Implementation of Client-Centered Care Coordination for HIV Prevention with Black Men Who Have Sex with Men: Activities, Personnel Costs, and Outcomes—HPTN 073

Background Black men who have sex with men (MSM) experience disproportionate rates of HIV infection in the USA, despite being no more likely to engage in sexual risk behaviors than other MSM racial/ethnic groups. HIV pre-exposure prophylaxis (PrEP) has been shown to reduce risk of HIV acquisition; however, rates of PrEP use among Black MSM remain low. Clinical, psychosocial, and structural factors have been shown to impact PrEP use and adherence among Black MSM. Care coordination of HIV prevention services has the potential to improve PrEP use and adherence for Black MSM, as it has been shown to improve HIV-related care outcomes among people living with HIV. Methods Client-centered care coordination (C4) is a multi-level intervention designed to address clinical, psychosocial, and structural barriers to HIV prevention services for Black MSM within HPTN 073, a PrEP demonstration project among Black MSM in three cities in the USA. The current study examined the implementation process of C4, specifically investigating the activities, cost, time, and outcomes associated with the C4 intervention. Results On average, participants engaged in five care coordination encounters. The vast majority of care coordination activities were conducted by counselors, averaging 30 min per encounter. The cost of care coordination was relatively low with a mean cost of $8.70 per client encounter. Conclusion Although client-centered care coordination was initially implemented in well-resourced communities with robust HIV research and service infrastructure, our findings suggest that C4 can be successfully implemented in resource constrained communities.

The Relationship of Alcohol to ART Adherence Among Black MSM in the U.S.: Is it Any Different Among Black MSM in the South?

Alcohol-using Black MSM (Men who have sex with men) are disproportionately impacted by HIV in the U.S.—particularly in the southern U.S.—despite the availability of antiretroviral therapy (ART). The purpose of this study was to summarize the current evidence on alcohol use and ART adherence among Black MSM in the U.S. and in the South and to identify future research needs. A systematic review was conducted using eight databases to identify relevant peer-reviewed articles published between January 2010 and April 2021. The authors also snowballed remaining studies and hand-searched for additional studies. Including both quantitative and qualitative studies, five published studies examined alcohol and ART adherence among Black MSM in the U.S. The search identified 240 articles, the study team reviewed 114 in full-text and determined that only five met the inclusion criteria. Three of the five included studies identified alcohol use as a barrier to ART adherence. In conclusions, the general lack of literature on HIV disparities among alcohol-using Black MSM in the U.S. (specifically in the South) indicates a critical need for research on this population’s unique risks and needs to inform the development of tailored interventions.

Living While Black, Gay, and Poor: The Association of Race, Neighborhood Structural Disadvantage, and PrEP Utilization Among a Sample of Black Men Who Have Sex With Men in the Deep South

Utilizing the Andersen Healthcare Utilization Model, we examined the role of neighborhood context on pre-exposure prophylaxis (PrEP) utilization among a sample of Black men who have sex with men (MSM) residing in a medium-sized city in the Deep South. Data were derived from a sample of 142 Black MSM aged 18–64 years who were eligible for PrEP from a community-based study known as “ACCELERATE!” We used multilevel structural equation modeling to assess PrEP use. Social support, sexual risk, and health care access were predictive of PrEP use. Notably, residing in a neighborhood with concentrated poverty was associated with decreased PrEP use. Our findings reveal neighborhood structural disadvantage is associated with decreased PrEP use among Black MSM, after adjusting of individual-level sociodemographic characteristics. There is an urgent need to develop HIV prevention interventions and programs that explicitly address structural-level factors to eliminate racial/ethnic differences in HIV.

Recruiting Black men who have sex with men (MSM) couples via dating apps: Challenges and successes (Preprint)

BACKGROUND HIV disproportionately impacts Black men who have sex with men (MSM) and targeting the primary relationship (i.e., couples) using mobile technology for health (mHealth) holds promise for HIV prevention. Online recruitment of MSM is commonly employed in HIV prevention and intervention research. However, little known about recruiting Black MSM couples online in the US. OBJECTIVE To describe the process of recruiting Black MSM couples over social networking and dating applications (apps) frequented by MSM. We describe the activities for recruiting, screening, and enrolling participants as part of a randomized trial employing a multipronged recruitment approach. METHODS Black MSM in couples were recruited via three apps (i.e., Jack’d, Adam4Adam, and Growlr) between May 2020 and March 2021, during the COVID-19 pandemic in the US. Black MSM couples were eligible if one or both partners are Black, MSM, and living with HIV; and if both partners were 18 years or older, have been together for at least two months in what they both consider to be a primary relationship (i.e., one in which both partners reported feeling most committed to over any other partner or relationship). RESULTS A total of 25 couples (n = 50) were enrolled; of these, 10 couples (n = 20) were enrolled via apps. App recruitment activities were a combination of passive (e.g., in-app advertisements) and active (e.g., direct messaging of users) engagement. A full-time staff recruiter experienced challenges such as bugs (i.e., technical errors in computer program or system), navigating idiosyncratic advertising and technical requirements specific to each app, and online harassment from users. CONCLUSIONS Despite challenges, it was possible to recruit Black MSM couples virtually into research as part of a multipronged recruitment strategy. We identify tips for using online dating and other social-networking apps as part of a recruitment strategy in future research with Black MSM couples.

Using the Think Aloud method to assess the feasibility and acceptability of Network Canvas among Black MSM and transgender persons in Atlanta, GA: Qualitative Analysis (Preprint)

BACKGROUND Characteristics of one’s social network have been important factors in understanding infectious disease transmission patterns. Social network data collection is generally time and resource intensive, yet is crucial to our understanding of the complex epidemiologic landscape of human behaviors among stigmatized social groups. OBJECTIVE We sought to evaluate the feasibility and acceptability of a self-administered social network data collection tool, Network Canvas, among Black MSM (BMSM) and transgender persons using the think aloud method, which is a robust and flexible research technique used to perform usability testing. METHODS We piloted a self-administered network interview within the Network Canvas Software Suite. Participants ≥ 18 years were recruited through a community-based organization in Atlanta, GA and were included based upon willingness to share information on sexual behaviors and drug use for themselves and their social networks. A semi-structured interview guide was used to document cognitive decision-making processes while using the tool. Recorded interviews were transcribed verbatim, and thematic analyses were performed. RESULTS Among seven BMSM and transgender participants, three main themes were identified from cognitive processes: Network Canvas’s utility, navigation, and intuitive design. Overall, Network Canvas was described as ‘easy to use,’ with suggestions mainly directed toward improving navigation tools and implementing an initial tutorial on the program prior to use. Participants were willing to use Network Canvas to document their social networks and characteristics. In general, observed verbal responses from participants matched their behavior although there were some discrepancies between verbal affirmations of use and understanding versus external observation. CONCLUSIONS We found Network Canvas to be a useful new tool to capture social network data. Self-administration allowed for more autonomy for participants when providing sensitive information about themselves and their social networks. Further, automated name generation and visualization of one’s social network in the application has the potential to reduce cognitive burden during data collection. More efficient methods of social network data collection have the potential to provide epidemiologic information to guide prevention efforts for populations with stigmatized health conditions or behaviors.