Text Messaging to Improve Linkage, Retention, and Health Outcomes among HIV-positive Young Transgender Women: Protocol for a Randomized Controlled Trial (Text Me, Girl!) (Preprint)
Authors: Reback Cathy J. , Fletcher Jesse B. , Fehrenbacher Anne E. , Kisler Kimberly 
Published: December 2018

BACKGROUND

Many transgender women in the U.S. experience numerous cofactors for HIV acquisition and transmission, including increased rates of homelessness, alcohol and drug use, high rates of sex work, as well as non-prescribed hormone injections and/or medically unsupervised soft-tissue filler injections, HIV risk factors specific to this population. In addition, trans women face discrimination and social/economic marginalization more intense and deleterious than that experienced by lesbian, gay, or bisexual individuals, further worsening health outcomes. Although little research has been done specifically on young trans women under the age of 35 years old, existing evidence suggests even further elevated rates of homelessness, substance use, and engagement in HIV transmission risk behaviors relative to their older trans women and non-trans young adult counterparts. Young trans women living with HIV experience a range of barriers that challenge their ability to be successfully linked and retained in HIV care.

OBJECTIVE

Text Me, Girl! was a randomized controlled trial to assess the impact of a 90-day, theory-based, transgender-specific, text-messaging intervention designed to improve HIV-related health outcomes along the HIV Care Continuum among young (18 to 34 years) transgender women (N=130) living with HIV/AIDS.

METHODS

Participants were randomized into either Group A) Immediate Text Message Intervention Delivery (ID: n=61); or, Group B) Delayed Text Message Intervention Delivery (DD: n=69) whereby participants were delivered the text-messaging intervention after a 90-day delay period. Over the course of the 90-day intervention, participants received 270 theory-based text messages that were targeted, tailored, and personalized specifically for young transgender women living with HIV. Participants received three messages per day in real-time within a 10-hour gradual and automated delivery system. The text-message content was scripted along the HIV Care Continuum and based on Social Support Theory, Social Cognitive Theory, and Health Belief Model. The desired outcome of Text Me, Girl! was virological suppression.

RESULTS

Recruitment began on November 18, 2016 and the first participant was enrolled on December 16, 2016; enrollment closed on May 31, 2018. Intervention delivery ended on November 30, 2018, and follow-up evaluations concluded on August 31, 2019. Primary outcome analyses began immediately following the conclusion of the follow-up evaluations.

CONCLUSIONS

Text messaging is the ideal communication platform for engaging young trans women in HIV care because it is easily accessible, private, portable, and inexpensive. Text Me, Girl! aimed to improve HIV Care Continuum outcomes among young trans women by providing culturally responsive text messages to promote linkage, retention, and adherence with the ultimate goal of achieving viral suppression. The Text Me, Girl! text message library is readily scalable and can be adapted for other hard-to-reach populations.