Connecting Youth and Young Adults to Optimize ART Adherence: YouTHrive Efficacy Trial

Youth between the ages of 13 and 24 accounted for 22% of all new HIV infections in 2015. Less
than half (44%) of youth living with HIV (YLWH) in the US are estimated to be virally
suppressed, which is a well recognized critical factor in individual health and
non-infectiousness. Given the high demands of social identity development during adolescence
and early adulthood, as well as the increasing use of social media as important and
influential communication channels, there is an ongoing need for innovative programs that
leverage current communication channels to foster social support for ART adherence behaviors.

The investigators developed a program first called Thrive With Me (TWM) as an intervention
that leverages enhanced peer-to-peer interaction, ART adherence reminders and
self-monitoring, and ART and HIV informational content to improve ART adherence. Given
youth's broad acceptance and adoption of many of the components of the TWM intervention, and
the critical need for novel and scalable ART adherence interventions for this population, we
have adapted TWM for a younger audience and all genders in a program called YouTHrive (YT).

Focus groups will provide insights into what features and functions of the current TWM study
youth like and dislike to assist intervention adaptation. The investigators will conduct
focus groups in three cities (Houston, Bronx, and Chicago) and will recruit up to 16 YLWH per
city, and use the results to develop the YT intervention. Ahead of the RCT, the investigators
will conduct usability testing on YT to gain feedback about the developed intervention. The
investigators will recruit 12 YLWH in six cities to use the intervention for a two-week
period for usability testing.

The randomized controlled efficacy trial will compare YT (N=150) to a control group (N=150).
YLWH in the control arm will receive weekly static information-only emails, compared to daily
use of the dynamic YT social network site for the intervention group. Participants will be
recruited from six cities: Houston, Chicago, Atlanta, Tampa, Philadelphia, and the Bronx.
Assessments will be collected at baseline, 5, 8, and 11-month follow-up.

Specific Aims include:

Primary Aim: In a 2-arm RCT (n=300), assess the efficacy of YouTHrive (YT) to suppress viral
load (VL) among YLWH at the 5-month follow-up timepoint, compared to an HIV information-only
control condition.

H1: A higher proportion of participants in the YT intervention arm than in the
information-only control arm will have undetectable VL at the 5-month follow-up time point.

Secondary Aim 1: Assess whether YT is more beneficial for substance-using than non
substance-using YLWH.

H2: Among YLWH in the YT intervention arm, a higher proportion of substance-using YLWH will
demonstrate VL suppression at the 5-month follow-up time point compared to
non-substance-using YLWH.

Secondary Aim 2: Assess the efficacy of YT to suppress viral load (VL) among YLWH at the
11-month follow-up timepoint, compared to an HIV information-only control condition.

H3: A higher proportion of participants in the YT intervention arm than in the
information-only control arm will have undetectable VL at the 11-month follow-up time point.

Inclusion Criteria:

1. 15-24 years of age at the enrollment visit;

2. Medical-chart verified HIV-positive status;

3. Receiving HIV clinical care in the Chicago, Houston, NYC, Philadelphia, Atlanta, or
Tampa area;

4. Medical chart-verified that most recent VL test was detectable (above the lower limit
of detection for the clinical assay) within 45 days of enrollment date and an ART
prescription for at least 90 days prior to this VL test date;

5. Medical-chart evidence of an ART prescription with refills that extends from the date
of detectable VL to the date of enrollment;

6. English-speaking;

7. Anticipated continuous internet access and SMS messaging for the intervention period
(approximately 5 months); and

8. Availability to meet with project staff at baseline and 5-month and 11-month follow-up
assessments.

Exclusion Criteria:

1. Aged 14 years or younger or 25 years or older at time of screening;

2. HIV-negative or unknown serostatus;

3. Is not in HIV clinical care or does not receive HIV clinical care in the Philadelphia,
Houston, NYC, Atlanta, Tampa, or Chicago area;

4. Most recent VL test was undetectable (below the lower limit of detection for the
clinical assay) within 45 days of enrollment date;

5. No active prescription for ART medications or has been on ART for less than 90 days;

6. Does not speak or read English;

7. Cannot send or receive SMS messages and regularly access the internet for the
intervention period (approximately 5 months);

8. Currently incarcerated; and

9. Enrolled in another ART adherence intervention research study at the time of
screening.

Participants who are or become pregnant during the study period will not be excluded.