Abstract
Young Black and Latinx men and transgender women who have sex with men (YBLMT) face persistent underrepresentation in clinical trials. This study examined the odds of study enrollment among 3327 eligible YBLMT (ages 15-29) screened between July 2020 and August 2022 for a status-neutral mHealth HIV prevention and care intervention in the United States. Only 23% of eligible individuals enrolled. In adjusted analyses, higher education (associate's degree or higher, AOR 1.53, 95% CI 1.22-1.92), recent anal sex (AOR 1.64, 95% CI 1.10-2.43), and known HIV status (negative, AOR 1.36, 95% CI 1.02-1.82; positive, AOR 2.25, 95% CI 1.63-3.10 vs. unknown status) were associated with greater odds of enrollment. Recruitment through social media (AOR 4.41, 95% CI 3.35-5.81) and research registries or community referrals (AOR 1.93, 95% CI 1.53-2.43) resulted in higher enrollment than sexual networking apps. Younger participants (ages 15-17) had higher odds of enrolling than those aged 18-24 (AOR 1.96, 95% CI 1.06-3.70). These findings highlight the need for inclusive, community-informed recruitment strategies and suggest that perceived HIV relevance and trust in digital platforms influence enrollment. Future mHealth interventions should prioritize accessible, affirming study designs and targeted outreach to improve YBLMT engagement and representation in HIV research.