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      Behavioral economics-based incentives supported by mobile technology on HIV knowledge and testing frequency among Latino/a men who have sex with men and transgender women: Protocol for a randomized pilot study to test intervention feasibility and acceptability

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          Abstract

          Background

          Mobile Technology and Incentives (MOTIVES) is a randomized pilot study of a mobile technology-based and behavioral economics-supported HIV prevention intervention. Behavioral economics (BE) uses financial incentives in a way that departs from the traditional focus on large monetary payments. Instead, BE suggests that relatively small “nudges” can effectively initiate and sustain behavior change. This pilot study examines the feasibility and acceptability of an HIV prevention intervention that uses text messages in combination with BE incentives to improve retention of HIV prevention information and increase frequency of HIV testing among Latino/a men who have sex with men (MSM) and transgender women (TGW). The pilot will also estimate mission-critical design parameters with point and confidence interval estimates of the intervention to inform a future, fully powered effectiveness study.

          Methods

          The project will be conducted in collaboration with Bienestar Human Services, Inc. ( Bienestar), a non-profit community-based service organization. The intervention is being tested in a small, randomized controlled trial to pilot the intervention’s feasibility and acceptability among 200 Latino/a MSM and TGW from Bienestar’s HIV testing sites. Information on feasibility will include recruitment, refusal, and retention rates as well as message sending success rates; acceptability will include perceived appropriateness based on responses to the intervention. Participants will be randomized into either the “information only” control group (e.g. receiving text messages with HIV prevention information) or the “information plus” intervention group (e.g. additionally receiving quiz questions that provide the possibility of winning prizes). Participants will be followed for 12 months from enrollment. In addition to using data abstracted from Bienestar’s routine data collection mechanisms, we will also collect survey data (blinded outcome assessment) from participants at 0, 6, and 12 months to provide an initial assessment of whether incentives affect their level of HIV knowledge and testing frequency.

          Discussion

          If shown to be acceptable, feasible, and resource-efficient, MOTIVES will provide an innovative way to communicate the latest HIV prevention information and support trimestral HIV screening among Latino/a MSM and TGW.

          Trial registration

          ClinicalTrials.gov, NCT03144336. Registered on 5 May 2017.

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          A structured review of the effect of economic incentives on consumers' preventive behavior.

          Improving participation in preventive activities will require finding methods to encourage consumers to engage in and remain in such efforts. This review assesses the effects of economic incentives on consumers' preventive health behaviors. A study was classified as complex preventive health if a sustained behavior change was required of the consumer; if it could be accomplished directly (e.g., immunizations), it was considered simple. A systematic literature review identified 111 randomized controlled trials of which 47 (published between 1966 and 2002) met the criteria for review. The economic incentives worked 73% of the time (74% for simple, and 72% for complex). Rates varied by the goal of the incentive. Incentives that increased ability to purchase the preventive service worked better than more diffuse incentives, but the type matters less than the nature of the incentive. Economic incentives are effective in the short run for simple preventive care, and distinct, well-defined behavioral goals. Small incentives can produce finite changes, but it is not clear what size of incentive is needed to yield a major sustained effect.
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            Txt2stop: a pilot randomised controlled trial of mobile phone-based smoking cessation support.

            To conduct a pilot randomised controlled trial of mobile phone-based smoking cessation support intervention for the UK population. Randomised controlled trial (txt2stop). Community. 200 participants responding to radio, poster and leaflet-based promotions regarding the trial. The response rate for the outcome measures planned for the main trial. Participants' qualitative responses to open-ended questions about the intervention content. Secondary outcomes were the outcomes planned for the main trial including the point prevalence of self-reported smoking at 4 weeks and pooled effect estimate for the short-term results for the STOMP and txt2stop trials. The response rate at 4 weeks was 96% and at 6 months was 92%. The results at 4 weeks show a doubling of self-reported quitting relative risk (RR) 2.08 (95% CI 1.11 to 3.89), 26% vs 12%. The pooled effect estimate combining txt2stop and a previous New Zealand trial in the short term is RR 2.18 (95% CI 1.79 to 2.65). Mobile phone-based smoking cessation is an innovative means of delivering smoking cessation support, which doubles the self-reported quit rate in the short term. It could represent an important, but as yet largely unused, medium to deliver age-appropriate public health measures. The long-term effect of this mobile phone-based smoking cessation support will be established by a large randomised controlled trial currently in recruitment.
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              Emerging technologies for HIV prevention for MSM: what we have learned, and ways forward.

