Effectiveness of the smart program: Stepped-care HIV prevention for gay and bisexual adolescent boys

Adolescent men who have sex with men (AMSM) have high HIV incidence and low rates of HIV testing and pre-exposure prophylaxis (PrEP) use. There are few evidence-based HIV prevention programs that meet the unique needs of AMSM. The sequential, multiple assignment, randomized trial (SMART) program is a stepped care package of increasingly intensive eHealth interventions that were developed specifically for English- and Spanish-speaking AMSM. The sequence included universal sexuality education (SMART Sex Ed), an automated motivation and behavioral skills focused intervention (SMART Squad), and motivational interviewing via videoconferencing (SMART Sessions).

This SMART compared HIV testing, PrEP use, condomless anal sex (CAS), condom use intentions, and condom use self-efficacy outcomes for different embedded treatment sequences in the SMART program among a large sample of English- and Spanish-speaking AMSM (ages 13-18) in the U.S. states and territories (N = 1,306).

In most of the embedded treatment sequences, there were significant improvements across 12 months for most of the outcomes, including CAS with casual partners, HIV testing, PrEP use, and condom use self-efficacy. There were largely no changes in CAS inclusive of serious partnerships and condom use intentions declined in some regimes.

Findings from 12 months of follow-up provide evidence of the SMART program's long-term effectiveness, with particular benefits for the important outcomes of HIV testing and PrEP use. Given the lack of effective interventions for this high HIV-incidence population coupled with the potential for high reach given the eHealth modality, funders should put in place the resources to enable rapid implementation. (PsycInfo Database Record (c) 2025 APA, all rights reserved).