In the US, Black women living with HIV/AIDS (WLHA) are less likely to be engaged in care, adherent to antiretroviral therapy (ART), and virally suppressed compared to White WLHA. Concurrently, Black women are also disproportionately affected by interpersonal violence ? physical, sexual, and/or psychological abuse by a current or former intimate partner or non-intimate partner ? which may co-occur with poor mental health and/or substance use disorders, further contributing to ART non-adherence, lower CD4 counts, and reduced viral suppression. Peer Navigation, while highlighted as a successful model of care in improving HIV care outcomes, requires resources that HIV service agencies often lack. A scalable and sustainable solution is the use of mobile health (mHealth) smartphone applications (?apps?). Although there has been an increase in mHealth interventions developed for HIV prevention and care among at-risk and HIV-positive MSM and youth, we are unaware of any to improve retention in care, ART adherence, and viral suppression among Black WLHA, nor any mHealth interventions that are responsive to Black women?s experiences with interpersonal violence. To address this gap, we will develop and pilot test a culturally tailored, trauma-informed smartphone app, called LinkPositively, for Black WLHA affected by interpersonal violence. Core components of LinkPositively include: a) Virtual Peer Navigation that includes phone and text check-ins and 4 weekly one-on- one video sessions to build skills to cope with barriers and navigate care; b) Social Networking platform to receive peer support; c) Educational and Self-care database with healthy living and self-care tips; d) GPS- enabled Resource Locator for HIV care and ancillary support service agencies; and e) ART self-monitoring and reminder system. Guided by the Theory of Triadic Influences and Syndemic Theory, the study will be conducted in 2 phases with corresponding aims.
In Aim 1, 4 focus groups with Black WLHA with experiences of interpersonal violence, one focus group with peer navigators, and 4-6 key informant interviews with providers will be conducted to determine which app features, content, and functions are most likely to support downloading, initiating use, and sustaining engagement over time.
Aim 1 will culminate in usability testing by Black WLHA affected by interpersonal violence (n=5), to finalize intervention components and procedures.
In Aim 2, we will pilot test LinkPositively to assess feasibility and acceptability and determine preliminary effects of the intervention on HIV care outcomes (i.e., retention in care, ART adherence, viral suppression) and mechanism of change variables (i.e., social support, self-efficacy). Participants will be randomly assigned to either the intervention (n=40) or control (Ryan White standard of care, n=40) arm, with follow-up at 3- and 6- months. This study will benefit the advancement of HIV prevention science by harnessing technology to promote engagement in HIV care, while improving social support through peers and social networking ? all under the auspices of being trauma-informed for Black WLHA with experiences of interpersonal violence.

Public Health Relevance

Black women living with HIV/AIDS (WLHA) who are also impacted by interpersonal violence and co-occurring mental health and/or substance use disorders, suffer from poor outcomes along the HIV care continuum. Although peer navigation improves HIV care outcomes, this requires resources that HIV medical and service organizations often lack, calling for the need for more sustainable and scalable approaches. We propose to develop and pilot test LinkPositively, a culturally-tailored, trauma-informed smartphone app for Black WLHA with lifetime experiences of interpersonal violence, with the goal of improving retention in care, antiretroviral therapy adherence, and viral suppression.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Planning Grant (R34)
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Special Emphasis Panel (ZRG1)
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Senn, Theresa Elaine
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University of California, San Diego
Internal Medicine/Medicine
Schools of Medicine
La Jolla
United States
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