Aims Youth are overrepresented in the number of new HIV cases and fare worse across the HIV care continuum. To address these challenges, we implemented a text-messaging intervention to increase engagement in care and improve viral suppression (VLS) rates. The aim of this study was to determine if intervention participation increased achieving or maintaining VLS after 6 months.

Methods We recruited 100 HIV-positive youth receiving care in our program and meeting at least one additional criterion (newly diagnosed; not linked to care; out of care more than six months in last 2 years; viral load >200 copies/mL). The automated two-way text-messaging intervention included medication reminders, appointment reminders, a housing/utilities needs assessment and mood checks. Participant challenges reported triggered action alerts to case managers who responded via text or phone. Results were examined over 6 months.

Results Participants in the intervention were mostly male (79%), Black (91%), and YMSM (71%), with an average age of 24.58 (SD=2.88). Youth in our intervention group experienced trauma (29. 4% reported intmate partner violence and 34.3% experienced sexual assault) and participated in survival sex (22.5% traded sex and 28.4% received payment for sex). 46.2% of participants reported alcohol use and 55.8% reported marijuana use several times per month. 81% of youth participated in 89,120 text exchanges. Text responses triggered 395 alerts. The most common alerts were for missed medication, missed appointments and housing issues. Twenty-five participants newly achieved VLS and 35 maintained VLS during the 6 months. A significantly greater proportion of participants were virally suppressed at 6 months versus baseline (p=0.018)

Conclusion Even with high rates of adversity experiences this two-way texting intervention improved VLS for youth and for those with gaps in care.