Development of an mHealth intervention to reduce substance use and HIV risk for young adult women affected by sex trafficking

PROJECT SUMMARY Sex trafficking is a global concern that results in millions of individuals being sexually exploited annually. Racial-ethnic and sexual minority youth, particularly those from indigenous groups, as well as those with history of trauma, maltreatment, and running away, are at increased risk for experiencing sex trafficking. Sex trafficking has known adverse health effects including increased rates of physical illness (e.g., HIV, sexually transmitted infections), violence-related injuries (e.g., traumatic brain injury), mental health conditions (e.g., depression, posttraumatic stress disorder, suicidality), and substance use disorders (SUDs), with additional deleterious effects including stigmatization and criminalization. There is a currently a dearth of research on interventions that support exit from sex trafficking, prevent revictimization, and facilitate treatment of victim’s mental and physical health needs. In the U.S., victims who are under the age of 18 are provided with services funded through state and federal resources. However, once they “age out” of the child welfare system, many of these services end, leaving them vulnerable and at increased risk for revictimization. Mobile health (mHealth) interventions have demonstrated efficacy for increasing engagement in HIV, substance use, and mental health services in survivors of sexual assault, but these have not been adapted for sex trafficking victims. Given the extensive need for intervention, the current project will include developmental work to adapt an existing mHealth intervention for young adult women affected by sex trafficking and assess its feasibility and efficacy. The proposed study will utilize qualitative and ecological momentary assessment (EMA) methods to establish the needs of the population, available resources, and complex determinants that contribute to HIV risk and substance use behaviors among sex trafficking victims, including which determinants are the most influential in shaping risk behavior. Findings will guide components of a new mHealth intervention (Smartphone Technology to Reduce Risk and Offer Navigation and Guidance or STRONG) for young adult women affected by sex trafficking that includes resource and just-in-time adaptive intervention (JITAI) components. A two-group pilot randomized controlled trial (RCT) will be conducted to assess the feasibility and efficacy of STRONG on HIV risk, substance use frequency, and engagement with health and social services. The findings from this study will inform a follow-up full-scale RCT that will test the effects of the new intervention. This work will lay the groundwork for future implementation of the intervention across the U.S.