TY - JOUR
T1 - An mHealth Intervention for Gay and Bisexual Men’s Mental, Behavioral, and Sexual Health in a High-Stigma, Low-Resource Context (Project Comunică)
T2 - Protocol for a Randomized Controlled Trial
AU - iu-Weinberger, Corina Lelu
AU - Filimon, Mircea L.
AU - Hoover, Donald
AU - Lixandru, Mihai
AU - Hanu, Lucian
AU - Dogaru, Bogdan
AU - Kovacs, Tudor
AU - Fierbin eanu, Cristina
AU - Ionescu, Florentina
AU - Manu, Monica
AU - Mari, Alexandra
AU - Pană, Elena
AU - Escu, Cristian Dorobăn
AU - Streinu-Cercel, Adrian
AU - Pachankis, John E.
N1 - Publisher Copyright: ©Corina Lelu iu-Weinberger, Mircea L Filimon, Donald Hoover, Mihai Lixandru, Lucian Hanu, Bogdan Dogaru, Tudor Kovacs, Cristina Fierbin eanu, Florentina Ionescu, Monica Manu, Alexandra Mari, Elena Pană, Cristian Dorobăn escu, Adrian Streinu-Cercel, John E Pachankis. Originally published in JMIR Research Protocols (https://www.researchprotocols.org),06.05.2024. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.
PY - 2024
Y1 - 2024
N2 - Background: The World Health Organization reported that 80% of new HIV diagnoses in Europe in 2014 occurred in Central and Eastern Europe. Romania has a particularly high HIV incidence, AIDS prevalence, and number of related deaths. HIV incidence in Romania is largely attributed to sexual contact among gay and bisexual men. However, homophobic stigma in Romania serves as a risk factor for HIV infection for gay and bisexual men. The Comunică intervention aims to provide a much-needed HIV risk reduction strategy, and it entails the delivery of motivational interviewing and cognitive behavioral therapy skills across 8 live text-based counseling sessions on a mobile platform to gay and bisexual men at risk of HIV. The intervention is based on the information-motivation-behavior and minority stress models. There is preliminary evidence suggesting that Comunică holds promise for reducing gay and bisexual men’s co-occurring sexual (eg, HIV transmission risk behavior), behavioral (eg, heavy alcohol use), and mental (eg, depression) health risks in Romania. Objective: This paper describes the protocol for a randomized controlled trial designed to test the efficacy of Comunică in a national trial. Methods: To test Comunică’s efficacy, 305 gay and bisexual men were randomized to receive Comunică or a content-matched education attention control condition. The control condition consisted of 8 time-matched educational modules that present information regarding gay and bisexual men’s identity development, information about HIV transmission and prevention, the importance of HIV and sexually transmitted infection testing and treatment, heavy alcohol use and its associations with HIV transmission risk behavior, sexual health communication, finding social support, and creating sexual health goals. Participants undergo rapid HIV and syphilis testing and 3-site chlamydia and gonorrhea testing at baseline and the 12-month follow-up. Outcomes are measured before the intervention (baseline) and at the 4-, 8-, and 12-month follow-ups. Results: The study was funded in September 2018, and data collection began in May 2019. The last participant follow-up was in January 2024. Currently, the data analyst is cleaning data sets in preparation for data analyses, which are scheduled to begin in April 2024. Data analysis meetings are scheduled regularly to establish timelines and examine the results as analyses are gradually being conducted. Upon completion, a list of manuscripts will be reviewed and prioritized, and the team will begin preparing them for publication. Conclusions: This study is the first to test the efficacy of an intervention with the potential to simultaneously support the sexual, behavioral, and mental health of gay and bisexual men in Central and Eastern Europe using motivational interviewing support and sensitivity to the high-stigma context of the region. If efficacious, Comunică presents a scalable platform to provide support to gay and bisexual men living in Romania and similar high-stigma, low-resource countries.
AB - Background: The World Health Organization reported that 80% of new HIV diagnoses in Europe in 2014 occurred in Central and Eastern Europe. Romania has a particularly high HIV incidence, AIDS prevalence, and number of related deaths. HIV incidence in Romania is largely attributed to sexual contact among gay and bisexual men. However, homophobic stigma in Romania serves as a risk factor for HIV infection for gay and bisexual men. The Comunică intervention aims to provide a much-needed HIV risk reduction strategy, and it entails the delivery of motivational interviewing and cognitive behavioral therapy skills across 8 live text-based counseling sessions on a mobile platform to gay and bisexual men at risk of HIV. The intervention is based on the information-motivation-behavior and minority stress models. There is preliminary evidence suggesting that Comunică holds promise for reducing gay and bisexual men’s co-occurring sexual (eg, HIV transmission risk behavior), behavioral (eg, heavy alcohol use), and mental (eg, depression) health risks in Romania. Objective: This paper describes the protocol for a randomized controlled trial designed to test the efficacy of Comunică in a national trial. Methods: To test Comunică’s efficacy, 305 gay and bisexual men were randomized to receive Comunică or a content-matched education attention control condition. The control condition consisted of 8 time-matched educational modules that present information regarding gay and bisexual men’s identity development, information about HIV transmission and prevention, the importance of HIV and sexually transmitted infection testing and treatment, heavy alcohol use and its associations with HIV transmission risk behavior, sexual health communication, finding social support, and creating sexual health goals. Participants undergo rapid HIV and syphilis testing and 3-site chlamydia and gonorrhea testing at baseline and the 12-month follow-up. Outcomes are measured before the intervention (baseline) and at the 4-, 8-, and 12-month follow-ups. Results: The study was funded in September 2018, and data collection began in May 2019. The last participant follow-up was in January 2024. Currently, the data analyst is cleaning data sets in preparation for data analyses, which are scheduled to begin in April 2024. Data analysis meetings are scheduled regularly to establish timelines and examine the results as analyses are gradually being conducted. Upon completion, a list of manuscripts will be reviewed and prioritized, and the team will begin preparing them for publication. Conclusions: This study is the first to test the efficacy of an intervention with the potential to simultaneously support the sexual, behavioral, and mental health of gay and bisexual men in Central and Eastern Europe using motivational interviewing support and sensitivity to the high-stigma context of the region. If efficacious, Comunică presents a scalable platform to provide support to gay and bisexual men living in Romania and similar high-stigma, low-resource countries.
KW - HIV prevention
KW - behavioral intervention
KW - gay and bisexual men
KW - heavy alcohol use
KW - mental health
KW - mobile phone
KW - stigma
UR - http://www.scopus.com/inward/record.url?scp=85193816546&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85193816546&partnerID=8YFLogxK
U2 - 10.2196/52853
DO - 10.2196/52853
M3 - Article
SN - 1929-0748
VL - 13
JO - JMIR Research Protocols
JF - JMIR Research Protocols
M1 - e52853
ER -