Still Climbin': A Randomized Controlled Trial of an Intervention to Improve Coping with Discrimination, Address Medical Mistrust, and Reduce Health Disparities among Black Sexual Minority Men

项目总结/摘要 黑人男性，特别是黑人性少数群体男性（SMM），受到健康和医疗保健的负面影响 差异：他们显示出可预防的疾病和可预防的慢性并发症的结果更差。 条件，并且不太可能比白色男性和女性参与医疗保健。基于证据 和理论，歧视有助于有意义的差距，我们正在进行一个随机的 一项为期8个疗程的文化一致性认知行为治疗组干预的对照试验（RCT）， Climbin '，旨在加强对交叉耻辱和歧视的有效应对措施，以及 减少黑人SMM之间的医疗不信任，目的是改善医疗保健参与和接受 循证预防保健。在我们之前的试点工作中，“攀登”仍然有很强的科学基础， 建议的干预措施是关键利益相关者可以接受的，可行的，并与 提高有效应对能力。家长资助的具体目的是：（1）进行随机对照试验，以检验Still的效果 Climbin '，一种文化一致的认知行为治疗小组干预，对医疗保健参与和 接受基于证据的预防性护理的黑人性少数男性;（2）审查机制， 干预措施对改善医疗保健参与和接受循证预防护理的影响， 包括更有效的应对技能和减少医疗不信任;（3）检查潜在的调节剂 干预的效果。在建立社区-学术伙伴关系的背景下，我们将开展 随机对照试验中，300例黑人SMM患者随机分为干预组和对照组，各150例。 参与者将在基线和基线后4个月、8个月和12个月完成调查， 结果，以及潜在的中介者，协变量和主持人。医疗保健参与，证据的接收- 基础护理和健康状况将通过医疗记录进行核实。拟议的补充研究将 将母研究中感染艾滋病毒的老年黑人SMM的子样本量增加70名参与者，以：（1） 检查心理和身体健康结果的相关性，包括弹性因素（例如，社会 支持，有效应对）和风险因素（例如，交叉污名，无效应对，孤独），使用 扩大基线样本的老年黑人SMM艾滋病毒感染者;和（2）评估仍然攀登'干预 对老年黑人SMM中与精神和身体健康结果相关的风险和弹性因素的影响 艾滋病毒携带者我们还将探索对HIV病毒载量抑制的初步影响。除了我们的 在我们自己的工作中，我们不知道有任何干预措施解决跨部门歧视问题， 身份，以改善黑人SMM的健康结果。尽管结构性干预措施 作为一项长期战略，减少社会歧视至关重要，个人层面的干预-如斯蒂尔 需要同时减少歧视对健康的直接影响。

PROJECT SUMMARY/ABSTRACT Black men, especially Black sexual minority men (SMM), are negatively affected by health and healthcare disparities: They show worse outcomes for preventable conditions and preventable complications from chronic conditions, and are less likely to engage with healthcare than are White men and women. Based on evidence and theory that discrimination contributes meaningfully to disparities, we are conducting a randomized controlled trial (RCT) of an 8-session culturally congruent cognitive behavior therapy group intervention, Still Climbin’, which aims to increase effective coping responses to intersectional stigma and discrimination, and reduce medical mistrust among Black SMM, with the goal of improving healthcare engagement and receipt of evidence-based preventive care. Still Climbin’ has a strong scientific basis in our prior pilot work, which found that the proposed intervention is acceptable to key stakeholders, feasible to conduct, and associated with improved effective coping. The parent grant specific aims are: (1) To conduct an RCT to test the effects of Still Climbin', a culturally congruent cognitive behavior therapy group intervention, on healthcare engagement and receipt of evidence-based preventive care among Black sexually minority men; (2) To examine mechanisms of the intervention’s effects on improved healthcare engagement and receipt of evidence-based preventive care, including more effective coping skills and reduced medical mistrust; and (3) To examine potential moderators of the intervention’s effects. In the context of established community-academic partnerships, we will conduct the RCT with 300 Black SMM, randomizing 150 to the intervention group and 150 to a wait-list control group. Participants will complete surveys at baseline and 4-, 8-, and 12-months post-baseline to assess the primary outcomes, and potential mediators, covariates, and moderators. Healthcare engagement, receipt of evidence- based care, and health conditions will be verified with medical records. The proposed supplement study would increase the sub-sample size of older Black SMM living with HIV in the parent study by 70 participants to: (1) Examine the correlates of mental and physical health outcomes, including resilience factors (e.g., social support, effective coping) and risk factors (e.g., intersectional stigma, ineffective coping, loneliness), using an expanded baseline sample of older Black SMM living with HIV; and (2) Evaluate Still Climbin’ intervention effects on risk and resilience factors related to mental and physical health outcomes among older Black SMM living with HIV. We also will explore preliminary effects on HIV viral load suppression. With the exception of our own work, we are not aware of any interventions that address coping with discrimination from intersectional identities in order to improve health outcomes among Black SMM. Although structural-level interventions are critical for reducing societal discrimination as a long-term strategy, individual-level interventions—such as Still Climbin’—are needed in tandem to reduce discrimination’s immediate health effects.