Developing a Gay-Specific, Theory-Based Text-Messaging Intervention for Methamphetamine-Using Men Who Have Sex with Men (MSM)

Background: Methamphetamine use among men who have sex with men (MSM) is deeply integrated into socio-sexual networks including digital spaces such as cell phone applications, websites, and digital chat rooms where MSM “hook up” for sex encounters and methamphetamine use. On the West Coast, methamphetamine use has been identified as a major driving force in the transmission of HIV among MSM. Objective: Project Tech Support (clinicaltrials.gov ID# NCT02008526) is a SMS (i.e., text-messaging) intervention that capitalizes on the use of digital spaces among methamphetamine-using MSM to intervene at the exact time they are most likely to engage in high-risk behaviors. Methods: 285 out-of-treatment, methamphetamine-using MSM from Southern California will be enrolled in an 8-week, gay-specific, theory-based SMS intervention designed to decrease methamphetamine use and HIV sexual risk behavior. Participants are randomized into one of three conditions: Condition 1: five gay-specific, theory-based text messages sent by automation each day in addition to unlimited messages interactively transmitted (“push” and “pull”) by Peer Health Educators (TXT-PHE) plus a weekly text-message assessment; or, Condition 2: the same five automated text messages but no interaction with PHEs (TXT-Auto) plus a weekly text-message assessment; or, Condition 3: a weekly text-message assessment-only control (AO) with no gay-specific, theory-based text messages. Prior to implementation, 616 pre-written text messages were developed to target six different possible risk profiles. Each of the 616 pre-written text messages are tailored to be gay-specific and were developed according to the theoretical principles of Social Support Theory, Social Cognitive Theory, or the Health Belief Model. Results: The Dimagi Inc.'s CommConnect SMS system banks the 616 pre-written text messages and, for those randomized into TXT-PHE and TXT-Auto it sends five automated messages to each participant, based on his risk profile. The CommConnect SMS platform features were significantly expanded for this study to add live and real-time SMS interactions between PHEs and study participants via a web-based interface (TXT-PHE only). Each participant in TXT-PHE has a unique chat window allowing for 1) live messaging conversations, 2) the display of message histories from previous SMS conversations, and 3) organization and display of all theory-based automated messages designed for the intervention (for quick and targeted use of each message by the PHEs). PHEs utilize a sortable and keyword-searchable bank of the 616 pre-written text messages to identify and select messages that can be incorporated into live messaging conversations. Weekly SMS assessment responses are hidden from chat windows so that PHEs are blinded to all data. PHEs push unscripted check-in messages to engage the participants enrolled into interactive conversations. Participants in TXT-PHE may also push conversations or in response to an automated message. Logs of message conversations are retained for quality assurance and for a theory-based dose-response analysis at the conclusion of the study. Conclusions: Enrollment began in March 2014. Research is currently in progress. []