title: +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.
authors.affiliation: Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, TX, USA. Christine.Markham@uth.tmc.edu
authors.forename: Christine Margaret
authors.initials: CM
authors.lastname: Markham
authors.forename: Ross
authors.initials: R
authors.lastname: Shegog
authors.forename: Amy Dolph
authors.initials: AD
authors.lastname: Leonard
authors.forename: Thanh C
authors.initials: TC
authors.lastname: Bui
authors.forename: Mary E
authors.initials: ME
authors.lastname: Paul
mesh_terms: D000293:Adolescent; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D020407:Internet; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D010865:Pilot Projects; D012307:Risk Factors; D021841:Safe Sex / Q000523:psychology*; D012648:Self Care / Q000379:methods*; D020377:Self Efficacy; D055815:Young Adult