Computerized Tailored Interventions to Enhance Prevention and Screening for Hepatitis C Virus Among People Who Inject Drugs: Protocol for a Randomized Pilot Study.

BACKGROUND: Hepatitis C virus (HCV) infection is a growing problem among people who inject drugs. Strategies to reduce disease transmission (eg, syringe exchange programs) and facilitate HCV screening and linkage are available but are under-utilized in many communities affected by injection drug use. Novel approaches to increasing the use of these strategies are needed. OBJECTIVE: The goals of this project are to (1) develop and pilot test a computerized tailored intervention for increasing HCV screening and decreasing risky drug use behavior among people who inject drugs and (2) determine the feasibility of disseminating such an intervention using peer-based referrals in the setting of a community-based syringe exchange program. METHODS: This 2-arm, randomized pilot study is being conducted in a large-volume, multisite syringe exchange program in southern Wisconsin. A social network-based strategy was used to recruit a total of 235 adults who reported past-month injection of opioids, cocaine, or methamphetamine. Network recruiters were identified among clients requesting services from the syringe exchange program and were enlisted to refer eligible peers to the study. All participants completed a computer-adapted questionnaire eliciting information about risk behaviors and their knowledge, attitudes, and prior experiences related to HCV screening. Subjects were then randomly assigned to receive usual care, consisting of standard counseling by syringe exchange staff, or the Hep-Net intervention, which provides algorithm-based, real-time tailored feedback and recommendations for behavior change in the style of motivational interviewing. Changes in drug use behaviors and attitudes will be assessed during a second session between 90 and 180 days after the baseline visit. Frequency of repeat HCV testing and HCV incidence will be assessed through a database search 1 year after study completion. RESULTS: Recruitment for this study was completed in April 2015. Follow-up of enrolled participants is expected to continue until March 2016. Network recruiters were enrolled who referred a total of 195 eligible peers (overall N=235). At baseline, the median age was 34 years; 41.3% (97/235) were non-white; and 86.4% (203/235) reported predominantly injecting heroin. Most participants (161/234, 68.8%) reported sharing injection equipment in the past and of these, 30.4% (49/161) had never been tested for HCV. CONCLUSIONS: This study will provide preliminary evidence to determine whether incorporating computerized behavioral interventions into existing prevention services at syringe exchange programs can lead to adoption of healthier behaviors. TRIAL REGISTRATION: ClinicalTrials.gov NCT02474043; https://clinicaltrials.gov/ct2/show/NCT02474043 (Archived by WebCite at http://www.webcitation.org/6dbjUQG7J)

Risky business: An examination of the relationship between message frame, risk perceptions and intentions to seek HIV-antibody testing

In 2006, over half of HIV-infected adolescents were unaware of their status (CDC, 2006) which raises the possibility that increases in HIV testing could reduce HIV transmission. There are multiple ways to construct a message promoting HIV testing. The way in which a message is framed has implications for its persuasiveness. The discussion around gain/loss framing has centered on whether framing effects are consistent and systematic with little empirical investigation of the mechanisms of framing effects. Applying prospect theory (Kahneman & Tversky, 1981) in the context of health communication research, researchers argue that gain framed messages should be more effective for prevention behaviors while loss frames should be more effective for detection behaviors (Rothman & Salovey, 1997). Evidence in support of this taxonomy has been mixed. This dissertation examines whether the effects of message framing on intentions to be tested for HIV-antibodies is moderated by perceived risk of a positive test result and potential mechanisms of effect. This experiment utilizes a single factor (frame: gain/loss) between subjects design, with a separate HIV test promotion control group and a no message control group. Stimulus messages utilize an exemplar of the story of a young Black woman who describes how she discovered her HIV+ status. Consequently, this study also includes an examination of exemplification effects. The sample (N=1052) was recruited through Survey Sampling International and included 51% Black women (49% White). Average age was 22 (SD =2.22). It was hypothesized that perceived risk moderates framing effects such that among women with high perceived risk, loss framed messages would be more persuasive with no differences in frame effectiveness among women with low perceived risk. Results demonstrate that the HIV test promotion messages were more effective than no message but there were no other main effects for condition. Perceived risk moderates the framing effects, not in the hypothesized directions but in ways consistent with Rothman and Salovey (1997). Framing effects were mediated through message elaboration, which was partially mediated through attitudes and normative perceptions. Exemplification effects were evident but not mediated through homophily. Limitations and implications for theory and practice are discussed

Risky business: An examination of the relationship between message frame, risk perceptions and intentions to seek HIV-antibody testing