              Technology-enabled HIV research and prevention has emerged in the past 10 years as an exciting dynamic field that offers great potential to help bring HIV prevention efforts to scale in key risk communities. Evolutions in technologies and in HIV epidemics suggest mutual opportunities to reach most at risk populations in novel ways. New technologies cannot completely replace interventions and services currently delivered by the people. However, we suggest that emerging technologies hold promise to bring services to scale and produce efficiencies in reaching rural populations of men who have sex with men (MSM), connecting with populations who are not reached in current urban outreach efforts, and providing services or research surveys that can be described algorithmically. Furthermore, the types of technologies (eg, internet-based, smartphone-based, text messaging) should be matched with both the content to be delivered and the technology usage patterns of target populations. We suggest several key principles and lessons learned that comprise a framework in which to consider the opportunities of technologies and HIV prevention and research. Future directions include improvement of data quality in online surveying, better characterization of biases, developing improved sampling approaches, working with funders to ensure compatibility of funding mechanisms and online research proposals, and promoting consensus approaches to the duplication and presentation of research and program evaluation results from online research. Given the current calls for comprehensive packages of prevention services for MSM, effective prevention might require an intentional combination of technology-enabled prevention services to achieve scale and strategic use of personally delivered package components in cases where non-algorithmic services, such as individualized counseling, are needed.
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                Author and article information

                Contributors
                310-393-0411 , slinnema@rand.org
                310-393-0411 , sarahm@rand.org
                310-393-0411 , akim@rand.org
                646-774-6943 , Rebecca.giguere@nyspi.columbia.edu
                646-774-6930 , ac72@cumc.columbia.edu
                323-727-7896 , jbarreras@bienestar.org
                Journal
                Trials
                Trials
                Trials
                BioMed Central (London )
                1745-6215
                5 October 2018
                5 October 2018
                2018
                : 19
                : 540
                Affiliations
                [1 ]ISNI 0000 0004 0370 7685, GRID grid.34474.30, RAND Corporation, Economics, Sociology, and Statistics, ; 1776 Main Street, Santa Monica, CA USA
                [2 ]ISNI 0000 0004 0370 7685, GRID grid.34474.30, RAND Corporation, Behavioral and Policy Sciences, ; 1776 Main Street, Santa Monica, CA USA
                [3 ]ISNI 0000 0000 8499 1112, GRID grid.413734.6, HIV Center for Clinical and Behavioral Studies, Division of Gender, Health and Sexuality, , New York State Psychiatric Institute and Columbia University, ; 1051 Riverside Drive, Unit 15, New York, NY USA
                [4 ]GRID grid.423275.5, Bienestar Human Services, Inc., ; 5326 East Beverly Blvd, Los Angeles, CA 90022 USA
                Author information
                http://orcid.org/0000-0001-6468-8009
                Article
                2867
                10.1186/s13063-018-2867-1
                6173939
                30290851
                94e4e1c2-4c21-4ef6-a4f7-fd2c1cd6724d
                © The Author(s). 2018

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 5 January 2018
                : 20 August 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000025, National Institute of Mental Health;
                Award ID: 1R34MH109373-01A1
                Award Recipient :
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2018

                Medicine
                feasibility and acceptability,hiv testing,mobile technology,behavioral economics,intervention,incentives,latino,men who have sex with men,transgender women

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