In the U.S., Black men who have sex with men (BMSM) have a higher incidence and background prevalence of HIV than other groups. Once linked to HIV care, HIV+ BMSM (+BMSM) have significantly lower odds than other MSM to be engaged in each step of the HIV continuum of care: detection of HIV, linkage to care, retention in care, adherence to antiretroviral therapy (ART), and viral suppression. The biggest drop off in the continuum for +BMSM is in retention in care, in which over 40% drop out of care, and, thus, is the focus of this research. Despite the importance of this issue, there are no gold-standard interventions to find these men once they have fallen out of care. Further, although interventions exist that focus primarily on structural barriers to care (e.g., intensive case management, patient navigation), key psychosocial factors involved in +BMSM dropping out of care (e.g., depression, substance use, HIV-related stigma, lack of social support) have not been sufficiently addressed. In addition, there is a dearth literature on how best to locate +BMSM who have left HIV care (+BMSM-LC) in order to re-engage them in care. Thus, the overarching goal of this application is to develop and conduct a preliminary test of a ?portable? intervention, ?Black Men's Care? (BMC), to re-engage +BMSM-LC in care that is flexible with respect to where it can be conducted.
The aims of the study are:
Aim 1 ?to conduct formative research to develop BMC content and optimize its delivery;
Aim 2 ?to develop BMC, a theory-based, combination in-person and text messaging (mHealth) intervention for +BMSM-LC;
and Aim 3 ? to evaluate the acceptability, feasibility, and preliminary outcomes of BMC in preparation for submitting an R01 proposal to finalize and conduct an efficacy trial of BMC.
Aims 1 and 2 will comprise the formative phase of the proposed study.
Aim 1 will consist of semi-structured interviews with 2 staff members at each of 3 city and county health clinics, 3 community-based organizations, and 3 emergency rooms to identify effective settings for intervention.
Aim 2 will consist of semi-structured interviews with 10 +BMSM-LC and 10 +BMSM who remain in care to develop intervention content. Findings from these semi-structured interviews and Aim 1 will be used to develop a preliminary intervention protocol that will be refined across 2 sets of 3 sequential, single- subject iterations of the intervention sampled by age (n=3 for ages 18 to 29 years, n =3 for ages 30 and up).
For Aim 3, a pilot study of 18 +BMSM-LC purposively sampled by age will assess acceptability, feasibility, and preliminary outcomes of BMC for re-engaging +BMSM-LC in care. The research and career development activities of this K23 proposal will allow the PI to achieve the goal of becoming an independent, R01-funded investigator. The PI will gain a broad range of critical skills (e.g., intervention development; qualitative research methods; trial design, safety monitoring, and process and outcome evaluation) and experiences to address the health needs of vulnerable populations at greatest risk of morbidity and mortality.
The National HIV/AIDS Strategy and the National Institutes of Health emphasize achieving viral suppression among HIV+ persons in order to reduce HIV transmissibility, particularly for disproportionately affected groups such as Black men who have sex with men (BMSM), by retaining them in HIV care. However, critical psychosocial barriers to retention in care for HIV+ BMSM (+BMSM), beyond structural barriers that are addressed via case management or patient navigation, have not been sufficiently addressed. Thus, the proposed study aims to develop an intervention that is strategic in that it will 1) be a focused on an approach that combines an in-person session with post-session, two-way text messaging to continue the intervention and reinforce the gains from the in-person session and 2) ultimately find +BMSM who have left HIV care where they are likely to present (e.g., city and county health clinics, community-based organizations, emergency rooms).
|Vincent, Wilson; Pollack, Lance M; Huebner, David M et al. (2017) HIV risk and multiple sources of heterosexism among young Black men who have sex with men. J Consult Clin Psychol 85:1122-1130|
|Gordon, Derrick M; Moore, Kelly E; Vincent, Wilson et al. (2017) Intimate Partner Violence Among Low-Income Fathers: Testing a Stress-Coping Model. J Interpers Violence :886260517736878|