1. 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

2. Logo

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

4. 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.

5. 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

6. 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.

7. Creating a Pseudo Random Order

8. 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!

9. Screenshots

10. Screenshots

11. 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

12. 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.

13. 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.

14. Flyers
Portrait
and
Landscape

15. 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.

16. Discussion Cathy Reback: reback@friendsresearch.org
Jesse Fletcher:
Molly Lancaster:
Prudence Mendiola: