This project will develop a multi-component, technology-delivered intervention designed to reduce HIV and intersectional stigma and improve the use of HIV pre-exposure prophylaxis (PrEP) among HIV-negative Thai vulnerable emerging adults (18-29 years).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
154
mHC is a four-session, 20-minute, motivational interviewing-based intervention, which will be delivered on the CIAS platform. It will be tailored to participants' responses given during the interaction in the intervention. In the first two sessions, the (virtual) counselor will motivate participants to overcome stigma and utilize HIV prevention services by using tailored motivational interviewing strategies, develop an individualized change goal based on their readiness, and provide cognitive behavioral strategies. In the last two sessions, the counselor will review the change plan, monitor progress, and provide support for sustained behavioral change. The sessions will occur within three months after baseline.
FRESH content includes six 10-15 minute sessions with interactive, culturally sensitive multimedia modules, which will be delivered on the CIAS platform. The content will aim to improve self-efficacy, reduce intersectional stigmas and promote HIV preventative behaviors. The sessions will occur within three months after baseline.
Institute of HIV Research and Innovation
Bangkok, Thailand
RECRUITINGRainbow Sky Association of Thailand
Bangkok, Thailand
RECRUITINGSWING Foundation
Bangkok, Thailand
RECRUITINGIntervention Acceptability: System Usability Score (SUS)
The SUS is a 10-item, 5-point Likert scale for evaluating subjective usability. Each item is scored from 1 to 5, with the calculation involving either subtracting 1 from the user response or the user response from 5 depending on the item. The scores are then summed and multiplied by 2.5 to obtain a total score ranging from 0 to 100. A score above 80 indicates that the intervention is acceptable.
Time frame: Month 3, Month 6
Intervention Acceptability: Exit Interview
Participants will be asked about their experiences using mHC and FRESH content and potential improvements.
Time frame: Month 3
Intervention Feasibility: Participant retention
Participant retention rate of over 85% at 6-month follow-up will be the minimum criterion for feasibility.
Time frame: Baseline through Month 6
Intervention Feasibility: Number of FRESH sessions viewed
Intervention feasibility will be evaluated by the total number of FRESH sessions viewed.
Time frame: Baseline through Month 6
Intervention Feasibility: Number of mHC sessions completed
Intervention feasibility will be evaluated by the number of completed intervention sessions.
Time frame: Baseline through Month 6
PrEP Uptake: Self-report
PrEP uptake will be assessed using a self-report measure and confirmed via chart review and pharmacy records.
Time frame: Month 3, Month 6
PrEP Adherence: Visual analog scale
PrEP adherence will be assessed through the Young Adult Adherence Interview, which contains a visual analog scale (VAS) ranging from 0 to 100. Higher percentages on the VAS indicate greater adherence to ART.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
All participants will receive one-on-one, face to face counseling from focusing on sexual and behavioral risk assessment for HIV/STIs, risk reduction, and HIV prevention. For those not on PrEP, the sessions will focus on risk perception, awareness of PrEP, and facilitators and barriers to PrEP access. For those on PrEP, the sessions will focus on adherence. The counseling will be provided at baseline, 3 months, and 6 months.
Time frame: Baseline, Month 3, and Month 6
PrEP Adherence: Self-Reported Adherence
PrEP adherence will be evaluated through self-reported adherence over the past four weeks. Participants will rate their adherence on a scale ranging from 0 to 100%, with higher percentages indicating better adherence to PrEP. The result will be triangulated with DBS reports.
Time frame: Baseline, Month 3, and Month 6
PrEP Adherence: DBS testing
PrEP adherence will be evaluated by tenofovir concentrations in dried blood spots (DBS). The result will be triangulated with self-reports.
Time frame: Baseline, Month 3, and Month 6
HIV testing uptake: Self-report
HIV testing uptake will be assessed via self-report and confirmed through chart review.
Time frame: Baseline, Month 3, and Month 6
Intersectional stigma
Intersectional stigma will be assessed using the Intersectional Discrimination Index, which includes three subsets: anticipated, day-to-day, and major discrimination. The anticipated and day-to-day discrimination measures each consist of 9 items, while the major discrimination measure includes 13 items. The anticipated discrimination score is calculated as a mean ranging from 0 to 4. The day-to-day discrimination score is based on frequency and can range from 0-9 (lifetime) or 0-18 (past-year). The major discrimination score is based on frequency and can range from 0-26 (lifetime) or 0-13 (past-year). For all three measures, higher scores indicate a greater level of anticipated discrimination or experienced discrimination.
Time frame: Baseline, Month 3, and Month 6
Internalized stigma
Internalized stigma will be evaluated using the Internalized AIDS-related Stigma Scale, a 6-item scale. Scores range from 0 to 6, with higher scores indicating greater internalized stigma.
Time frame: Baseline, Month 3, and Month 6
Perceived stigma
Perceived stigma will be evaluated using a 13-item, 4-point Likert scale, with a maximum score of 52. Higher scores indicate a higher level of perceived stigma.
Time frame: Baseline, Month 3, and Month 6
Anticipated stigma
Anticipated stigma will be evaluated from three different sources (friends and family, neighbors, and others in the community, and healthcare workers) using a 9-item, 5-Likert scale. Scores can reach up to 45, with higher scores indicating a greater expectation of experiencing stigma in the future.
Time frame: Baseline, Month 3, and Month 6
Enacted stigma
Enacted stigma will be evaluated with an 8-item, 4-point Likert scale enacted stigma scale. The total score can reach up to 32, with higher scores indicating having more stigma experiences.
Time frame: Baseline, Month 3, and Month 6
PrEP stigma
PrEP stigma will be evaluated with a 10-item, 5-point Likert scale. Higher scores indicate a higher level of perceived stigma surrounding PrEP.
Time frame: Baseline, Month 3, and Month 6
Empowerment
Empowerment will be assessed using the Healthcare Empowerment Inventory. It's an 8-item, 5-point Likert scale, with total scores ranging from 8 to 40. Higher scores indicate a greater sense of empowerment in her health care.
Time frame: Baseline, Month 3, and Month 6
Information: HIV Knowledge
HIV transmission risk awareness will be assessed through an 18-item HIV Knowledge Questionnaire. The total scores can range from 0 to 18, with higher scores indicating a higher level of HIV knowledge.
Time frame: Baseline, Month 3, and Month 6
Information: PrEP Knowledge
PrEP knowledge will be assessed through a 13-item PrEP Knowledge Scale. The total score can range from 0 to 13, with higher scores indicating a higher level of PrEP knowledge.
Time frame: Baseline, Month 3, and Month 6
Motivation: Rollnick's Readiness Ruler
Motivation will be evaluated using the 5-item Rollnick's Readiness Ruler. Each item ranges from 0 to 10, with higher scores indicating a greater readiness for change in HIV prevention and risk behaviors.
Time frame: Baseline, Month 3, and Month 6
Motivation: Decisional Balance for Problem Behavior
Motivation will be assessed using the Decisional Balance for Problem Behavior scale. This 36-item, 5-point Likert scale evaluates the perceived pros and cons of using PrEP.
Time frame: Baseline, Month 3, and Month 6
Behavioral Skills
Behavioral skills will be assessed using an adapted version of the Self-Efficacy for Health Promotion and Risk Reduction Questionnaire. This 8-item, 5-point Likert scale measures confidence levels in HIV prevention behaviors, including condom use and adherence to the PrEP schedule. Higher scores indicate a greater confidence in health promotion and HIV prevention.
Time frame: Baseline, Month 3, and Month 6
HIV
Fourth-generation HIV-1/2 antigen/antibody combi testing will be used to detect HIV infection.
Time frame: Baseline, Month 3, and Month 6
STI
Treponemal test with rapid plasma reagin (RPR) will be used for syphilis, while urine, oropharyngeal, and rectal swabs will be used for gonorrhea and chlamydia.
Time frame: Baseline and Month 6
Sexual Risk
Sexual risk will be assessed using a Timeline Followback interview via CASI for any risky sexual behavior over the past 30 days.
Time frame: Baseline, Month 3, and Month 6
Adaptive coping
Adaptive coping will be assessed by the Brief Resilient Coping Scale, a four-item, 5-point Likert scale questionnaire. Higher scores indicate greater resilient coping.
Time frame: Baseline, Month 3, and Month 6
Resilience
Resilience will be assessed by the Connor-Davidson Resilience Scale. It is a 10-item, 5-point Likert scale questionnaire, with scores ranging from 0 to 40. Higher scores indicate a greater ability to cope with challenges.
Time frame: Baseline, Month 3, and Month 6
Substance use: Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)
Substance use will be assessed with ASSIST, an 8-item questionnaire that measures the use of ten substances, including alcohol, smoking, cannabis, and other drugs. Each item is scored from 0 to 12, resulting in a risk score for each ranging from 0 to 31 for tobacco and 0 to 39 for alcohol and other drugs. Higher scores indicate a higher risk of substance use disorder.
Time frame: Baseline, Month 3, and Month 6
Substance use: Alcohol Use Disorder Identification Text (AUDIT-C)
Substance use, specifically alcohol use disorder, will be assessed by using AUDIT-C. Each item is scored from 0 to 4, with 0 indicating no alcohol consumption and 4 indicating more hazardous drinking habits. The total score can range up to 12, with higher scores suggesting greater risks of hazardous alcohol consumption.
Time frame: Baseline, Month 3, and Month 6
Mental health
Mental health will be evaluated using the Thai General Health Questionnaire. The questionnaire has 12 4-point Likert scale items that assess psychological distress, including depression and anxiety. Scores range up to 48, with higher scores indicating a higher level of psychological distress.
Time frame: Baseline, Month 3, and Month 6
Perceived HIV risk
Perceived HIV risk will be assessed using the Perceived Risk of HIV Scale (8 item, 4-point Likert scale). The score ranges up to 40-, with higher scores indicating a high level of perception in HIV risk.
Time frame: Baseline, Month 3, and Month 6
Social support
Social support will be assessed using the Social Provision Scale (13-item, 5-point Likert scale). The survey assesses the availability of five forms of social supportsd: attachment, guidance, social integration, reliable alliance, and reassurance of worth. Scores range from 13 to 65, with higher scores indicating receiving a higher level of social support.
Time frame: Baseline, Month 3, and Month 6