HIV Infection, Pregnancy (Unwanted), Sexual Behavior, Sexually Transmitted Disease (STD)
Conditions
Keywords
transgender youth, Nonbinary youth, Assigned female at birth (AFAB), Pregnancy prevention, Text messaging, mHealth, Sexual health, Gender minority youth, HIV prevention, Contraception
Brief summary
Transgender and gender-diverse young people who were assigned female at birth (AFAB), including transgender boys, nonbinary youth, and others, face real sexual health disparities. Existing pregnancy and HIV prevention programs are designed for cisgender girls and do not meet the needs of AFAB trans youth, leaving this group without programs that speak to their lives. #TranscendentHealth is a text messaging sexual health program developed specifically for AFAB transgender and gender-diverse youth ages 14 to 18. It builds on Girl2Girl, a program shown to improve sexual health behaviors in LGB+ cisgender girls, and updates the content to reflect the identities, relationships, and health needs of AFAB trans youth. The study has two parts. In the first part, AFAB trans youth help shape the program through focus groups, Content Advisory Teams (youth review panels that give feedback on program messages), and a small pilot test. In the second part, a national randomized controlled trial enrolls 467 AFAB transgender youth ages 14 to 18 across the United States. Participants are randomly assigned to receive either #TranscendentHealth or a general sexual health text messaging program. Both programs are delivered entirely by text message over 5 months, with no in-person visits required. Youth complete short online surveys at the start of the program, at program end (5 months), and at 3 and 6 months after the program ends. The study's main goals are to determine whether #TranscendentHealth improves rates of condom-protected sex, use of other birth control methods (such as the pill, shot, or IUD), and HIV/STI testing. Secondary goals include reducing unintended pregnancy, increasing PrEP uptake among eligible participants, and improving intentions to use sexual health services.
Detailed description
Background AFAB transgender and gender-diverse youth experience substantial sexual health disparities yet are largely absent from evidence-based prevention programs. Pilot data from an earlier cohort recruited by Dr. Ybarra show that, compared with cisgender girls, AFAB trans youth are less likely to use barrier protection at last sex (p \< 0.5) and at least as likely to experience adolescent pregnancy. Programs designed for cisgender girls do not address the social stressors these youth face (including discrimination, gender dysphoria, and rejection) and do not affirm their gender identities. As a result, these programs have limited uptake and effectiveness in this population. Intervention #TranscendentHealth adapted Girl2Girl, an evidence-based text messaging sexual health program, for AFAB trans youth. The resulting program addresses condom use, birth control options, HIV/STI testing, PrEP, gender-affirming care, dysphoria, and relationships as experienced by AFAB trans youth. The control arm delivers a universal (not gender-tailored) sexual health text messaging program with a comparable number of messages. Study Design National RCT (Aim 2): A total of 467 AFAB trans youth ages 14-18 are recruited nationally through social media (Instagram and Facebook) and randomized 1:1 to intervention or control, stratified by gender (transgender boy vs. nonbinary) and sexual experience at baseline. A permuted block randomization procedure is used. All study procedures are conducted remotely: online screener, telephone enrollment, text messaging program, and online surveys. No in-person contact is required. Participants complete assessments at baseline, program end (month 5), 3 months after program end, and 6 months after program end. Participants receive graduated incentives. Recruitment targets are set to ensure diversity: at least 25% Hispanic, 28% multiracial, 15% Black/African American, 30% from low-income households, and approximately equal representation across urban, suburban, and rural settings. Approximately 40% of the RCT sample will be sexually inexperienced at baseline.
Interventions
BEHAVIORAL#TranscendentHealth
A 5-month text messaging sexual health program for AFAB transgender and gender-diverse youth ages 14-18, adapted from the Girl2Girl program. Content is gender-inclusive and addresses sexual health protective behaviors, gender-affirming care, relationships, and social stressors specific to AFAB trans youth. Delivered entirely via text message; no in-person contact is required.
BEHAVIORALUniversal Sexual Health Program
5-month general (non-gender-tailored) text messaging sexual health program covering contraception, STI testing, and healthy relationships - same duration and message volume as Arm 1, no Text Buddy feature
Sponsors
Center for Innovative Public Health Research
National Institute of Nursing Research (NINR)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)
Masking description
Both the control and intervention content are written to address issues of pregnancy prevention with the intention of blinding those who have been assigned to the control.
Eligibility
Sex/Gender
FEMALE
Age
14 Years to 18 Years
Healthy volunteers
Yes
Inclusion criteria
* Assigned female sex at birth * Does not have an exclusively cisgender gender identity (e.g., identifies as transgender boy, nonbinary, gender fluid, or unsure of gender identity) * Age 14 to 18 years and has not yet graduated from high school * Exclusive owner of a cell phone with an unlimited text messaging plan * Has access to the Internet to complete online surveys * Plans to keep the same cell phone number for at least the next 6 months * Able to provide informed assent (ages 14-17) or consent (age 18), including the capacity to do so * Has not participated in a prior #TranscendentHealth study activity and does not know anyone currently enrolled in the study
Exclusion criteria
* Has graduated from high school * Has participated in a prior #TranscendentHealth study activity (focus groups, Content Advisory Teams, or beta test) * Knows another person currently enrolled in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rate of Condom-Protected Sex | Month 5 (program end), 3 months post-program end, 6 months post-program end | The number of sex acts in the past 90 days divided by the number of sex acts in which a condom was used, assessed separately for penile-vaginal sex, penile-anal sex, sex with a sex toy and vagina, and sex with a sex toy and anus. |
| % of Participants who Report Use of Birth Control Other Than Condoms | Month 5 (program end), 3 months post-program end, 6 months post-program end | The number of youth who report using any other type of birth control (i.e., oral contraceptive pill, injectable contraceptive (Depo-Provera), vaginal ring (NuvaRing), transdermal patch (Xulane), intrauterine device (IUD, e.g., Paragard), or subdermal implant (e.g., Implanon)) divided by the number of youth in the cohort. |
| Rate of HIV and STI Testing | Month 5 (program end), 3 months post-program end, 6 months post-program end | The percent of participants who report being tested for HIV, and being tested for STIs other than HIV, since the last survey. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| % of Participants who Report an Unintended Pregnancy | Month 5 (program end), 3 months post-program end, 6 months post-program end | The number of youth who report an unintended pregnancy divided by the number of youth in the cohort. Assessed since the last survey (follow-up assessments) and ever (baseline). |
| Rate of PrEP Use | Month 5 (program end), 3 months post-program end, 6 months post-program end | Among participants who meet clinical criteria indicating PrEP use (based on reported sexual behaviors), this will be the number of youth who report having used pre-exposure prophylaxis (PrEP) divided by the total number of youth who are eligible for PrEP. |
| Relative Magnitude of Sexual Health Behavioral Intentions | Month 5 (program end), 3 months post-program end, 6 months post-program end | Using scales adapted for this intervention, continuous measures will be created by summing the responses to 5-point Likert scale items that reflect: Intentions to use condoms, initiate birth control, get tested for HIV/STIs, and discuss PrEP with a healthcare provider. Both sexually experienced and inexperienced participants will provide responses to these scales. |
Countries
United States
Contacts
CONTACTMichele Ybarra, PhD
Outcome results
None listed