LITE-2 is a national longitudinal cohort study specific to sexual AND gender minority adolescents that examines and models the trajectories of sexual behavior, gender identity development, HIV transmission risk and HIV prevention engagement of SGM (inclusive of gender diverse and non-binary individuals) ages 13-34 over time.
Interested in LITE-2?
Certain populations in the United States (US) bear an overwhelming burden of new HIV diagnoses, including adolescents and young adults, but especially Black and Latinx young gay, bisexual and other men who have sex with men (GBMSM) and transgender women. Complex factors drive the HIV epidemic among young sexual and gender minorities (SGM) and multiple vulnerabilities exacerbate HIV risk. Given this, adherence to PrEP is crucial for protection against HIV infection, yet youth struggle to use PrEP daily[1-4].
Examining and modeling the trajectories of sexual behavior, gender identity development, HIV transmission risk and HIV prevention engagement over time among a large cohort of adolescent SGM is needed because the absence of rich, longitudinal data on an increasingly visible population of youth hampers the ability of public health programs to intervene and improve health outcomes in any meaningful way.
Digital interventions have been shown to increase knowledge, self-efficacy, and motivation for behavior change and ameliorate distrust, fear, stigma and discrimination across a variety of health conditions[5-10]. Furthermore, access to credible and trusted online resources is critical given that misinformation via social media can increase the risk of stigmatization, decrease community cooperation and increase mistrust and engagement in behaviors that perpetuate HIV.
Given the current situation, we have developed a comprehensive, integrated, HIV status-neutral and scalable digital health platform that leverages advances in data science and precision health to deliver tailored, evidence-based content, decision-tools and support, thus, providing SGM youth with a digital “community” to support their diverse needs. Our feature-rich digital health platform HMP was built from years of prior human-centered design and research to build a supportive, confidential, online community among young SGM, that encourages positive norms and supportive relationships[11-13].
This study aims to utilize a prospective cohort design with limited in-person interaction to monitor and investigate HIV risk and prevention behaviors among young SGM ages 13-34 in the US. Potential participants will be recruited online and retained using a digital research platform.
Eligible participants (n=6000, inclusive of ~1500 LITE-1 participants who meet inclusion criteria) will complete baseline questionnaires and HIV self-testing remotely. Participants will complete quarterly online questionnaires and HIV testing every 12 months through a study-supplied home testing kit. Participants who seroconvert while on study as evidenced by an uploaded and verified HIV test result, as well as those newly diagnosed at baseline (“prevalent positives”), will continue to be followed and will have access to clinical trial opportunities
To enroll and retain a large (n=6000; 3000/year), diverse cohort of sexually active, SGM adolescents and young adults, ages 13-34, using innovative digital recruitment, engagement and retention strategies.
To longitudinally characterize the sexual behavior, HIV transmission risk, and PrEP uptake trajectories of SGM youth utilizing epidemiological trajectory analyses to identify the most effective points of intervention.
To examine the efficacy of HMP Enhanced to improve PrEP adherence among HIV-negative youth (n ≥750) and viral suppression among HIV-positive youth (n ≥150) compared to HMP Basic in a randomized clinical trial.
To maximize the impact of the cohort by testing new and innovative digital health devices, HIV/STI diagnostics and interventions, informed by the previous aims as well as emerging NIH prevention priorities.
More coming soon!
- Health Tracker – Medication and sexual activity tracking allows users to visualize patterns in their adherence, self monitor and receive feedback for improvement. Reminders help folx never miss a dose!
- Avatar customization – Supports ongoing engagement by unlocking new accessories the more users engage with the app.
- Forum – Users can participate in forum discussions and polls to foster community support and peer-to-peer sharing within the app.
- Store – Users can earn “bucks” by using the app. Bucks can be redeemed for real-world swag!
- Resources & Activities – Provides educational content across a range of health topics, as well as supports app engagement and behavior change through information and skill-building.
