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. James Thing, Ph.D.

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RCT Study Design

Eligibility and Inclusion Criteria Target Population Gender identity as a woman (self-identified); Assigned a biological sex of male at birth (self-reported); Between the age of 18-34 years; HIV-positive serostatus that can be verified*; and, The ability to receive daily text messages on either a personal cell phone or an email account. *To verify that a potential participant is HIV positive she must provide a diagnosis form, or other medical documentation such as laboratory results, or an ART prescription, or, if none of the aforementioned are available, she will be retested at FCC.

Eligibility and Inclusion Criteria Are aware of their HIV status but have never been in care; Are aware of their HIV status but have refused referral to care; Have previously been in HIV care but have dropped out of care; Have been previously unaware of their HIV status; or Have been or are in care but have not achieved viral load suppression.

Overall Outreach/Recruitment Strategy Six recruitment strategies will be utilized to ensure enrollment targets are met and a diversity of participants are enrolled: 1) Online Recruitment: Online banner ads and digital flyers will be placed through geo-mapping on websites and social media that target trans women such as TGLife, trans-health.com, frockmagazine.com craigslist.org, Transformation, and through local digital spaces (e.g., tglife.com, Adelante.com). 2) Print Media: Ads will be placed in print media for trans women or that trans women read (e.g., LAxpress).

Overall Outreach/Recruitment Strategy 3) Street- and Venue-based Outreach: Conducted by two Research Assistants Semi-structured time-space sampling methodology Sites identified where young HIV+ trans women congregate including boutiques, parks, street corners, bars, clubs, hotels, nail and hair shops, cruising boulevards, hotels Sites regularly reviewed through the Community Advisory Board and ongoing community mapping The Research Assistants are trained on appropriate outreach strategies and confidential screening in public places 4) Poster Advertisement: Project posters are posted at collaborating community-based organizations. The posters contain details about how to contact a Research Assistant for further information regarding the project.

Overall Outreach/Recruitment Strategy 5) In-services at collaborating community-based organizations and other projects at our site: Conducted by two Research Assistants 6) Participant-incentivized Snowball Sampling: Current participants may recruit a maximum of three potential new participants. Current participants will receive a small gift (e.g., make-up, earrings; valued at approximately $2) when they bring a potential participant to the site Current participants will receive $20 if an eligible participant enrolls Again, a maximum of three eligible and enrolled participants per active participant.

Potential Challenges Achieving robust enrollment numbers can be problematic, particularly among hard-to-reach, hidden, underserved and/or marginalized target populations. Multiple recruitment strategies will be implemented

Determining Eligibility All potential participants who inquire about the study will be scheduled for an intake within 24-48 hours. At intake, potential participants will be screened for eligibility. Eligibility is assessed through a cloud-based tablet screener.

Screening Process (If the potential participant reports “HIV positive,” ask the following…) Are you currently receiving HIV care? Yes ___ No ___   When was the last time you had a HIV medical care visit? _______ days _______months ______years Are you currently taking medically prescribed antiretroviral therapy medication (HIV medication)? Yes ___ No ___ In the past 30 days, how would you rate your ability to take all your HIV medications as prescribed? Very poor Poor Fair Good Very good Excellent If the potential participant reports “Yes” to currently receiving HIV care, AND the date of last HIV care visit was “within 6 months,” AND “Yes” to being on ART, AND “Excellent” to rating her ability to take all her ART medication, then the potential participant is not eligible to participate.

Potential Challenges Given that suboptimal HIV care is based on self-report, it is possible that a potential participant will misrepresent her HIV care status to enroll in the project. In our previous HRSA-funded study with trans women of color living with HIV, this only happened once. Most women, particularly young trans women, need to be linked or re-engagement in HIV care. 

Enrollment Process Once deemed eligible and interested, a Research Assistant will begin the Informed Consent process. After it is confirmed that the potential participant understands the project and has signed the Informed Consent Form, she will begin the ACASI. Following the baseline assessment the potential participant will be randomized into either the Immediate Delivery condition or the Delayed Delivery condition. Randomization variables: age (18-24, 25-34), race/ethnicity (Latino/Hispanic, all other race/ethnicities), HIV Care Continuum status (linked, non-linked) Following randomization, the participant is given a study ID# and is considered enrolled.

Discussion Cathy Reback: reback@friendsresearch.org Jesse Fletcher: jfletcher@friendsresearch.org James Thing: jthing@friendsresearch.org