Brothers building brothers by breaking barriers (B6): A resilience-focused intervention for young Black gay and bisexual men living with HIV

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PROJECT SUMMARY Young Black gay, bisexual and other men who have sex with men (YB-GBMSM) encounter multilevel barriers to engaging in HIV care, as a direct result of structural and interpersonal racism, homonegativity and HIV stigma. These barriers lead to HIV disparities in which YB-GBMSM have high HIV prevalence and incidence, but suboptimal rates of engagement across the HIV Care Continuum. Resilience at both the individual and community levels can buffer the deleterious effects of stigma and discrimination on HIV care engagement. We have previously developed a culturally-specific resilience-building intervention for YB-GBMSM living with HIV called Brothers Building Brothers by Breaking Barriers (B6). B6 specifically targets intersectional identity affirmation (an individual-level resilience factor) and social capital (a community-level resilience factor) as a strategy for improving engagement in HIV care. The objective of this R34 application is to adapt B6, originally developed as an in-person intervention, for telehealth delivery within the context of a community-based organization (CBO). The rationale for the project is that telehealth delivery and CBO partnership will remove barriers to participation and facilitate scalability and sustainability. Our study will be based in Atlanta, Georgia – an HIV epicenter. This study will pursue three specific aims: (1) to adapt B6 for telehealth delivery, in collaboration with YB-GBMSM, community advisors, and subject matter experts; (2) to conduct a pilot randomized controlled trial (RCT) to evaluate feasibility and acceptability of tele-B6 among YB-GBMSM living with HIV in Atlanta; and (3) to evaluate the process of implementing B6 within the context of our partner CBO. For the first aim, we will use the ADAPT-ITT framework to convert B6 from an in-person to a telehealth intervention (tele-B6). For the second aim, we will test tele-B6 with N=60 YB-GBMSM and examine feasibility and acceptability of the intervention. We will also explore intervention impacts on social capital, identity affirmation, and HIV care engagement. In the third aim, we will utilize the Consolidated Framework for Implementation Research to examine the process of implementing tele-B6 within the structure of our partner CBO. The proposed research is highly significant because of its potential to develop a culturally relevant, scalable intervention for YB-GBMSM, a group who continues to be heavily and disproportionately impacted by HIV.