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As HIV infection continues unabated, there is a need for effective interventions targeting at-risk men who have sex with men MSM. A randomized controlled trial RCT conducted online among U. MSM recruited from several gay sexual networking websites assessed the impact of 2 HIV prevention videos and an HIV prevention web compared to a control condition for the study outcomes HIV testing, serostatus disclosure, and Craigslist Sabina sex anal intercourse UAI at day follow-up.

No participant incentives were provided. Findings from this online RCT of MSM recruited from sexual networking websites suggest that a low cost, brief digital media intervention deed to engage critical thinking can increase HIV disclosure to sexual partners and decrease sexual risk. Effective, brief HIV prevention interventions featuring digital media that are made widely available may serve as a complementary part of an overall behavioral and biomedical strategy for reducing sexual risk by addressing the specific needs and circumstances of the target population, and by changing individual knowledge, motivations, and community norms.

This is an open-access article distributed under the terms of the Creative Commons Attributionwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This study was funded by the Centers for Disease Control and Prevention CDCwhere technical assistance was provided through a federal cooperative agreement in the de and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, and approval of the manuscript.

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The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Competing interests: The authors have declared that no competing interests exist.

S have an undetectable viral load, [1] which is likely the result of social and behavioral barriers, [2] including the lack of awareness of HIV status. Early in the epidemic, community-wide safer sex messages delivered through print and media campaigns were effective at educating the gay community and lowering transmission risk behaviors.

Technology-based HIV behavioral interventions are increasingly incorporating digital media, ranging from brief, untailored video interventions to complex computer-tailored multimedia interventions that target individual behaviors. Although online research studies tend to report higher attrition than offline research as there are fewer social constraints, [32] a growing of validity studies indicate higher reporting of sexual risk and substance-using behaviors with computer-based surveys compared to mail, phone, and in-person surveys.

The two HIV prevention videos used in this trial were deed to reflect issues specific to MSM, while incorporating social learning theory, situated cognition, and developmental learning theory into the dialogue, storyline, and realism of the characters [41][42] ; principles of these theories are reflected in the videos' use of realistic stories, recognizable character types, and conflict to promote critical thinking. The study de was based on an online pre-post test video-based intervention Craigslist Sabina sex conducted in The primary objective of this 5-arm RCT was to assess the feasibility and efficacy of implementing a large-scale single-session online intervention, using HIV prevention videos or an HIV prevention web versus a no-content control, among sexually active U.

MSM, aged 18 and over, who were recruited from four gay-oriented sexual networking websites.

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Eligibility criteria for the intervention were programmed into the online baseline survey. Participants had to: 1 identify as a man; 2 be age 18 or older; 3 reside in the U. Men who completed the baseline survey but were ineligible for the intervention were automatically transferred to the exit that contained links Craigslist Sabina sex health-related websites and hotlines. In Aprila banner ad was placed on four gay-oriented sexual networking websites for U.

The demographic characteristics of the banner ad sampling frame are undefined as we do not know who was exposed to ad views. After several weeks of slow recruitment, one of the websites agreed to send s through its internal system to all of its U. Members of this site are automatically ased an address upon becoming a member, thus ensuring a valid user address. The sent to members contained a study banner, and all recipients were considered potentially eligible for study inclusion. A total ofs were sent nationwide, with a The absorption rate was calculated by dividing the of delivered sby all invitations sent.

A waiver of documentation of written consent was obtained, given the internet-based research approach. Men who clicked on the study banner ad provided informed consent online by reading the consent form and clicking agreement to participate in the baseline survey. Following completion of the baseline survey, participants who met the inclusion criteria for the RCT were provided a second consent form inviting them to participate in additional study activities.

The five study conditions included a: 1 dramatic video; 2 documentary video; 3 both dramatic and documentary videos; 4 prevention web; and 5 control i. The videos were based on social learning theories and strategies [41][42][46] that informed the instructional de and delivery of the online intervention along three important de dimensions: 1 the medium selected i.

Both HIV prevention videos were deed to tell the same story, through drama, on the one hand, and through documentary, on the Craigslist Sabina sex. Both videos provided positive and negative modeling examples of HIV disclosure to sex partners, which emphasized critical thinking and decision-making. Participants randomized to both videos were provided the videos in random order.

Participants Craigslist Sabina sex to the control condition were only provided with links to HIV prevention resources following completion of the behavioral survey. All participants could view their ased online content, though once they closed their web browser they could not view the content again. Participants were ed 60 days post-baseline to complete the follow-up survey, which paralleled the baseline survey.

A hyperlink was embedded in theand when clicked on, automatically transferred the participant to a second consent and follow-up survey. For those who did not respond to the follow-upwe waited one week before sending a first reminderanother week before sending the second reminder, and a third week before sending the final reminder for an additional 21—30 days.

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We hypothesized that between baseline and day follow-up, there would be increases in HIV disclosure and HIV testing, and decreases in UAI among those randomized to an HIV prevention video or a prevention web, compared to those in the control condition. HIV disclosure was defined as partial i.

Men were asked about the three most recent sexual partners in the past 60 days beginning with the most recent. Due to a software programming error, baseline HIV disclosure data captured information for only the last partner reported in the past 60 days. To address this limitation, we compared primary outcome data between the last partner reported at baseline and the corresponding last partner reported during follow-up.

