Identifying socioecological profiles that impact changes in care outcomes among Black Sexual minority men living with HIV

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Project Summary/Abstract The U.S. will not meet the targets of the Ending the HIV Epidemic Plan (EHE) without an intentional focus on improving outcomes among Black sexual minority men living with HIV (BSMM LWH). Only 55% of BSMM LWH maintain 100% daily treatment adherence and only 62% are virally suppressed. Research proves that multilevel factors such as racism, stigma, depression, victimization, and economic instability are important unaddressed determinants of HIV care outcomes. Updates to health care delivery models due to COVID-19 (i.e. telehealth) provided novel ways to improve HIV care engagement, retention, and adherence. However, BSMM still experience worse outcomes than others even when accounting for differences in access to resources. The literature collectively suggests that multilevel factors could create distinct socioecological patterns that impact HIV care outcomes for BSMM LWH, especially across age groups. BSMM LWH have not adequately engaged or retained in care activities because previous approaches do not account for their current or combined socioecological experiences. Previous studies are outdated, cross-sectional, utilize culturally inappropriate measures, and have small samples of Black participants. Sustainable approaches to engage this population remain elusive, especially for young BSMM LWH. There is no digital, limited interaction cohort study centered on BSMM LWH despite focus given to other priority populations such as transwomen, drug users, and adolescents. The goal of this Limited Interaction Targeted Epidemiology proposal is to conduct a prospective cohort study to identify the HIV care riskscape for BSMM LWH and examine how multilevel factors impact changes in retention in HIV care, treatment adherence, and viral suppression. Phase 1 will identify effective recruitment strategies (Aim 1) and validate commonly accepted scales among BSMM LWH to aid in survey design (Aim 2). Then we will explore the feasibility and acceptability of enrolling a large digital cohort of Mid-Atlantic BSMM LWH (Aim 3). Phase 2 will collect and analyze prospective cohort data collected at baseline, 3-months, 6-months to quantify the cross sectional and longitudinal relationships between multilevel factors and HIV care outcomes among 1,500 BSMM LWH (Aim 4). This study will be the largest prospective cohort focused on BSMM LWH ever conducted and targets high-priority EHE locales. This study aligns with NIH priorities to map longitudinal trajectories of the HIV care continuum, identify predictors of changes in viral suppression, and support large studies led by Black investigators. This work also builds upon the existing collaboration, resources, and support of the Mid Atlantic CFAR Consortium and is the next step needed in our work to design equitable approaches to improve HIV care outcomes for BSMM LWH.