A multilevel mHealth drug abuse and STI/HIV preventive intervention for clinic settings in the United States: A feasibility and acceptability study

Youth-to-youth empowerment study to support health equity for urban American Indian/Alaska Native and Black adolescents in Denver Metro, Colorado, USA: a mixed methods, youth-centred aetiological study protocol

Introduction

Promoting positive substance use and sexual health outcomes for urban American Indian and Alaska Native (AIAN) and Black youth requires multilevel approaches that address the underlying structural conditions that promote behavioural health inequities. However, researchers rarely employ this complex approach. Developing and operationalising a strengths-based conceptual framework grounded in the socioecological model is a critical first step to inform multilevel interventions to reduce these inequities.

Methods and analysis

Guided by the socioecological model, a youth-centred mixed methods approach will be employed to develop and evaluate a comprehensive multilevel conceptual framework of risks and protective factors associated with substance misuse and adverse sexual health behaviours among AIAN and Black youth of Denver Metro, Colorado. We will use multilevel structural equation modelling, with secondary and geographical data. The secondary data include the Healthy Kids Colorado Survey data (n=631 AIAN, n=5350 Black and n=30 557 non-Hispanic white), the Colorado Department of Education School View data (n=33 schools) and the American Community Survey data (n=73 neighbourhoods). We will also engage approximately 30 youth through scenario-based interviewing to capture perspectives on the constructs that are not captured in the secondary data. The quantitative and qualitative data will be integrated to elucidate a conceptual framework that will be used to develop and optimise a multilevel intervention to reduce adverse substance use and sexual health outcomes in AIAN and Black youth in Denver Metro, Colorado.

Ethics and dissemination

The results of the study will be shared at conferences, meetings and in published articles. Study findings will also be presented to the local community through presentations, social media, newsletters, flyers and brochures. The names of all participants, schools and neighbourhoods will be kept private. This study was approved by the Colorado Multiple Institutional Research Board (protocol number 21-4038).

Advancing Adolescent and Young Adult HIV Prevention and Care and Treatment Through Use of Multi-level Theories and Frameworks: A Scoping Review and Adapted HIV Ecological Framework

While multi-level theories and frameworks have become a cornerstone in broader efforts to address HIV inequities, little is known regarding their application in adolescent and young adult (AYA) HIV research. To address this gap, we conducted a scoping review to assess the use and application of multi-level theories and frameworks in AYA HIV prevention and care and treatment empirical research. We systematically searched five databases for articles published between 2010 and May 2020, screened abstracts, and reviewed eligible full-text articles for inclusion. Of the 5890 citations identified, 1706 underwent full-text review and 88 met the inclusion criteria: 70 focused on HIV prevention, with only 14 on care and treatment, 2 on both HIV prevention and care and treatment, and 2 on HIV-affected AYA. Most authors described the theory-based multi-level framework as informing their data analysis, with only 12 describing it as informing/guiding an intervention. More than seventy different multi-level theories were described, with 38% utilizing socio-ecological models or the eco-developmental theory. Findings were used to inform the adaptation of an AYA World Health Organization multi-level framework specifically to guide AYA HIV research.

Efficacy of a Digital Health Preventive Intervention for Adolescents With HIV or Sexually Transmitted Infections and Substance Use Disorder: Protocol for a Randomized Controlled Trial

BACKGROUND

HIV or sexually transmitted infections remain a significant public health concern in the United States, with adolescents affected disproportionately. Adolescents engage in HIV/STI risk behaviors, including drug use and condomless sex, which increase the risk for HIV/STIs. At-risk adolescents, many of whom are racial minorities, experience HIV/STI disparities. Although at-risk adolescents are disproportionately affected by HIV/STI risk behaviors and infections and although the Centers for Disease Control and Prevention recommends routine HIV/STI testing for adolescents, relatively few adolescents report having ever been tested for HIV/STI. With expected increases in health clinic visits as a result of the Affordable Care Act combined with technological advances, health clinics and mobile health (mHealth), including apps, provide innovative contexts and tools to engage at-risk adolescents in HIV/STI prevention programs. Yet, there is a dearth of efficacious mHealth interventions in health clinics to prevent and reduce both condomless sex and drug use and increase HIV/STI testing for at-risk adolescents.

