Texting Intervention to Sustain HIV prevention in women in high-drug-use contexts

PIs: Thomas L. Patterson (lead PI); Steffanie A. Strathdee; Shirley J. Semple
Funding Source: NIH R01 DA039071-01A1
Project Period: July 2015 – May 2020

Treatment effects of health behavior interventions erode, often with relapse rates greater than 50% within 6 months, possibly because the constructs that sustain behavior change differ from those that favor behavior acquisition. The principal aim of this study is to evaluate the efficacy of Mujer Saludable Siempre (MSS, Always Healthy Woman), a behavior-maintenance intervention using text messages that is focused on acquired safer-sex behaviors among female sex workers in Tijuana, Baja California and Ciudad Juarez, Chihuahua (both in Mexico). The text messages employed by MSS will use the constructs of behavior maintenance theory to target the maintenance of behavioral effects of a single-session safer-sex counseling intervention (Mujer Más Segura) that was shown (R01 DA023877) to be efficacious in reducing HIV/STI incidence by more than 60% among both drug-using and non-drug-using female sex workers (FSWs) in the same two cities.

The specific aims are:
(1) To determine if the theory-based MSS text-messaging intervention is associated with the long-term (24-month) maintenance of significant reductions in HIV/STI incidence (primary outcome) among drug-using and non-drug-using FSWs in Tijuana and Cd. Juarez relative to a time-equivalent control condition;
(2) To determine if the MSS intervention is associated with greater reductions in unprotected vaginal and anal sex with male clients, better attendance at regularly scheduled STI screenings, and reduced sharing of drug paraphernalia for FSW-IDUs (secondary outcomes) relative to a time-equivalent control condition;
(3) To determine if substance use factors (frequency, intensity, and patterns of alcohol and drug use) mediate or moderate the efficacy of the intervention, taking into account environmental risk factors (e.g., drugs in the workplace), maintenance constructs (e.g., maintenance self-efficacy), and personal characteristics (e.g., age, sexual abuse, depression); and
(4) To evaluate the cost-effectiveness of MSS compared to the control condition, to Mujer Más Segura alone (data from previous studies), and to usual care in Mexico.

To meet these aims, we will deliver the Mujer Más Segura intervention to 600 HIV-negative FSWs (300 in each city) who report unsafe sex with at least one client in the previous 6 months, and we will randomize these women to either Group 1 (n=300), which will consist of twice-daily MSS text-messages, five days a week, or Group 2 (control condition, n=300), which will consist of general health text messages at the same frequency. Both conditions will receive their respective message types for 24 months post-counseling, since this is the period during relapse is likeliest to occur. Participants will undergo follow-up behavioral assessments and STI testing at 6, 12, 18, and 24 months.

This study will advance the use of commonly available information technology to empower high-risk women in lower- to middle-income countries (LMICs) to prolong the benefit of an efficacious HIV prevention intervention.