Network Supported Engagement in HIV Care for Younger Black Men

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DESCRIPTION (provided by applicant): This goal of this project is to refine and pilot test a flexible Network Supported Engagement in Care (NSEC) intervention that recruits and motivates one or more organic social support network members of recently HIV diagnosed young black men who have sex with men (YBMSM) to improve engagement in HIV primary care. While data exist for young black men on factors related to HIV acquisition and antiretroviral adherence, there is a lack of empirically tested interventions on a key intermediate step in the treatment cascade: retention in care. Several existing strategies seek to address challenges to retention in care, including peer support groups, case management programs, multi-modal peer outreach, and peer health navigation. These efforts all share a common ingredient - newly created network members - a traditional public health intervention approach. What is often missing in these strategies is a coordinated attempt to harness organic social support networks that naturally exist. Our use of "organic" refers to an endogenous existing network; and can be contrasted to newly generated support persons such as assigned peer navigators or lay health workers. The concept of organic social support as a powerful force in the health of HIV infected persons is well documented; but has been underutilized to retain YBMSM newly diagnosed with HIV in care. Living with HIV requires persistent, deep and ongoing social support; support often only available from existing confidants - friends, partners, kin and other individuals - with whom one might share personal information with and be influenced by. Flexibility of NSEC ensures that a support confidant (SC) is selected based upon factors such as providing a supportive function (e.g., emotional support) as opposed to their status (e.g., mother). Such SCs are likely important not only to retention in care, but also to sustained health maintenance, risk reduction behavior maintenance and long-term adherence to antiretrovirals (ARVs). We have developed a theoretically and conceptually grounded NSEC brief intervention that 1) utilizes social support network visualization and network theory to help YBMSM safely identify a SC to engage in retention in care activities; 2) uses an Information-Motivation-Behavioral Skills (IMB) Model targeted at the SC to activate and maintain HIV-specific social support within the dyad; and 3) uses a linked HIV-specific social support conceptual model to then drive appointment adherence among the index YBMSM. Our primary aims are to: 1) Refine intervention protocol, materials and assessments by 1) coordinating intervention components that activate the SC through individual and dyadic sessions; and 2) systemizing social support of the index via interactive mini-booster cell-phone/text sessions directed at both members of the dyad; and 2) Pilot test the feasibility and initial efficacy (lower missed visit proportion (MVP) of the NSEC intervention versus standard linkage to care at 3- and 12- months post randomization among a sample of 94 YBMSM, ages 16-29. Secondary outcomes to be assessed include dyadic closeness, self- efficacy and social support, antiretroviral adherence and HIV viral load.