Anne M. Teitelman

Purpose: This study evaluated the feasibility, acceptability, usability, and HPV vaccine completion rate of the Now I Know (NIK) mHealth intervention to promote HPV vaccine completion among minority and low-income young women. Methods: This quasi-experimental pilot study recruited 35 women aged 18–26 at two federally supported outpatient clinics in a large city in the Northeastern United States. Participants were allocated to two groups: 24 received the NIK intervention plus usual care and 11 received usual care only. After completing a baseline assessment, intervention group participants launched the NIK mobile app, which entailed HPV vaccine education, self-managed vaccine record & reminder, and Q&A features. Follow-up visits were conducted at 2 and 6 months. Feasibility was assessed through screening, recruitment, fidelity, and retention. Acceptability and usability were evaluated via survey and exit interview. The primary outcome—HPV vaccine 3-dose series completion—was analyzed using descriptive statistics. Results: This study demonstrated feasibility by reaching the recruitment target (n = 35) and high retention rate (89%). Participants reported the app was acceptable, appreciating reliable information, convenient access, providing a personal touch, and raising awareness. Regarding usability, users found the app easy to navigate, accessible, well organized, and user-friendly. The HPV vaccine completion rate was higher in the intervention group (55%) than in the usual care group (45.5%). Conclusion: Findings showed improved vaccination completion among those using the Now I Know mHealth intervention (compared to usual care), acceptability of the intervention, and feasibility of recruiting, retaining, and delivering the intervention to promote HPV vaccine completion among young women in federally subsidized healthcare settings.

Background: Women comprise 19% of new HIV infections in the U.S. Many women, particularly women of color, are unaware of pre-exposure prophylaxis (PrEP) as an HIV prevention option. We conducted a pilot randomized controlled trial (RCT) to assess feasibility and acceptability of a theory-based, contextually-relevant behavioral intervention, Just4Us, to promote PrEP initiation and adherence among women in New York City and Philadelphia. Methods: Eligibility criteria included: cisgender women, aged 18-55, not living with HIV, not currently taking PrEP, and meeting PrEP eligibility guidelines. Participants were randomized 3:1 to the Just4Us Education and Activities (E&A) arm or to the Information arm (Info); all were provided with PrEP information and a referral list. E&A arm participants received an individually-delivered session with a counselor-navigator, who provided information, motivation enhancement, skills-building, problem-solving, and referrals. Between baseline and 3-month follow-up, E&A arm participants received phone calls to support linkage to care and text-messages to promote adherence. Feasibility and acceptability were assessed. Results: Eighty-three women were enrolled (61 intervention; 22 Info); 79% were Black, 26% Latina, exceeding diversity and enrollment targets. Attendance rate for the initial E&A and Info intervention session was 100%. Three-month retention rate was high at 90%. E&A arm participants reported feeling “very satisfied/satisfied with the following: overall session, 95%; discussion with counselor-navigator, 97%; tablet activities, 95%; text-messaging set-up, 93%.; and video, 90%. Among Info and E&A arms, 78% felt the session length was just right, and 95% stated that they would recommend/strongly recommend Just4Us to others. Conclusions: The pilot RCT demonstrated feasibility and acceptability of the Just4Us E&A intervention, a promising intervention to increase uptake of PrEP among cisgender women. The team was able to recruit, implement the interventions with a high degree of fidelity, and retain the target number of PrEP-eligible socially disadvantaged women. Overall, participant feedback indicated they were generally very satisfied with their intervention.

Background: The incidence of sexually transmitted infections has been increasing throughout the world. Additionally, substantial changes in emerging adults’ attitudes toward sex and the popularization of premarital sex could further affect the diagnosis and treatment of sexually transmitted infections. With the high acceptability and effectiveness of instant messaging (IM) interventions for health promotion, there is potential for such interventions to improve condom use knowledge and promote safer sex practice. Objective: The study evaluates the feasibility of a nurse-led IM intervention to promote safer sex practices in emerging adults. Methods: A 30-minute adaptive IM intervention and a 5-day booster dose of daily messages after 2 weeks through WhatsApp (Meta Platforms, Inc) were conducted with emerging adults in local universities in Hong Kong aged between 18 and 29 years with previous sexual experience. A questionnaire was distributed 1 week after the intervention that measured the consistency in condom use, the change in condom use knowledge and attitudes, and the acceptability of the intervention. The feasibility of the intervention was assessed by Bowen’s feasibility framework. Results: A total of 20 participants completed the intervention and questionnaire. Results showed (1) high satisfaction level (mean satisfaction score: 9.10/10), (2) high demand of the intervention (retention rate: 95%), (3) smooth implementation of the intervention, (4) high practicality (13/20, 65% of the participants viewed IM to be an effective means of intervention), (5) potential integration of the intervention, and (6) significant mean increase in condom use knowledge and attitudes (mean increase 9.05; t19=3.727; 95% CI 3.97-14.13; P=.001). Conclusions: The IM intervention was feasible, acceptable, and had potential impacts on improving safer sex practices. These findings will support the future development of IM interventions in the arena of sexual health promotion.

