+CLICK: harnessing web-based training to reduce secondary transmission among HIV-positive youth

Abstract

Adolescents and young adults account for over 10 million HIV infections worldwide. Prevention of secondary transmission is a major concern as many HIV-positive youth continue to engage in risky sexual behavior. This study pilot-tested “ + CLICK”, an innovative, web-based, sexual risk reduction intervention for HIV-positive youth as an adjunct to traditional clinic-based, self-management education. The theory-based application, developed for perinatally and behaviorally infected youth 13–24 years of age, provides tailored activities addressing attitudes, knowledge, skills, and self-efficacy related to sexual risk reduction. HIV-positive youth (N=32) pilot-tested “ + CLICK” to assess usability (ease of use, credibility, understandability, acceptability, motivation) and short-term psychosocial outcomes (importance and self-efficacy related to abstinence and condom use) using a single group, pre-/post-test study design in a hospital-based pediatric clinic and community locations. A subsample of participants (n=20) assessed feasibility for clinic use. Participants were 62.5% female, 68.8% Black, and 28.1% Hispanic. Mean age was 17.8 years (SD = 2.55), 43.8% were infected behaviorally, 56.2% perinatally, and 68.8% were sexually experienced. Usability ratings were high: 84.4% rated the application very easy to use; 93.8% perceived content as trustworthy; 87.5% agreed most words were understandable; 87.5% would use the application again. Short-term psychosocial outcomes indicate a significant increase in condom use self-efficacy (p=0.008) and positive trends toward importance (p=0.067) and self-efficacy (p=0.071) for waiting before having sex. Regarding feasibility, participants accessed “ + CLICK” during waiting periods (average time, 15 minutes) in their routine clinic visit. Clinic staff rated “ + CLICK” highly in providing consistent, confidential, and motivational sexual health education without significant disruption to clinic flow. Results suggest that the application is a feasible tool for use in the clinic and has the potential to affect psychological antecedents to sexual behavior change. Further research on long-term and behavioral effects is indicated prior to broader dissemination into clinical practice.

Keywords:

• HIV-positive
• youth
• computer-based interventions
• behavioral interventions
• self-management training

Acknowledgements

This study was conducted with funding from the Baylor College of Medicine-University of Texas at Houston Center for AIDS Research, under grant number, P30 A103621 1-12. Christine Markham, corresponding author, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors made substantial contributions to the study's conception and design, and to the acquisition, analysis, and interpretation of data; all authors participated in drafting or revising the manuscript for intellectual content, and provided final approval of the version to be published.