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., Jesse B. Fletcher, Ph.D. Molly Lancaster, Ph.D., Prudence Mendiola

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Text Message Content by Theoretical Foundation Text Message Content along the HIV Care Continuum Theoretical Foundation

The Development of the Text Messages October-December 2015: CJR reviewed 616 Text Message Library Bank from our current NIDA-funded RCT with methamphetamine using MSM. The Library Bank included 56 messages about HIV-positive status, 56 messages about ART medication adherence, 270 messages on risk reduction. All messages from the MSM bank of 616 that could not be adapted for young trans women living with HIV were eliminated. That left approximately 257 potential text messages. Two focus groups with trans women to review the potential text messages and write new ones. The focus groups yielded a potential library bank of 265 messages. February 2016: CJR, JBF, and KK made minor revisions to apply a theoretical foundation to each text message.

Minor revisions to make messages targeted, tailored, and personalized, and to apply a theoretical foundation to each text message Trans pride is taking care of yourself Take care of yourself General Message - HIV Positive/Physical & Emotional Health Trans specific - Social Support Theory Protect your trans beautiful body, see your doctor See your doctor General message - Linkage/Retention in HIV Care Trans specific - Health Belief Model Take your meds, girl! You can do it! Take your meds Trans specific General message - ART Medication - Social Cognitive Theory

The Development of the Text Messages February 2016: Trans-specific CAB meeting to review, refine and approve the text messages. Following the CAB meeting we had a message bank of 270 messages. March-April 2016: CJR and JBF created a “pseudo random” order of delivery so that the messages delivery would follow the proposed one message/care continuum/day, and one message/theoretical foundation/day.

Creating a Pseudo Random Order

The Qualtrics Platform June 2016: The 270 text messages, in “pseudo random” order were sent to Qualtrics for development of the delivery platform. June-September 2016: Qualtrics designed and developed the delivery platform. September 2016: The text message delivery platform was piloted. Eight staff were identified to pilot the text message delivery system. It was a disaster and aborted after one week. October 2016: Qualtrics spent another month redesigning the delivery platform. The same eight staff piloted the text message delivery system. Finally, all systems are go!

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Implementation Recruitment / Enrollment from November 2016 to February 2018 Enroll ~7 to 8 participants/month Have obtained full IRB approval All staff have been hired and trained Last CAB meeting was November 9, 2016, next CAB meeting will be in Spring 2017 Partnerships will HIV care clinics have been solidified

Implementation Challenges Greatest implementation challenge has been the development of the text-messaging platform Achieving scientific/research needs through marketing/advertising programming platforms. Ensuring ongoing message delivery and adequate intervention exposure. Achieving a consistent user-experience across methods of delivery and devices. Establishing ongoing reporting mechanisms to ensure unexpected events (participant self-withdrawals, lost/replaced devices, etc.) can be quickly discovered and adapted to in real-time. Programming the Local Evaluation Complex skip patterns based on surgical status, behavior, and prior answers from the multi-site evaluation. Multiple rounds of testing and edits.

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 anticipate most participants will be recruited from strategies #6, #3, and #5, in that order Recruitment materials are completed and finalized Recruitment and enrollment to start this week. Delays were related to developing the ACASI for the Local Assessment and glitches with the Qualtrics platform.

Flyers Portrait and Landscape

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.

Discussion Cathy Reback: reback@friendsresearch.org Jesse Fletcher: jfletcher@friendsresearch.org Molly Lancaster: mlancaster@friendsresearch.org Prudence Mendiola: pmendiola@friendsresearch.org