Identifying key engagement characteristics to enhance the effectiveness of digital HIV interventions for at-risk youth

PROJECT SUMMARY Digital health interventions (DHIs) have shown significant promise in promoting HIV prevention and care among at-risk youth. Despite the great potential for behavior change that DHIs offer, the effectiveness of DHIs has varied across studies, largely due to the varying degrees of participant engagement. Therefore, identifying key engagement characteristics in DHIs is important to evaluate the efficacy of DHIs with rigor and enhance the efficacy of DHIs for at-risk youth by promoting engagement. DHI studies have utilized single indicators of engagement, such as amount, frequency, and duration, and have focused on cross- sectional relationships between engagement and outcomes. This approach has limited the ability to evaluate the multidimensional aspects of engagement and the prospective effects of engagement on outcomes over time. Moreover, the one-size-fits-all approach may not be suitable for designing DHIs for youth. Therefore, there is a need to analyze engagement across multicenter research trials dedicated to HIV prevention and care for youth in the US. Our research aims to identify key characteristics of engagement to enhance the efficacy of DHIs for at-risk youth by pooling data from Adolescent Medicine Trials Network for HIV Interventions (ATN) - UNC/Emory Center for Innovative Technology (iTech) trials. In this study, we propose using secondary data from more than 900 individuals who participated across five ATN-iTech trials (MyChoices, LYNX, TechStep, Get Connected, and P3). The study's specific aims are: 1) To harmonize archived paradata into common data elements of participants' DHI engagement across ATN trials; 2) To identify engagement typologies and examine their associations with HPC outcomes; and 3) To examine longitudinal associations between participants’ prospective engagement and desired HPC outcomes over time. This research significantly contributes to current scientific knowledge by detangle the complex relationship between engagement and DHI outcomes to optimize DHIs for youth by pooling a multicenter research network in the U.S. Our findings will help to understand the characteristics driving higher engagement, rigorously evaluate the efficacy of DHIs while considering engagement, and propose optimized strategies to promote engagement, ultimately enhancing the efficacy of DHIs for youth. These insights will provide a blueprint for researchers to rigorously evaluate DHIs and enhance their effect sizes for adolescents and young adults at risk for HIV and inform the development of an implementation science framework for engagement in digital HIV interventions, which may be used in future studies for at-risk youth.