Implementation of a triadic network case management intervention for younger Black sexual minority men

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We will conduct a Hybrid Type II effectiveness-implementation randomized controlled trial of a Case Management Dyad (CM2) intervention, an evidence-based triadic social work intervention that uses a case manager dyad to engage younger Black sexual minority men (YBSMM) aged 18-35 in economic stability services. CM2 innovates on existing care continuum engagement models by (1) prioritizing resource counseling to improve HIV care and prevention continuum outcomes, and (2) utilizing a triadic network approach where a client meets with a dyadic case management team in tandem–forming a triad with the client–which provides additional supports for the client and the case managers. CM2 is timely given that intensive interventions are critical for engaging community members who have not benefited from existing Getting to Zero efforts. CM2 will also test robust implementation strategies to support CM2 implementation and to enhance the professional development and prevent burnout in the HIV front-line workforce, some of whom are directly impacted by HIV. The CM2 intervention and associated implementation strategies emerge from prior work conducted by the Investigative Team. We will build upon these experiences, infrastructures, and relationships to evaluate the effectiveness and implementation of CM2 among N=180 YBSMM. Data collection, at baseline, and every 6 months over 18 months, will include surveys and electronic medical record data. To study implementation, we will use the Consolidated Framework for Implementation Research as the determinant framework and RE-AIM as the evaluation framework. The specific aims are to: (Aim 1a) Evaluate the primary (financial well-being, food security) and secondary (integrated PrEP persistence/viral load suppression) effectiveness of CM2 vs routine Ryan White Non-Medical Case Management and PrEP Resource Counseling among YBSMM; (Aim 1b). Evaluate the effectiveness (time to successful resource referral completion, CM job satisfaction, CM burnout and CM-client relationship) of the CM2 intervention vs. routine Ryan White Case Management and/or PrEP Resource Counseling among case manager study participants; (Aim 2a) Determine the extent to which financial well-being and food security mediate the relationship between CM2 and downstream 18-month integrated care continuum outcomes; (Aim 2b) Explore potential differential effects of CM2 on primary (resource) and secondary (care continuum) outcomes, based on mental health, substance use, housing, employment and HIV serostatus; and (Aim 3) Evaluate implementation strategies and outcomes at both YBSMM and case manager levels using RE- AIM to study reach, adoption, implementation, and maintenance. Implementation strategies include individual and dyadic supervision, team consultation, and a train-the-trainer model, and implementation outcomes are acceptability, feasibility, appropriateness, feasibility, fidelity and cost. If successful, CM2 will intensify existing case management resource support systems, which will not only impact the lives and care continua of YBSMM, but also fulfill an ending the epidemic priority of revitalizing and sustaining the HIV frontline workforce.