USING TEXT MESSAGING TO CONNECT AT-RISK

YOUTH TO TESTINGJOI JACKSON-MORGAN, MPH

YTH 2016

BAYVIEW HUNTERS POINT• TOTAL POPULATION=35,890 (SAN FRANCISCO

FOUNDATION, 2010)• ONE OF THE LARGEST NEIGHBORHOODS THAT

COMPRISE D10• AVERAGE PER CAPITA INCOME=$19,484 VS.

$26,880 DISTRICT-WIDE AND $44,373 CITY-WIDE• GREATER THAN 50% OF RESIDENTS HAVE AN

EDUCATIONAL LEVEL OF HIGH SCHOOL OR LESS

UNIQUE PROBLEMS WE FACE• SUPERFUND SITE: HIGHEST RATES OF

CHRONIC DISEASES (I.E. ASTHMA, DIABETES AND CANCER)• HIGHEST RATES OF ARRESTS AND

INCARCERATION IN SF• HIGHER UNEMPLOYMENT RATES• HIGHER RATES OF STDS IN BOTH ADULTS

AND YOUTH• INCREASED EXPOSURE TO TRAUMA

ADOLESCENTS…HOW DO WE CONNECT WITH YOUTH?

DO THEY WANT TO ATTEND GROUPS OR COME TO THERAPY?

ADOLESCENT COMMUNICATION PREFERENCES

TEXT MESSAGE INTERVENTIONS• INDICATIONS OF SUCCESS: ASTHMA

MANAGEMENT, WEIGHT LOSS, MEDICATION ADHERENCE, DIABETES MANAGEMENT, SMOKING CESSATION• DISEASE MANAGEMENT, DISEASE

PREVENTION• PROVIDE INFORMATION• REMINDERS

OUTCOMES

• GREATER HIV KNOWLEDGE• IMPROVED CONDOM ATTITUDES• INCREASED PERCEIVED HIV RISK SCORE• TREND IN NUMBER ENGAGED IN UNPROTECTED SEXUAL INTERCOURSE

WHY SCREEN?

STUDY DESIGN

CLINIC DATA

TEXTING DATA• APPROACHED: 153

• REFUSED: 28 (18%)

• INELIGIBLE: 25 (16%)

• CONSENTED: 100

• SENT TEXT: 97• 5 TEXTS 79• 5+ TEXTS: 18

• POST-TEST: 88

EXAMPLE TEXTS• HEY YOU GUYS THIS __, DID YOU KNOW THIRD ST YOUTH CLINIC IS NOW LOCATED ON 1728 BANCROFTS AVE. RIGHT AROUND THE CORNER FROM WINGSTOP• HEY GIRL THIS _____________ WEN U CUM BCK FRM TEXAS HERE AT THE

CLINIC ON 3RD U SHULD STP BI THEY HAV GUD CLASSES N PROGRAM N ULL FEL LYK HOME• COME TO THE THIRD ST YOUTH CLINIC FOR STD CHECK• HEY. SO I'M AT THE CLINIC AND I'M GONNA GET TESTED.  YOU SHOULD

COME GET CHECKED TOO.  I'LL COME WITH YOU IF YOU WANT.  IT'S OVER ON 3RD NEXT TO THE NEW WINGSTOP.• HEY I'M AT THE THIRD STREET CLINIC IT'S A GOOD IDEA TO GET

CHECKED OUT• I JUST GOT CHECKED OUT AT THE 3RD ST CLINIC AND THEY WERE REALLY

NICE THEY OFFER FREE TESTING AND HELPED ME A LOT, YOU SHOULD COME DOWN TOO.

CONCERNS• NOTHING (N=55)• RESPONSE FROM FRIEND (N=17)• OTHER (N=28)• THAT FRIENDS WOULD REMEMBER• THEY WON’T TAKE MY ADVICE• NOT AGREE TO GO TO CLINIC• THINK I HAVE SOMETHING• TOO MANY PEOPLE CALL CLINIC PHONE

•“ARE YOU OK”•“ARE YOU FINNA BE A DADDY?•“LOL. WHAT? THAT WAS HECCA RANDOM”•“LMFAO. NICE. OKAY WELL WHEN I GET HOME”•“OK!! LET ME CHECK IT RIGHT OUT” •“FA SHO. WHAT TIME IT ENDS? I GET OUT @ 4”•“I JUST GOT CHECK, THAT SHIT AIN’T NOTHING TO BE PLAYED WITH”•“BITCH WHAT YOU TELLING ME FOR? I GO TO MY DR. EVERY 3 MONTHS FOR

THE •FREE AND I DAMN SHO AINT GOT HIV”

RESPONSES

NUMBER OF PATIENTS

STI TESTS

POSITIVE STI

HIV TESTING

CONCLUSIONS & LESSONS LEARNED• GET RID OF SMALL GROUP

INTERVENTIONS?• TRADE OFFS: INTENSITY VS. REACH• BEHAVIOR CHANGE MODELS STILL HOLD• USE THE STRENGTHS OF TECHNOLOGY• DON’T FORGET THE SCIENCE• DANGERS?• OPPORTUNITIES

THANK YOUDr. Marguerita LightfootDr. Ayanna BennettNational Institute of Drug AbuseNational Institute of Mental HealthWilliam T. Grant FoundationMAC FoundationResearch TeamAgencies, schools, providers3rd Street Youth Center & ClinicYouth willing to share their lives