Structural Intervention to Promote HIV Care in Black Sexual Minority Men

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PROJECT SUMMARY The goals of this research project are to use the ADAPT-ITT framework to adapt elements of an existing career readiness interventions tailored to young SMM and trans women of color at-risk for HIV infection (Work2Prevent) to the needs of young Black SMM (YBSMM), ages 18-29, living with HIV. Once adapted, a pilot study of the intervention (Work2Prevent Plus; W2P+) will be conducted with 40 YBSMM to determine intervention feasibility, acceptability, and efficacy for improving care engagement. To ensure W2P+ can serve the needs of HIV-positive YBSMM, the research team will engage in a formative phase of adaptation, wherein quantitative and qualitative data will be collected from employers. A sample of potential employers (n=50) will complete a survey focused on challenges related to hiring and retaining individuals with a range of minority identities. A second sample (n = 20) of potential employers will complete an interview with project staff, where they will respond to vignettes focused on successes and challenges a hiring manager could encounter when trying to hire and retain employees who are YBSMM living with HIV. These data will inform the adaptation of W2P+. Next, a series of focus groups will be conducted with members of the population (n = 40) to identify what they most need in a career readiness intervention. More specifically, this phase will use the ADAPT-ITT framework to ensure the adapted intervention addresses the range of concerns associated with employment for YBSMM irrespective of HIV status. Next, the research team will conduct a theater test with 8 YBSMM aged 18-29 years old and 10 stakeholders serving YBSMM, wherein stakeholders will observe the administration of content from the existing interventions to identify which content should be retained, adapted, or replaced. Next, 3 to 5 experts on employment and treatment barriers will be asked for additional feedback for intervention revision. The feedback will be used for additional revision of W2P+. Finally, a computerized readability test will ensure that language used in the revised intervention manual and activities is accessible to a 6th grade reading level. After the intervention manual and delivery procedures with the ADAPT-ITT model are finalized, 40 YBSMM, ages 18-29, will be enrolled in a single arm pilot trial, with follow- up assessments at 6 and 12 months. The primary research outcomes for the pilot study are feasibility and acceptability. Additional outcomes include hours worked per week, job seeking self-efficacy, and proportion of missed HIV care visits. Further, we will use implementation science measures to identify the best approach for delivering the intervention in a CBO setting. Primary implementation outcomes are relative advantage of the intervention and implementation climate. Secondary outcome is readiness for implementation.