1. Use of social media to improve engagement in care and health outcomes for young MSM and transgender women with HIV

2. Our intervention
weCare harnesses established social media platforms that MSM and transgender women between the ages commonly use, including
Texting
GPS-based mobile applications (“apps”)
A4A/Radar, badoo, Grindr, Jack’d, & SCRUFF
Facebook
Our intervention will use
Facebook
text messaging
GPS-based mobile apps that MSM often use for social and sexual networking (“hookup apps”)
In the bottom of this slide are the logos of popular apps that we are planning to use: Jack’d, badoo, Scruff, Grindr, and Adam 4 Adam Radar
Focus on using the social media platforms that these communities are already using, rather than reinventing the wheel

3. Targeted! Tailored! & Personalized!
Intervention is targeted for diverse young MSM and transgender women with HIV
The intervention is tailored by social media use/preferences
The intervention is personalized to each participant’s needs
Implemented by a Cyber Health
Educator (CHE):
Eli Hall (married 12/2016!)
Antwine Jenkins

4. Recruitment Started recruitment on September 26, 2016.
Current: N=85 (goal=192); I=41; UC=42
2 haven't been randomized yet
Needed to recruit 17/month through 08/2017 for an 18-month follow-up
Revised to11/month through 2/2018 for 12-month follow-up
Mean age=26; range: 18-34
Latino=20%
African American/black = 60%
White=15%
Multi-racial=21%
Other=4%

5. Recruitment successes
Overall, we have had very few refusals from eligible and potential participants
Cooperation of clinic staff and providers
Being seen as part of/integrated into the clinic
Being available nearly every day, whenever needed
Having very quiet and comfortable space to explain the project to potential participants
Explaining the project as simply as possible
Being friendly and not imposing/requiring
Being personable (smiling, greeting participants using first names, and thanking participants for considering)

6. Recruitment challenges
Community partners (testing sites, health departments, and DIS) are eager to meet and collaborate
But follow through is low (competing demands)
Good-hearted people but prejudices still exist in communities
African American/black and Latino MSM, transgender women, apps for social and sexual networking, immigration
Closure of a local ASO
Potential participants may feel healthy = no perceived need for help (despite need)

7. Strategies to overcome challenges
Clinic discussions
About ways we can support efforts to get new patients and those not yet enrolled in the study to initiate recruitment
Increased coordination with STD clinic at local health department
Meetings with DIS
In our catchment area they provide most results
New collaboration with Piedmont Health Services and Sickle Cell Agency
Craigslist advertisements (under IRB review)

8. Implementation
Steering committee continues to meet (Currently quarterly)
Provide strategies for recruitment; created/refined social media messages
Recruiting younger members for steering committee
Continue to work with partners
Continue to implement the social media intervention
381 conversations, highlights:
Regular check-in = 40%
Appt reminders = 26%
Helping to re/schedule appts = 20%
Acknowledgement of attending appts/care = 12%
Problem solving/overcoming barriers = 7%
Social support = 5%
Following-up on previous conversation = 4%
Medication adherence = 2%
Facebook secret group posts/Existing content

9. Implementation successes
Table of theory-based messages is useful for CHEs (and for team)
A real face/person behind social media messages
Personalized messages are critical
Multiplatform approach is valuable
Reflects tech-savvy youth and gives them “control”
Facebook provides insights into participants’ lives that CHEs can use
Rapid response by CHEs
Clinic staff/schedulers and case managers are not as fast, efficient, caring… or do not have the ability/approval to use social media (hence, the importance of this demonstration project!)

10. Implementation challenges and strategies to overcome them
Participants change phone numbers/phones are disconnected
Participants do not reply to/answer social media messages
Collecting more contact info at follow-up data collection (trust has been built)
Being present at a clinic appointment to “find” a participant, working with pt. navigators to locate a participant, problem-solving as a team to strategize locating a participant, harnessing DIS to locate a lost participant
Participants become incarcerated
Wait until reentry
Participants move to another state/out of country
Try our best to retain
“All participants need us!” Randomization isn’t so cool.
(Affects relationship building with community organizations too.)
Remembering the power of rigorous and strong evidence!
Usual care is pretty good, actually.

11. Retention
N=29
No one has been lost to follow-up (operationalized as outside of the follow-up window period)
However, ready to implement retention strategies, such as:
Collecting more contact info at follow-up data collection (trust has been built)
Being present at a clinic appointment to “find” a participant, working with pt. navigators to locate a participant, problem-solving as a team to strategize locating a participant, harnessing DIS to locate a lost participant
Among those who become incarcerated, waiting until reentry
Among those who move to another state/out of country, try our best to retain

12. Discussion Jorge Alonzo: jalonzo@wakehealth.edu
Rita Groce:
Eli Hall:
Antwine Jenkins:
Lilli Mann:
Scott D. Rhodes:
Katherine R. Schafer:
Eunyoung Song:
Amanda Tanner: