Developing Online Interventions to Reduce Stigma-Related Stress, Sexual Health, and HIV Risk Among Young Chinese MSM
Condition: LGBTQ; Sexual Behavior; HIV Risk
Study type: Interventional

Summary: 
      This study is a 2-arm RCT that will assess the efficacy of a culturally adapted, 10-session
      SGM-affirmative, internet-based cognitive behavioral therapy (iCBT) among young men who have
      sex with men (YMSM) in Hunan province China. The affirmative treatment called ESTEEM is based
      on a minority stress-focused, CBT framework. In collaboration with colleagues at Central
      South University (CSU), the investigators will assess whether a culturally adapted version of
      iCBT ESTEEM demonstrates significant reductions in HIV risk behavior and mental health
      symptoms (e.g., depression, anxiety) compared to self-monitoring of stress and mood.
    

Detailed description: 
      The primary objective is to evaluate the preliminary efficacy of a Chinese-adapted version of
      iCBT ESTEEM on YMSM's sexual health and HIV risk behavior. The secondary objectives of this
      study are to determine whether iCBT ESTEEM impacts HIV/sexually transmitted infections (STI)
      results and symptoms of depression and anxiety, as well as whether baseline minority stress
      exposure moderates treatment efficacy, such that participants with the most minority stress
      exposure benefit more from iCBT ESTEEM than those in the self-monitoring of stress and mood
      condition.

      The proposed prospective study will follow a 2-arm RCT design where 120 Chinese YMSM
      participants will be randomly assigned to one of two conditions:

        1. ESTEEM iCBT: This online CBT treatment consists of 10 weekly modules that participants
           will complete over the course of 10 weeks. Modules contain weekly psychoeducational text
           and vignettes about minority stress and mental health; brief videos illustrating the CBT
           skills; and homework exercises that therapists review and provide feedback on. Homework
           exercises include weekly tracking of stress and mood, practicing new skills (e.g.,
           mindfulness, cognitive restructuring), and exercises related to considering the origins
           of stress and negative emotions that participants may be experiencing. Therapists
           provide feedback after each homework assignment, including reviewing each participant's
           treatment goals as part of the first session's homework. Therapists who support this
           condition will be instructed to incorporate SGM-specific content and feedback into
           homework reviews. In the US, modules were adapted directly from the in-person materials
           (e.g., therapist manual, participant handouts) used in our previously successful trials
           of this treatment. The treatment has also been recently culturally adapted for in-person
           treatment among Chinese YMSM and found to be acceptable and feasible.

        2. Self-monitoring control: In this control condition, participants will be asked to
           indicate their past 7-day mood, stress experiences, and mental and behavioral health on
           an online survey. This type of self-monitoring has been shown to yield improvement in
           behavioral health outcomes. Self-reporting SGM stress experiences has also been shown to
           produce reductions in depression symptoms over time. Participants will record these
           experiences once per week for 10 weeks.

      Before the full trial is launched, the investigators will ensure comprehension of the ESTEEM
      iCBT online module material with 10 separate YMSM, as well as gather their feedback on the
      usability of the iCBT online platform.
    

Intervention name(s): ESTEEM iCBT; Self-monitoring control
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The online CBT treatment consists of 10 weekly modules that participants will complete over the course of 10 weeks.; Participants will be asked to indicate their past 7-day mood; stress experiences; and mental and behavioral health on an online survey experience once per week for 10 weeks
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Health Services Research