Integrating mHealth and Supportive Adults to Increase Sexual Health and HIV Prevention Knowledge among Southern Black Adolescents and Young Adults: The AdolescentsSpeaksStudy Protocol (Preprint)

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BACKGROUND HIV disproportionately impacts specific United States (US) populations, including Black adolescents and young adults (AYA) living in the US South. Multiple platforms for HIV pre-exposure prophylaxis (PrEP) are available but use by Black AYA remains low. Studies have shown that some AYA desire to receive help from adults in the form of tangible support (e.g. money for medicines or transportation), informational support (e.g. discussing options, side effects), and emotional support (e.g. encouragement). mHealth apps have improved certain components of sexual health behavior but have not been trialed explicitly with this population to increase types of support. OBJECTIVE The objective of this study is to explore if the combination of support persons and a mHealth app, HealthMPowerment (HMP), adapted to this population can facilitate Black AYA sexual health and HIV prevention communication with adult support persons. METHODS We will partner with an AYA community advisory board (CAB) and an adult support person CAB to guide this study. We will interview Black AYAs 14-21 years old who reside in the US South (n=25) and adult support persons aged 22 years and older who reside in the US South (n=25). Interviews will focus on attitudes towards and willingness to a) communicate with each other about HIV prevention and PrEP, and b) communicate using an app, exploring desirable app features. Then with the aid of the CAB and informed by the interview findings, we will administer a discrete choice experiment (DCE) to AYA (n=250) and adult support persons (n=250) in Alabama and metropolitan Atlanta, two high priority HIV jurisdictions. The DCE will focus on identifying preferred app features and app feature combinations. We will then work with the CAB to adapt the HMP app. We will pilot the refined HMP app with 10 AYA paired with a support person. RESULTS The primary outcomes will be app acceptability and feasibility using in-depth interviews. Secondary outcomes will be app paradata, e.g, engagement metrics including frequency of app use and time spent using specific features. Additionally, this study will provide valuable insights into how AYA may wish to partner with adult support persons, to optimize sexual health, which mHealth app features are most desirable for sexual health communication, and if partnering with adult support persons via an app can increase HIV prevention behaviors and PrEP use. CONCLUSIONS The development, piloting, and results from this digital health-enabled behavioral health intervention aim to strengthen HIV prevention strategies, including PrEP uptake. By leveraging digital tools to facilitate engagement, this intervention may improve sexual health in settings such as the US South, where structural barriers create significant impediments to accessing care and making healthy sexual choices. CLINICALTRIAL NCT06876324, NCT07535346

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