- Ask the Expert – Health care providers answer anonymous user questions and connect users to resources
- LITE News – Get daily updates on relevant content, take brief surveys, and receive positive affirmations
- Tango e-gift card integration for incentives – Allows users to redeem their choice of e-gift card as an incentive for completing study milestones like follow up surveys
- Test Kits – Users can complete in-home HIV and STI test kits and be linked to care if results are reactive
Findings and Takeaways
Sybil G. Hosek, PhD | Cook County Health
Audrey L. French, MD | Cook County Health
Lisa Hightow-Weidman, MD, MPH | Institute on Digital Health and Innovation, Florida State University College of Nursing
- Hosek SG, Landovitz RJ, Kapogiannis B, et al. Safety and Feasibility of Antiretroviral Preexposure Prophylaxis for Adolescent Men Who Have Sex With Men Aged 15 to 17 Years in the United States. JAMA Pediatr. 2017;171(11):1063-1071.
- Hosek S, Celum C, Wilson CM, Kapogiannis B, Delany-Moretlwe S, Bekker LG. Preventing HIV among adolescents with oral PrEP: observations and challenges in the United States and South Africa. J Int AIDS Soc. 2016;19(7(Suppl 6)):21107.
- Gill K, Johnson L, Dietrich J, et al. Acceptability, safety, and patterns of use of oral tenofovir disoproxil fumarate and emtricitabine for HIV pre-exposure prophylaxis in South African adolescents: an open-label single-arm phase 2 trial. Lancet Child Adolesc Health. 2020;4(12):875-883.
- Celum C, Hosek S, Tsholwana M, et al. PrEP uptake, persistence, adherence, and effect of retrospective drug level feedback on PrEP adherence among young women in southern Africa: Results from HPTN 082, a randomized controlled trial. PLoS Med. 2021;18(6):e1003670.
- Bauermeister JA, Muessig KE, LeGrand S, et al. HIV and Sexuality Stigma Reduction Through Engagement in Online Forums: Results from the HealthMPowerment Intervention. AIDS Behav. 2019;23(3):742-752.
- Mulawa MI, Rosengren AL, Amico KR, Hightow-Weidman L, Muessig K. mHealth to reduce HIV-related stigma among youth in the United States: a scoping review. Mhealth. 2020;ePub ahead of print.
- Hightow-Weidman LB, Muessig KE, Bauermeister J, Zhang C, LeGrand S. Youth, Technology, and HIV: Recent Advances and Future Directions. Curr HIV/AIDS Rep. 2015;12(4):500-515.
- Lelutiu-Weinberger C, Pachankis JE, Gamarel KE, Surace A, Golub SA, Parsons JT. Feasibility, Acceptability, and Preliminary Efficacy of a Live-Chat Social Media Intervention to Reduce HIV Risk Among Young Men Who Have Sex With Men. AIDS Behav. 2015;19(7):1214-1227.
- Rhodes SD, Hergenrather KC, Duncan J, et al. A pilot intervention utilizing Internet chat rooms to prevent HIV risk behaviors among men who have sex with men. Public Health Rep. 2010;125 Suppl 1:29-37.
- Muessig KE, Nekkanti M, Bauermeister J, Bull S, Hightow-Weidman LB. A systematic review of recent smartphone, Internet and Web 2.0 interventions to address the HIV continuum of care. Curr HIV/AIDS Rep. 2015;12(1):173-190.
- Hightow-Weidman LB, Fowler B, Kibe J, et al. HealthMpowerment.org: development of a theory-based HIV/STI website for young black MSM. AIDS Educ Prev. 2011;23(1):1-12.
- Hightow-Weidman LB, Muessig KE, Pike EC, et al. HealthMpowerment.org: Building Community Through a Mobile-Optimized, Online Health Promotion Intervention. Health Educ Behav. 2015;42(4):493-499.
- Hightow-Weidman LB, Pike E, Fowler B, et al. HealthMpowerment.org: feasibility and acceptability of delivering an internet intervention to young Black men who have sex with men. AIDS Care. 2012;24(7):910-920.