Effectiveness of the SMART Sex Ed program among 13-18 year old English and Spanish speaking adolescent men who have sex with men.

Adolescent men who have sex with men (AMSM) have a high HIV incidence and low utilization of testing and prevention services. However, very few HIV prevention programs exist that focus on the unique sexual health needs of AMSM. SMART is a stepped care package of eHealth interventions that comprehensively address the sexual and HIV prevention needs of AMSM. This study examines the impact of the first step of SMART, "SMART Sex Ed," on 13- to 18-year-old AMSM (n = 983) from baseline to three-month follow-up across 18 separate outcomes measuring HIV prevention attitudes, skills, and behaviors. We observed significant change from baseline to three-month post-intervention in nine HIV-related outcomes (e.g., receipt of HIV and STI test, HIV knowledge), as well as largely consistent effects across demographic subgroups (e.g., race, age, rural, low SES). Analyses observed no effects on condom use behaviors. SMART Sex Ed shows promise as an effective sexual health education program for diverse AMSM.

RESUMEN: Los adolescentes hombres que tienen sexo con otros hombres (AHSH) experimentan alta incidencia del VIH y baja utilización de servicios de prueba y prevención. Sin embargo, existen muy pocos programas de prevención del VIH enfocados en las necesidades particulares para la salud sexual de AHSH. SMART es un paquete de intervenciones de cuidado escalonado que usa plataformas electrónicas (eHealth) y que atiende de forma integrada las necesidades de salud sexual y prevención del VIH de AHSH. Este estudio examina el impacto de la primera etapa de SMART, llamada "SMART Sex Ed", entre AHSH (n = 983) entre las edades de 13 a 18 años e integra datos desde el reclutamiento con seguimiento cada 3 meses. Se recopilaron datos de 18 indicadores de actitudes, destrezas y prácticas de prevención del VIH (Ej. Historial de pruebas de VIH o ITS; conocimiento sobre VIH), así como los efectos en diferentes grupos demográficos (Ej. Raza, edad, área rural, y bajo nivel socioeconómico). Los análisis realizados demuestran que las características demográficas no tienen efecto en las prácticas de uso de condón. SMART Sex Ed es una intervención prometedora para educación sexual efectiva para AHSH.

Use of a custom testing center locator tool to improve STI and HIV testing rates in adolescent men who have sex with men as part of an online sexual health program.

Adolescent men who have sex with men (AMSM) experience high rates of HIV diagnoses and low utilization of HIV testing and prevention services. Meta-analyses and literature reviews have reported significant effects of online programs at reducing HIV and STI risk and improving use of protective behaviors. SMART is a stepped care package of eHealth interventions that comprehensively address the sexual health and HIV prevention needs of diverse 13-18 year old AMSM nationwide. As part of the online curriculum, educational tools were created to promote specific learning objectives, including the importance of STI and HIV testing. This study describes the use of an HIV and STI testing center locator custom designed for the SMART intervention to promote STI and HIV testing in AMSM. Data were collected between April 2018 and July 2020 as part of the SMART trial assessing the impact of the first intervention of the SMART program, titled SMART Sex Ed, on 13-18 year old AMSM. Measures included AMSM interaction data with the locator tool, history of HIV and STI testing, and confidence to get tested at baseline and 3 months post intervention. Upon entering the SMART program, most participants (69.3%) had never received an HIV or STI test in their lifetime. From those who were enrolled in SMART Sex Ed (n=1075), 82.6% used the custom developed HIV and STI testing center locator tool and those who used the tool were significantly more confident to receive an HIV test and STI test (p < 0.01). Qualitative feedback from SMART participants described the tool as interactive, useful, and easy to use. Preliminary data analysis suggests that our custom developed HIV and STI testing center locator is an acceptable and useful tool with potential for implementation outside the SMART Program. Future analysis should examine if the testing center locator is an acceptable and effective tool outside of the SMART intervention package. Given these results, providing AMSMs easy to use and acceptable online tools with comprehensive, culturally relevant didactic content can significantly improve AMSM's utilization of HIV testing and prevention services.