OBJECTIVE

To address this gap in knowledge, we developed a theory-driven, culturally congruent mHealth intervention (hereon referred to as S4E [Storytelling 4 Empowerment]) that has demonstrated feasibility and acceptability in a clinical setting. The next step is to examine the preliminary efficacy of S4E on adolescent HIV/STI testing and risk behaviors. This goal will be accomplished by 2 aims: the first aim is to develop a cross-platform and universal version of S4E. The cross-platform and universal version of S4E will be compatible with both iOS and Android operating systems and multiple mobile devices, aimed at providing adolescents with ongoing access to the intervention once they leave the clinic, and the second aim is to evaluate the preliminary efficacy of S4E, relative to usual care control condition, in preventing or reducing drug use and condomless sex and increasing HIV/STI testing in a clinical sample of at-risk adolescents aged 14-21 years living in Southeast Michigan.

METHODS

In this study, 100 adolescents recruited from a youth-centered community health clinic will be randomized via blocked randomization with random sequences of block sizes to one of the 2 conditions: S4E mHealth intervention or usual care. Theory-driven and culturally congruent, S4E is an mHealth adaptation of face-to-face storytelling for empowerment, which is registered with the Substance Abuse and Mental Health Services Administration's National Registry of Evidence-Based Programs and Practices.

RESULTS

This paper describes the protocol of our study. The recruitment began on May 1, 2018. This study was registered on December 11, 2017, in ClinicalTrials.gov. All participants have been recruited. Data analysis will be complete by the end of March 2024, with study findings available by December 2024.

CONCLUSIONS

This study has the potential to improve public health by preventing HIV/STI and substance use disorders.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03368456; https://clinicaltrials.gov/study/NCT03368456.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/47216.

Virtual screening, pharmacokinetics, and molecular dynamics simulations studies to identify potent approved drugs for Chlamydia trachomatis treatment

Background

The most frequent bacterial sexually transmitted disease is Chlamydia trachomatis (STD). In 2010, the Centers for Disease Control and Prevention (CDC) received 1.3 million reports of cases (CDC). Human chlamydial infections are linked to a variety of clinical symptoms. Inclusion (IncA) membranes are a promising drug target for the treatment of Chlamydia trachomatis. In the present study, molecular docking, ADMET, golden triangle, and molecular dynamics (MD) simulation studies were performed on a series of salicylidene acylhydrazides derivatives against Chlamydia trachomatis. Three types of docking software with different algorithms were used to screen the potential candidate against Chlamydia trachomatis.

Results

The results obtained from the docking analysis succeeded in screening nine novel hit compounds with high affinity to IncA membranes. Then, pharmacokinetics properties were calculated to spot out the drug-likeness of the selected compounds. Also, golden triangles were performed on the selected compounds. Compounds outside the golden triangle indicate that they would have clearance problems. Out of the nine novel hits drugs, four compounds pass the golden triangle screening and virtually all the quality assurance tests proposed by the model and were used for further analysis. One-ns molecular dynamics simulations on the docked complex of compound 44 (one of the highly active selected compounds of the dataset) aided in the further exploration of the binding interactions. Some crucial residues such as Ser111, Gln114, Asn107, Leu142, Gly144, Gln143, Lys104, Tyr149, Phe108, Phe145, and Arg146 were identified. Conventional and carbon–hydrogen bond interactions with amino residues Arg146, Asn107, Phe145, and Ser111 were critical for the binding of inclusion (IncA) membranes inhibitors.

Conclusion

Outcomes of the study can further be exploited to develop potent inclusion (IncA) membranes inhibitors.

"Dying is Not a Fear": Teen and Parent Perspectives on Messaging to Prevent Crystal Meth Use Among Teens in Rural North Idaho

