Strategies to Facilitate Service Utilization Among Youth at Risk for HIV: A Randomized Controlled Trial (ATN 149)

Area of Science:

• Public Health
• Social Science
• Health Services Research

Background:

• Sexual and gender minority youth (SGMY) face unique vulnerabilities, including higher HIV risk and competing needs for health and social services.
• Previous research indicated that a combination intervention increased pre-exposure prophylaxis (PrEP) use among SGMY.
• This study investigates the impact of different intervention components on ancillary support and healthcare utilization.

Purpose of the Study:

• To evaluate the efficacy of different intervention components on ancillary support and healthcare services utilization among SGMY.
• To determine if automated text-messaging, peer support, or strengths-based coaching influences the use of services like food, housing, transportation, and mental health support.

Main Methods:

• A randomized controlled trial involving 895 SGMY in Los Angeles and New Orleans.
• Participants were assigned to four conditions: automated text-messaging and monitoring intervention (AMMI), AMMI plus peer support (AMMI+PS), AMMI plus coaching (AMMI+C), or all three (AMMI+PS+C).
• Intent-to-treat multivariate regression analyses assessed changes in reported services use over 24 months.

Main Results:

• Overall ancillary services utilization declined from baseline (40% reporting 4.4 services) to 24 months (22.6% reporting 2.5 services).
• Food, housing, transportation, and other basic needs services were the most frequently utilized.
• Youth in the two coaching intervention arms (AMMI+C and AMMI+PS+C) reported higher sustained utilization of services compared to AMMI-only and AMMI+PS groups.

Conclusions:

• Strengths-based coaching interventions appear to support sustained engagement with essential ancillary services among SGMY.
• While overall service utilization decreased, coaching components helped mitigate this decline.
• Further research is needed to explore the long-term impact of these services on health outcomes and address potential self-report biases.