Based on the prevalence of behaviors in our studies, we calculated true proportions and sample sizes using chi-square tests for this 5-group de. Those who consented were randomized into one of the five study conditions using a computerized randomization program, which included a blocking scheme to balance randomization across the study conditions using a non-deterministic algorithm.

Once participants consented and were randomized, they were kept in their original asment condition and sent a link to the day follow-up survey i.

Thus, we used an ITT approach for primary outcome analyses. Since randomization was not stratified, for Tables 1 and 2we took a conservative approach and tested for baseline differences across conditions.

Chi-square tests assessed group-level comparisons of the dichotomous primary outcome measures at 60 days post-intervention. Follow-up sample characteristics were assessed using bivariate, rather than multivariate, logistic regression, as several characteristics were highly correlated.


In Table 3for group-level comparisons of primary outcomes at day follow-up, the control condition was compared to the pooled video condition and prevention web condition separately. Finally, we conducted sensitivity analysis and assessed follow-up non-response bias to examine the impact of attrition. One of the four sexual networking websites agreed to send s to all of its U.

A total of 23, 3.

Of those, 9, broke off from the landing immediately, and 13, consented to participate in the baseline survey. The of banner ad impressions men were exposed to was not available from the websites, therefore we could not calculate a click-through-rate for men recruited through banner .

Among the consenting 11, the following were excluded: residing outside of the US; 25 female, 17 female-to-male transgender, and 4 male-to-female transgender; duplicate cases were detected and excluded. In addition, 5, Craigslist Sabina sex were ineligible for study enrollment, and 2, men were eligible but refused participation. The drop-out rate for each study arm is provided in Figure 1. Tables 1 and 2 describe the demographic and behavioral characteristics of the 3, randomized participants at baseline.

Overall, respondents were predominantly white with high income and education, and were from every U. The median age was 39 range 18 to This was considered due to chance as participants were unaware of study hypotheses. Men who completed follow-up were also ificantly more likely to have non-main partners at baseline OR 1.

Figure 1 lists the reasons and rates of drop-out per condition. The median duration between completion of baseline intervention activities and the day post-baseline assessment was 61 days. Among men with non-main partners, those in the pooled video condition were ificantly more likely than men in the control condition to ask OR 1. No disclosure differences were seen for men with main partners.

Eight men who self-reported never testing at baseline were tested within the day follow-up period and reported a negative test result. No differences were found between the prevention web and control condition for the primary outcomes. ificant decreases in UAI were seen from baseline to follow-up within the digital media conditions OR 0. HIV-negative men in both the pooled video and web conditions reported ificant reductions in UAI from baseline to follow-up OR 0. For full disclosure, men in the pooled video condition were ificantly less likely to ask and tell, overall OR 0.

Regarding HIV testing from baseline to follow-up, no changes were seen in any of the conditions.

Comparing men who did and did not complete follow-up, we assessed the potential impact of attrition by conducting sensitivity analyses. We assessed HIV disclosure at follow-up with the last sexual partner for parsimony and made two different assumptions about HIV disclosure among those lost to follow-up.

To assess whether men who did not complete follow-up differed ificantly on the primary outcome estimates from those who did complete follow-up, we tested for non-response bias. Using the baseline primary outcome estimates, we calculated follow-up non-response bias by subtracting the mean difference between men who responded to follow-up and the baseline sample, divided by the baseline sample estimate.

We found ificant non-response bias for asking HIV status, though the magnitude was small and was biased towards Craigslist Sabina sex null. No differences were found between men who did and did not complete follow-up for the other primary outcomes. Findings from this online RCT of MSM recruited from sexual networking websites suggest that a low cost, brief digital media intervention conducted completely online can increase HIV disclosure to sexual partners and decrease sexual risk. MSM participating in the online trial were predominantly white with high income and education and were from every U.

As reporting a new sex partner at baseline was one eligibility criterion for inclusion into the online trial, men participating in our study reported considerable HIV transmission risk at enrollment. On average, men reported 2 anal sex partners in the past 60 days, with more than half reporting UAI with non-main partners.

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Men who completed day follow-up differed from men who did not complete follow-up by demographic and behavioral characteristics; most notably, men completing follow-up were ificantly more likely to be HIV-positive, report non-main partners at baseline, and report more lifetime anal sex partners than men not completing follow-up.

At day follow-up, modest group-level effects were seen for HIV disclosure. Among men who had non-main partners during follow-up, partial HIV disclosure was ificantly higher in the video condition than control condition.

ificant changes in sexual behavior and HIV testing were not seen at the group level. Contrary to expectations, some men were ificantly less likely to disclose their HIV status to sex partners from baseline to day follow-up.

In contrast, within-person effects were found for reduced UAI at follow-up compared to baseline, with men reporting ificant reductions in UAI in both the pooled video OR 0. The reduction in UAI among men in the pooled video condition is similar to a ly published one-group, pre-post pilot intervention — using one of the same videos used in the current trial — among MSM recruited from one of the same gay-oriented sexual networking websites that assessed within-person reduction of UAI OR 0.

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