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    UCSF DISPARITIES CORE: PROJECT 1

    Youth to Text or Telehealth for Engagement in HIV Care (Y2TEC)

    Parya Saberi and Carol Dawson-Rose, Principal Investigators

    There is a strong association between younger age and less engagement in care, lower adherence, and increased risk of virologic failure. Additionally, problematic substance use frequently occurs in youth living with HIV (YLWH) and disrupts the continuum of HIV care. In response to this public health dilemma, our research team proposes to assess the feasibility and acceptability of two delivery models (text messaging and teleconferencing) for improving engagement in HIV care and decreasing substance use among YLWH (18-25 years of age), using a Sequential, Multiple Assignment, Randomized Trial (SMART) design. We aim to adapt existing interventions for YLWH and further develop these interventions to create the Youth to Text or Telehealth for Engagement in HIV Care (Y2TEC) intervention for improved engagement in care and reduced substance use. If feasible and acceptable, it can be scaled up for a multi-site adaptive randomized clinical trial and ultimately offered in clinical care of YLWH.

    Screening and Brief Intervention in Youth Living with HIV (YLWH): Substance use screening followed by a brief intervention (BI) conducted by an individual trained in MI has been extensively examined in youth. BI approaches are typically delivered on site, and individuals with more severe substance use problems are also given referrals to treatment. Many studies have revealed significant reductions in alcohol use, binge drinking, and days of drug use; lower alcohol, tobacco, and cannabis use; and reductions in illicit drug use. Additionally, BI for non-treatment-seeking samples has strong support in the alcohol literature and some promising effects have been observed with respect to substance use3, 26, 27. Although the evidence-base supporting BI for substance use is still developing, studies have found that BIs can be effective in reducing heroin, cocaine, and amphetamine use26, 27. Additionally, the last component of SBIRT (i.e., referral to treatment) is often not adhered to28 due to lack of follow-through by participants.

    Our intervention, Y2TEC, will use elements of SBIRT25, which has emerged as an important model for identifying and addressing substance use problems in medical settings29. We will start from the established Screening and Brief Intervention procedures29 as a foundation, and then we will enhance the Referral to Treatment component and adapt it to a new target population to deliver via telehealth. Given the close connection between engagement in HIV care and substance use17, both must be addressed concurrently. Therefore, our intervention is innovative because it will be the first time the substance use screening and brief intervention model has been adapted to include engagement in HIV care.