Venue-based Outreach 4) Poster Advertisement: placed at collaborating community-based organizations 5) In-services at collaborating community-based organizations and other programs at our site 6) Participant-incentivized Snowball Sampling We anticipated most participants will be recruited from strategies #6, #3, and #5, in that order; however, #3 and #5 have been most successful Recruitment and enrollment has been much slower than anticipated.

General Recruitment Challenges Achieving robust enrollment numbers can be problematic, particularly among hard-to-reach, hidden, underserved and/or marginalized target populations. Due to design changes from ETAC from a 24-month to 18-month enrollment period coupled with delays in the development of the text-messaging platform, the monthly enrollment objective changed from ~5 participants/month to ~7-8 participants/month. Then, due to slower than expected enrollment, the monthly enrollment objective is now ~12 participants/month.

Specific Recruitment Challenges and Solutions Stigma related to disclosing HIV status. Solution: Carry flyers for multiple projects at Friends Community Center, including PrEP. Do not ask status but, rather, ask when was the last time tested? Unsuccessful recruitment sites. Solution: Staff wanted to try multiple venues for recruitment and some have proven to be unsuccessful. Recruitment venues have now been tightened. Major trans community event on June 24, 2017 to highlight the project. Late to start online recruitment. Solution: Have obtained a social marketing company that is working for Friends Research Institute pro bono and expect to see the success from these recruitment efforts soon.

Recruitment Solutions: Focus More on What Works Good, old-school street- and venue-based outreach has worked well and has been the most successful recruitment strategy. Given the insular nature of the trans networks and mistrust many trans women have for outsiders, face-to-face outreach is critical to build trust. Research assistants are trans peers RAs carry small trans woman-specific gift (e.g., make-up, jewelry, perfume, nail polish, body spray, eyelashes) to encourage communication and demonstrate respect for her need Hired a trans RA consultant as a recruitment specialist Meet potential participants where they are at Hidden population: meet them in hotels, apartments

Facebook Social Posting We launched Text Me, Girl! on the Friends Community Center Facebook page in March 2017 with Facebook ads. We acquired approximately 150 fans into our social community in the first month, and in four months reach approximately 7,500 Facebook members. Types of posting: Text Me, Girl! program related posts Syndicated news content posts related to transgender issues and HIV updates in mainstream media or internally at Friends Community Center Event posts such as Pride event postings or Friends Community Center event related postings; forums for Facebook community members to relate and discuss participation

Facebook Online Recruitment In May 2017, we launched a specific social media campaign to drive users into our online channels to learn more about the program. Estimated Daily Reach: 3,000 (total audience that the ads reach) Estimated Total Potential Reach: 200,000 Estimated Daily Link Clicks to Friends Community Center Website: 60-400 Clicks Per Day  Estimated Total Link Clicks for the Campaign: 6,300 (clicks back to Text Me, Girl! on Friends Community Center website)

Ad Results from Boosted Static Facebook Post

Facebook Online Recruitment In conjunction with the static image advertisement a mock text message conversation was created between a potential participant and a research assistant. The text-messaging video reached 2,300 individuals.

Ad Results from Boosted Video Facebook Post

Discussion Cathy Reback: reback@friendsresearch.org Jesse Fletcher: jfletcher@friendsresearch.org Ray Mata: rmata@friendsresearch.org