+CLICK: Harnessing Web-based Training to Reduce Secondary Transmission Among HIV-positive Youth

This journal article shares findings of a United States (US) study to pilot-test "+CLICK", a web-based, sexual risk reduction intervention for HIV-positive youth. The theory-based application, developed for perinatally and behaviourally infected youth aged 13 to 24, provides tailored activities addressing attitudes, knowledge, skills, and self-efficacy related to sexual risk reduction. The study suggests that interventions such as +CLICK may provide a viable adjunct to traditional clinic-based education.

According to the article, prevention of secondary transmission is a major concern, as many HIV-positive youth continue to engage in risky sexual behaviour. +CLICK targets four behaviours: choosing not to have sex, disclosing HIV status to a potential sex partner, using condoms correctly and consistently, and using an effective method of birth control along with condoms. The pilot test comprised two components: (1) a usability study to assess youths’ reactions to the application and short-term psychosocial outcomes; and (2) a sub-study assessing feasibility for clinic use. Together, these findings provide insight into the potential of web-based training as a systematic approach to clinic-based sexual health education. Twenty participants accessed "+CLICK" while waiting during their routine medical visit, 11 accessed it at the community agency, and one participant accessed it at another community location.

Findings include the following:

• According to the study, 84.4% of participants rated the programme very easy to use, and 93.8% felt the work pace was just right. A minimum of 93.8% perceived content as correct and trustworthy.
• In terms of understandability and acceptability, 87.5% agreed most words were understandable, and 81.2% liked the overall programme a lot; 75.0% liked the cartoons a lot, and 75.0% liked the videos a lot. Regarding the name "+CLICK", 62.5% liked it a lot.
• The study found that 87.5% would use the programme again, and 84.4% would tell their friends about "+CLICK". Open-ended responses suggested overall satisfaction with the application.
• Results indicate a trend toward increased perceived importance and self-efficacy regarding abstinence or waiting until older to have sex again. Regarding perceived importance of condom use, the mean score at pre-test was 9.8 on a scale from 0 to 10, with no significant increase at post-test. However, a significant increase in condom use self-efficacy was observed at post-test.

Participants reported that the application provided a non-threatening means to receive information on sensitive topics, such as condom and contraceptive use. In addition, participants reported that "+CLICK" was thought-provoking and generated open dialogue with clinic staff regarding reviewed material. Clinic staff rated the application highly as a method for providing consistent self-management education, especially on sensitive topics, and perceived high patient motivation to use the application again.

According to the article, 94% of participants believed that the programme would help them make healthy choices, and 87.5% reported they would use it again. This has particular utility for repeated use at subsequent clinic visits. Also promising, is that all youth who were invited to pilot-test the application agreed to do so. This, and the perception of the programme as a confidential medium to gain access to sensitive information, indicates the potential for this type of application to appeal to a broad HIV-positive youth population.

Findings demonstrated the potential to extend the "teachable moment" throughout the clinic encounter because "+CLICK" was accessed during waiting periods that would otherwise be used for non-educational activities. Furthermore, youth reported that it made it easier to talk with clinical providers about sensitive topics, such as condom and contraceptive use. Clinic staff rated "+CLICK" as providing consistent, confidential, and motivational self-management education that, importantly, did not significantly disrupt typical clinical activities or unduly extend appointment time.

The article concludes that provision of systematic, confidential education may positively impact the sexual health of HIV-positive youth and reduce the risk of secondary transmission. "+CLICK", a tailored, web-based, sexual risk reduction training, may provide a viable adjunct to traditional clinic-based education. The application meets usability and feasibility criteria and shows potential for affecting psychological antecedents to sexual behaviour change. Results suggest that further research on long-term and behavioural effects is warranted prior to broader dissemination into clinical practice.