Chattiya Nitpolprasert Implementation and impact of a technology-based HIV risk-reduction intervention among Thai men who have sex with men using 'Vialogues': A randomized controlled trial Chattiya Nitpolprasert

Background To conduct a randomized control trial to evaluate the impact of a novel technology-based intervention on HIV/AIDS knowledge, self-perceived risk, condom use attitudes, self-efficacy intentions, sexual risks and condom use behaviors among Thai MSM.

Methods The technology-based HIV risk reduction intervention was piloted by Adam's Love (www.adamslove.org). Participants aged 18 years or above, and having engaged in unprotected sex in the past six months were enrolled and randomly assigned to control or intervention arm, and received private clinic-based HIV counseling and testing at baseline, month 6 and month 12.

Methods Intervention arm participants engaged in 12 monthly HIV/STI prevention and educational sessions delivered via Vialogues.com. The differences in behavioral outcomes between the arms over the 12-month period were assessed. Intervention arm participants received once per month online intervention over the one year study period.

What is Vialogues? Asynchronous video and discussion platform Free to use from EDLab, Teachers College Columbia University Private room for discussion Vialogues (vialogues.com), derived from “video dialogues”, is an asynchronous Video discussion and interaction platform which can be used for leveraging digital videos for learning by adding group interaction as part of the online video experience. Upload a File: 1) Select a video 1 GB or less. Supported formats: MOV, MP4, MPEG 2) Use a video URL from YouTube or Vimeo.

Vialogues = Video + Dialogues How to Vialogues? Vialogues = Video + Dialogues Conversation Upload Knowledge Sharing Invite At baseline clinic visit, the participants randomized to intervention arm were assisted by the study staffs to create a ‘Vialogues’ account using pseudoname to ensure privacy, added to the main study ‘Vialogues’ room and briefly trained on how to access and participate in 12-monthly video sessions. The staffs felt this step was necessary as none of the participants had prior experience with the ‘Vialogues’ tool. 1. Online time-based videos followed by time-stamped discussions around the video content with our health educator, 2. Focusing on applying knowledge and skills learned during the session in setting long-term goals to reduce sexual risks.

172 assessed for eligibility Results 96 were excluded 26 did not pass criteria 70 refused to participate 172 assessed for eligibility 76 MSM enrolled Intervention Arm 37 MSM Control Arm 39 MSM Of 76 MSM enrolled, 37 were randomized to intervention and 39 to control arm. Median age was 28 (IQR 24-32) years Half spending >7 hours/day on Internet Majority (>60%) had ever sought sex online

Results Of 37 intervention arm participants, 33 (89.2%) completed 12 monthly Vialogues sessions. Mean session duration was 37.45 minutes.

Results Retention rates at month 12 among intervention and control arms were 97.3% and 79.5%, respectively. At month 12, median percentage of condom use for anal intercourse was higher in the intervention versus control arm (p=0.023). Over the 12-month period, intervention arm reported significant reduction in: self-perceived risk for HIV (p=0.001), popper usage (p=0.002), seeking sex online (p=0.01), median number of sexual partners in the past three months (p=0.003), and increased median percentage of condom use (p=0.006). Among intervention arm, process measures yielded high participant satisfaction of Vialogues (mean 4.67 on a 5-point scale, SD 0.48).

Qualitative Responses “By joining Vialogues, it gives me awareness about HIV and STI prevention. It helps me reducing my risk behaviors.” (26 year-old MSM)   “Doing Vialogues every month doesn’t disturb my daily life, it rather gives me some information that I didn’t know before joining this study.” (28 year-old MSM) “I like that this study uses technology and social network to engage participants, it’s my generation and it’s very convenient.” (23 year-old MSM)

Conclusions Our study provides evidence that 'Vialogues' intervention significantly reduced HIV risk. HIV program implementers are encouraged to harness the potential of free, online learning technologies used in this study. Our study provides clear evidence that 'Vialogues' intervention significantly reduced number of sexual partners and increased condom use rates among MSM. HIV program implementers are encouraged to harness the potential of free, online learning technologies used in this study.

For more information: tarandeepsinghanand@gmail.com Acknowledgements Tarandeep Anand1,2, Chattiya Nitpolprasert1,2, Jureeporn Jantarapakde1, Ratchadaporn Meksena1, Sangusa Phomthong1, Petchfa Phoseeta1, Praphan Phanuphak MD PhD1, Nittaya Phanuphak MD PhD1 1PREVENTION, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand 2Adam’s Love, Bangkok, Thailand The randomized control trial was supported by Aidsfonds. Funding support was provided in part by ViiV Healthcare, MAC AIDS Fund, and amfAR through a grant from the National Institute of Health’s National Institute of Allergy and Infectious Diseases, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Cancer Institute, National Institute of Mental Health, and National Institute on Drug Abuse as part of the International Epidemiology Databases to Evaluate AIDS (IeDEA; U01AI069907). We thank all research participants and study staff for their significant contributions. We are also very thankful to EdLab, Teachers College Columbia University for enabling free use of Vialogues, an award-winning discussion platform. For more information: tarandeepsinghanand@gmail.com