PUSH: Providing Unique Support for Health for Young Black and Latino Men

Statement of Problem

There are approximately 37,600 new human immunodeficiency (HIV) infections each year in the United States, with adolescents and young adults ages 13-24 making up 21 percent of new diagnoses. Urban cities such as Baltimore, Washington, D.C., and Philadelphia are especially burdened by high and increasing rates of new HIV infections. In addition, youth of color, young transgender women and men who have sex with men (MSM) are disproportionately affected by HIV.

One of the most challenging aspects of HIV prevention and treatment is medication adherence to prevent HIV infection or, for those living with HIV, to achieve viral suppression and engage and retain youth in care. Other risky behaviors, such as substance use, can further complicate and hinder prevention and treatment plans.  As a supplement to routine medical care, innovative digital solutions can provide real-time support and feedback for these young people—who are constant consumers of technology—to help them with HIV prevention and treatment as well as substance abuse treatment to improve their health outcomes.

Description

To help these populations most at risk, a panel of researchers from Children’s Hospital of Philadelphia, Johns Hopkins University, Children’s National, Whitman Walker Health and the Treatment Research Institute are conducting a study called Providing Unique Support for Health (PUSH). PUSH is a multiphase study consisting of:

  1. Formative research, with youth and community/provider stakeholder input via focus groups and interviews, to develop effective strategies for reaching youth and to help develop a mobile-enhanced engagement intervention (MEI) application with emocha Mobile Health Inc. for use throughout the study;
  2. Identification, recruitment and rapid HIV testing of young (age 15-24) Black and Latino men who have sex with men, including gender-expansive and transgender women who are living with HIV or at high-risk for contracting HIV by using a research method called respondent-driven sampling and social media/networking sites in three urban cities (Philadelphia, Baltimore and Washington, D.C.);
  3. Two randomized control trials (RCT) to:
    • Compare HIV and substance treatment MEI vs. standard of care over 18 months
    • Compare pre-exposure prophylaxis (PrEP) and substance treatment MEI vs. standard PrEP navigation referral over 12 months
  4. Explore technology preferences, health experiences and recommendations to improve engagement and retention among select youth who participated in the RCTs by conducting qualitative interviews

The unique MEI app is coupled with a supportive health coach trained in motivational interviewing and has a variety of features, including medication and appointment reminders with optional pill camera function, calendar tracker, place to store health insurance information, chat function to speak directly to trained health coaches, weekly substance use screening surveys and various health clinics’ contact information for ease of access. The MEI’s main focus is to bolster:

  1. Antiretroviral therapy (ART) adherence and suppressed viral loads among youth living with HIV
  2. PrEP uptake and adherence among high-risk HIV-uninfected youth
  3. Engagement in substance abuse treatment

 

Next Steps

PUSH may have broad implications for identifying, engaging, retaining and improving health outcomes for adolescents and young adults living with HIV and those at high risk for HIV infection who are underserved, underinsured and hard to reach. This type of mHealth intervention with direct health coach support and interaction provides an opportunity to diversify and improve health care using technology. Plans for mHealth/eHealth sustainability and MEI updates are in development.

This project page was last updated in July 2019.

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. PUSH: Providing Unique Support for Health for Young Black and Latino Men [online]. Available at: http://www.policylab.chop.edu [Accessed: plug in date accessed here].