BACKGROUND The incidence of sexually transmitted infections has been increasing throughout the world. Additionally, substantial changes in emerging adults’ attitudes toward sex and the popularization of premarital sex could further affect the diagnosis and treatment of sexually transmitted infections. With the high acceptability and effectiveness of instant messaging (IM) interventions for health promotion, there is potential for such interventions to improve condom use knowledge and promote safer sex practice. OBJECTIVE The study evaluates the feasibility of a nurse-led IM intervention to promote safer sex practices in emerging adults. METHODS A 30-minute adaptive IM intervention and a 5-day booster dose of daily messages after 2 weeks through WhatsApp (Meta Platforms, Inc) were conducted with emerging adults in local universities in Hong Kong aged between 18 and 29 years with previous sexual experience. A questionnaire was distributed 1 week after the intervention that measured the consistency in condom use, the change in condom use knowledge and attitudes, and the acceptability of the intervention. The feasibility of the intervention was assessed by Bowen’s feasibility framework. RESULTS A total of 20 participants completed the intervention and questionnaire. Results showed (1) high satisfaction level (mean satisfaction score: 9.10/10), (2) high demand of the intervention (retention rate: 95%), (3) smooth implementation of the intervention, (4) high practicality (13/20, 65% of the participants viewed IM to be an effective means of intervention), (5) potential integration of the intervention, and (6) significant mean increase in condom use knowledge and attitudes (mean increase 9.05; t19=3.727; 95% CI 3.97-14.13; P=.001). CONCLUSIONS The IM intervention was feasible, acceptable, and had potential impacts on improving safer sex practices. These findings will support the future development of IM interventions in the arena of sexual health promotion.

Approximately 90% of HPV-associated cancers are preventable with HPV vaccination, yet uptake is suboptimal, particularly among minority and low-income young women. A theory-based intervention (Step Up to Prevention) was developed to enhance knowledge and promote favorable attitudes about HPV vaccination among young women aged 18-26 attending federally supported clinics. This mixed-method study evaluated the acceptability, feasibility, and preliminary efficacy of the intervention. We presented the brief intervention to participants before their scheduled clinic visit and measured the impact on HPV vaccine uptake. We offered the information and tailored components of the intervention together and separately and compared them to usual care. Women (n=60) were randomized into four groups (computerized information, 1-to-1 tailored, combined, and usual care). They responded to pre/post-surveys before and immediately after the intervention and after their clinic visit. Significant differences in initial HPV vaccine uptake were observed among all intervention groups as compared to usual care (computerized information (p=0.006), 1-to-1 tailored (p=0.007), combined (p=0.043)). The qualitative findings suggest the various components of the intervention were all acceptable highlighting aspects that were empowering and informative. Results suggest this intervention has potential efficacy to provide additional support to providers and patients by promoting favorable views and improving health literacy among young women about HPV vaccination. Clinical Trial Registration: NCT02046265

HIV pre-exposure prophylaxis (PrEP) uptake among cisgender women in the United States is low. Just4Us, a theory-based counseling and navigation intervention, was evaluated in a pilot randomized controlled trial among PrEP-eligible women (n = 83). The comparison arm was a brief information session. Women completed surveys at baseline, post-intervention, and at three months. In this sample, 79% were Black, and 26% were Latina. This report presents results on preliminary efficacy. At 3 months follow-up, 45% made an appointment to see a provider about PrEP; only 13% received a PrEP prescription. There were no differences in PrEP initiation by study arm (9% Info vs. 11% Just4Us). PrEP knowledge was significantly higher in the Just4Us group at post-intervention. Analysis revealed high PrEP interest with many personal and structural barriers along the PrEP continuum. Just4Us is a promising PrEP uptake intervention for cisgender women. Further research is needed to tailor intervention strategies to multilevel barriers. Clinicaltrials.gov registration NCT03699722: A Women-Focused PrEP Intervention (Just4Us).

We aimed to elucidate the specific roles and responsibilities of expert clients in service delivery among adolescents living with HIV in Eswatini, and to provide recommendations for enhancing adolescent service provision among expert clients and similar lay health workers throughout low- and middle-income countries. An exploratory qualitative descriptive methodology using conventional content analysis was used to meet our study aims. We recruited 20 expert clients and 12 key informants (programme managers, programme coordinators and nurses) to participate in semi-structured interviews, and we arranged four focus group discussions among adolescents living with HIV with seven to ten participants per focus group. Adherence counselling in clinical and community settings was considered paramount to the roles and responsibilities of expert clients with regard to adolescent-specific HIV service delivery. The following recommendations were made to enhance expert client service delivery practices among adolescents: (1) training in adolescent developmental, sexual and reproductive needs; (2) training to enhance clinical knowledge and skills; (3) additional work equipment and compensation; and d) more parent and guardian engagement in their work. While expert clients meet the needs of adolescents living with HIV in several capacities, they require additional resources, skills and training to improve their work, especially in the realm of sexual and reproductive health. Future research is needed to evaluate the impact of expert client service delivery on adolescent health outcomes.

HIV pre-exposure prophylaxis (PrEP) uptake among cisgender women in the United States is low. Just4Us, a theory-based counseling and navigation intervention, was evaluated for preliminary efficacy in a pilot randomized controlled trial with PrEP-eligible women (n = 83). The comparison arm was a brief information session. Surveys were completed at baseline, post-intervention and at 3 months. In the study sample, 79% were Black and 26% were Latina. At 3 months follow-up, 45% made an appointment to see a provider about PrEP; only 13% received a PrEP prescription. There were no differences in PrEP initiation by study arm (9% Info vs 11% Just4Us; CI 1.07). Knowledge was significantly higher in the Just4Us group at post-intervention. Analysis revealed high PrEP interest with many personal and structural barriers along the PrEP continuum. Just4Us is a promising PrEP uptake intervention for cisgender women. Further research is needed to tailor intervention strategies on individual circumstances and barriers. Clinicaltrials.gov registration: NCT03699722: A Women-Focused PrEP Intervention (Just4Us)