In 2006, over half of HIV-infected adolescents were unaware of their status (CDC, 2006) which raises the possibility that increases in HIV testing could reduce HIV transmission. There are multiple ways to construct a message promoting HIV testing. The way in which a message is framed has implications for its persuasiveness. The discussion around gain/loss framing has centered on whether framing effects are consistent and systematic with little empirical investigation of the mechanisms of framing effects. Applying prospect theory (Kahneman & Tversky, 1981) in the context of health communication research, researchers argue that gain framed messages should be more effective for prevention behaviors while loss frames should be more effective for detection behaviors (Rothman & Salovey, 1997). Evidence in support of this taxonomy has been mixed. This dissertation examines whether the effects of message framing on intentions to be tested for HIV-antibodies is moderated by perceived risk of a positive test result and potential mechanisms of effect. This experiment utilizes a single factor (frame: gain/loss) between subjects design, with a separate HIV test promotion control group and a no message control group. Stimulus messages utilize an exemplar of the story of a young Black woman who describes how she discovered her HIV+ status. Consequently, this study also includes an examination of exemplification effects. The sample (N=1052) was recruited through Survey Sampling International and included 51% Black women (49% White). Average age was 22 (SD =2.22). It was hypothesized that perceived risk moderates framing effects such that among women with high perceived risk, loss framed messages would be more persuasive with no differences in frame effectiveness among women with low perceived risk. Results demonstrate that the HIV test promotion messages were more effective than no message but there were no other main effects for condition. Perceived risk moderates the framing effects, not in the hypothesized directions but in ways consistent with Rothman and Salovey (1997). Framing effects were mediated through message elaboration, which was partially mediated through attitudes and normative perceptions. Exemplification effects were evident but not mediated through homophily. Limitations and implications for theory and practice are discussed

An Evaluation of the Effectiveness of the Black Women\u27s Health Imperative (BWHI) #LetsTalkAboutPrep campaign among Black women living in Washington D.C.

Background: Black women in the District of Columbia (D.C.) are 50% of the female population, but account for 92% of women living with HIV. Pre-Exposure prophylaxis (PrEP) can reduce the risk of HIV infection by up to 92% when taken consistently by people who are at high risk of HIV infection but research suggests that very few Black women are aware of PrEP as a prevention option. This study tests the effectiveness of a culturally sensitive public health communication campaign to promote PrEP awareness among Black women in D.C., as part of the Black Women\u27s Health Imperative (BWHI) #LetsTalkAboutPrep media campaign. Methods: One hundred ninety two sexually active, HIV negative Black women ages 20-69 who live in D.C. who reported at least one HIV risk factor were surveyed about their knowledge of PrEP, uptake behaviors and sociodemographic characteristics. Participants also reported exposure to the #LetsTalkAboutPrep campaign (5 ads). We tested the relationship between exposure to the campaign and intention to use PrEP, as well as other outcomes related to uptake (i.e. discussion of PrEP with friends/physician). The independent variable was the sum of 5 dichotomous campaign exposure variables. The dependent variable was the sum of 5 dichotomous PrEP uptake behaviors, including considering to use PrEP and seeking more information about PrEP. Multivariate linear and logistic regressions were performed to assess the association between exposure to campaign ads (range 0-5) and PrEP uptake behaviors (range 0-5), controlling for sociodemographic variables. We hypothesized that there would be a dose response in which exposure to more ads is associated with increased intention to use PrEP. Preliminary results: The independent and dependent variables were significantly correlated at r = 0.26. The multivariate linear regression shows that with each additional campaign ad exposure, there is a B = 0.51 unit increase in the number of prep uptake behaviors, when controlling for education, marital status, income and age (p = 0.05). This model explains 22% of the variance in the outcome variable. Conclusion: There is evidence that exposure to the #LetsTalkAboutPrep campaign is associated with Black women\u27s intention to use PrEP behaviors. Further analysis is required to build on this research to create similar culturally sensitive communication campaigns to increase Black women\u27s awareness, knowledge and use of PrEP nationwide

Evaluation of the Acceptance Journeys Social Marketing Campaign to Reduce Homophobia

Objectives. To evaluate the effectiveness of the Acceptance Journeys social marketing campaign to reduce homophobia in the Black community in Milwaukee, Wisconsin. Methods. We assessed the campaign’s effectiveness using a rolling cross-sectional survey. Data were collected annually online between 2011 and 2015. Each year, a unique sample of Black and White adults, aged 30 years and older, were surveyed in the treatment city (Milwaukee) and in 2 comparison cities that did not have antihomophobia campaigns (St. Louis, MO, and Cleveland, OH; for total sample, n = 3592). Results. Black self-identification and Milwaukee residence were significantly associated with exposure to the campaign, suggesting successful message targeting. The relationship between exposure and acceptance of gay men was significantly mediated through attitudes toward gay men, perceptions of community acceptance, and perceptions of the impact of stigma on gay men, but not through rejection of stereotypes. This model accounted for 39% of variance in acceptance. Conclusions. This evidence suggests that the Acceptance Journeys model of social marketing may be a promising strategy for addressing homophobia in US Black communities