Examining a Multicomponent Intervention to Improve HIV Health among Black Men in Southern Ending the HIV Epidemic in the U.S. Jurisdictions

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PROJECT SUMMARY/ABSTRACT Black men who have sex with men (BMSM) in the U.S. continue to experience a vastly inequitable HIV burden, particularly in Southern Ending the HIV Epidemic in the U.S. (EHE) jurisdictions. To combat this alarming trend, there is a need for innovative, accessible, and community-developed interventions to promote HIV health among BMSM in these areas. Given research that daily and multilevel intersectional stigma contributes to HIV inequities among BMSM, a multicomponent intervention that addresses multilevel barriers to HIV health and combats intersectional stigma is essential. In collaboration with THRIVE SS, a leading BMSM- led community-based organization serving BMSM living with HIV in the Atlanta area, we developed THRIVE365, an evidence-based multicomponent HIV intervention that provides individual-level health education and motivation, builds social support among BMSM, facilitates access to culturally-affirmative healthcare, and combats barriers to housing and economic empowerment in line with the Information- Motivation-Behavioral skills, social capital, and socioecological models of health. Pilot evidence indicates THRIVE365 is feasible, acceptable, and efficacious in promoting daily antiretroviral treatment (ART) adherence and reducing daily depressive symptoms, anxiety symptoms, and emotion regulation difficulties among BMSM living with HIV. THRIVE365 is ready for a full-scale evaluation guided by the RE-AIM framework that includes a robust examination of its effectiveness for HIV-related behavioral and psychological outcomes, its moderation effects on intersectional stigma, and its maintenance and reach over time. We will do so with a fully-powered hybrid type 2 implementation-effectiveness trial using daily diary methods, self-report follow-ups over 6 months, and paradata to examine daily and longer-term intervention engagement, effects, and adaptations. The overarching aims of this research are to: 1) Test the effectiveness of THRIVE365 in improving daily and longer-term HIV-related behavioral health (primary outcome: ART adherence) and psychological health (e.g., secondary outcomes: lower depressive and anxiety symptoms) in a 6-month waitlist randomized controlled trial with 350 BMSM living with HIV in the four Atlanta-area EHE jurisdictions; 2) Examine the moderating effect of THRIVE365 on associations between intersectional stigma and our primary and secondary HIV outcomes; 3) Evaluate THRIVE365 maintenance and reach at the user-level (e.g., within-user changes in engagement and daily effects) and setting-level (e.g., intervention adaptations, BMSM community uptake). Together, these results will establish the effectiveness of THRIVE365, a community-led, multicomponent intervention, for improving HIV-related behavioral and psychological health among BMSM living with HIV in four of the EHE jurisdictions with the greatest HIV burden. THRIVE365 was designed for implementation and is poised to offer a model for effective HIV care among BMSM in high-stigma, low-resource areas of the U.S. South and beyond.