Evaluating a Multimedia Messaging Intervention to Increase Adolescent HIV Testing: Protocol for a Hybrid Type 1 Effectiveness Implementation Study.

Abstract

Sexual and gender minority (SGM) adolescents who can benefit from HIV testing due to their sexual behavior (eg, condomless anal or vaginal sex) report suboptimal HIV testing rates. However, interventions designed to increase HIV testing rates among SGM adolescents are lacking, and even when effective interventions exist, reaching SGM adolescents outside research settings can be a challenge. This hybrid type 1 study aims to evaluate the effectiveness of Sharing Health Education Resources (SHER), a multimedia messaging service (MMS) intervention in increasing adolescent HIV testing rates and to address implementation challenges of reaching and engaging SGM adolescents in digital interventions in real-world settings. This study first aims to adapt a digital sexual health intervention previously designed for adolescent sexual minority males to be inclusive of all SGM adolescents and reflect new advancements in HIV prevention science. The second aim is to test the adapted intervention through a hybrid type-1 effectiveness-implementation randomized controlled trial (RCT) with the primary outcome of HIV testing. The third aim is to gather expert recommendations on how to best reach and engage SGM adolescents outside of research settings. SHER is guided by the information-motivation-behavioral skills theory and expands upon a previous intervention tested in a 2014 pilot trial. The previous version of the intervention significantly increased self-reported HIV testing among adolescent sexual minority males compared to an information-only control. Updates to this intervention in this study were driven by stakeholder and adolescent feedback and included modernizing technology, content, and gender inclusivity. An RCT will compare the impact of SHER versus an information-only control condition on HIV testing rates among 360 US SGM adolescents aged 13-19 years. The implementation aim is focused on understanding expert and adolescent perspectives on best practices for reaching and engaging SGM adolescents outside of research settings. Data collection regarding intervention updates was concluded in January 2025 with publication of results planned in fall 2026. As of April 2026, 295 participants have been enrolled into the RCT, with the conclusion of data collection, analysis, and publication of results planned for Winter 2027. All data collection regarding best practices for reaching and engaging SGM adolescents outside of research settings was completed in September 2025, with publication of results planned for Summer 2026. This study will evaluate whether an MMS messaging intervention based on health behavior change theory will increase SGM adolescent HIV testing relative to an information-only version of this intervention. This study will also produce expert- and adolescent-informed best practices for reaching SGM adolescents for sexual health interventions in real-world settings. Overall, this study aims to contribute to increased engagement in sexual health care and HIV testing in SGM adolescents engaging in HIV transmission risk behaviors.