Crystal methamphetamine ("meth") use is on the rise in the USA, having devastating effects on individuals and communities. Innovative prevention strategies are therefore critical. Through an exploratory qualitative study, we examined the perspectives and experiences of teenagers and parents around meth prevention messaging formats and strategies. Teens and adults were recruited through middle and high schools, libraries, local sporting events, and word of mouth in three communities in North Idaho, May-September 2016. Guided by the theoretical framework of the Extended Parallel Process Model, we conducted focus groups and small group interviews (three teen; two adults). Using a deductive content analytic approach, we developed teen- and adult-specific codebooks, analyzed the transcripts with NVivo 12-Plus, and identified themes. Teens and adults were all acutely aware of meth use in their communities, personally knowing people who were addicted to meth, and all understood the oral ("meth mouth") and physical ("crank bugs") consequences of meth use. Three primary themes were identified, which focused on the effects of, addiction to, and messaging around crystal meth use. For teens and adults, images illustrating the effects of meth were least effective if they appeared unrealistic or comical. Teens resonated most with messages focusing on pain and vanity (bad teeth and breath), and there was consensus that showing teens images simulating changes in their appearance over time as a result of meth use in a clinical setting would be an effective prevention strategy. Teens and adults who had exposure to meth addiction in North Idaho felt that prevention messages focused on meth are imperative, given its high prevalence and deleterious effects. Future work will entail developing and testing a communication-based meth prevention strategy along with tailored messaging that can be used with teens in dental settings.

Pilot Study of a Multilevel Mobile Health App for Substance Use, Sexual Risk Behaviors, and Testing for Sexually Transmitted Infections and HIV Among Youth: Randomized Controlled Trial

BACKGROUND

Preventing and reducing substance use disorders, sexually transmitted infections (STIs)/HIV, and teen pregnancy, and the associated risk behaviors (ie, substance use and sexual risk behaviors) among youth remain public health priorities in the United States. Equally important is improving the uptake of STI/HIV testing among the youth. Mobile health (mHealth) apps may be a solution to ameliorate these public health concerns; however, few mHealth preventive interventions have demonstrated efficacy in reducing substance use or sexual risk behaviors or improving the uptake of STI/HIV testing among the youth, particularly in clinic settings.

OBJECTIVE

This small-scale study aimed to examine the feasibility of conducting a pilot randomized controlled trial (RCT). We evaluated the effects of Storytelling 4 Empowerment (S4E), relative to enhanced usual practice, on the potential mechanisms by which behavior change occurs, namely clinician-youth risk communication, prevention knowledge, and substance use and sexual risk refusal self-efficacy. We also assessed the ability to measure targeted outcomes of past 30-day substance use (ie, alcohol, tobacco, and other drug use), condomless sex, and alcohol or drug use before sex, as well as the uptake of STI/HIV testing.

METHODS

Employing community-based participatory research principles, 50 youths aged 13 to 21 years were recruited from a youth-centered community health clinic in Southeast Michigan, randomized sequentially to either S4E or enhanced usual practice, and assessed at baseline, immediately postintervention, and 30 days postintervention. S4E consists of 3 modules, including alcohol and drug use, tobacco, and STI/HIV.

RESULTS

Relative to youth in the enhanced usual practice group, S4E participants demonstrated higher youth-clinician risk communication (mean 3.22, SD 1.67) and increases in prevention knowledge (∆ score mean 0.36, SD 0.51) and self-efficacy (∆ score mean 0.16, SD 0.47). In addition, youth in the S4E group showed reductions in the proportions of past 30-day overall substance use (Cohen h=0.71, 95% CI 0.15 to 1.27), as well as past 30-day alcohol (Cohen h=0.71, 95% CI 0.15 to 1.27), tobacco (Cohen h=0.17, 95% CI -0.39 to 0.73), and drug use (Cohen h=1.28, 95% CI 0.72 to 1.84). The results also suggest a reduction in the proportion of youths who reported past 30-day condomless sex (Cohen h=0.18, 95% CI -0.38 to 0.74) and alcohol use before sex (Cohen h=0.44, 95% CI -0.12 to 1.00). Finally, the findings also demonstrated an increase in the proportion of youths who reported STI/HIV testing over time (Cohen h=0.16, 95% CI -0.39 to 0.72).

CONCLUSIONS

The findings suggest the feasibility of a small-scale pilot RCT. S4E demonstrated shifts in the hypothesized direction, reducing substance use, sexual risk behaviors, and improving the uptake of STI/HIV testing among youth in a clinic setting. The findings suggest that a larger RCT may be warranted.

TRIAL REGISTRATION

ClinicalTrails.gov NCT03855410, https://clinicaltrials.gov/ct2/show/NCT03855410.