LEVERAGING FAMILY-BASED ASSETS FOR BLACK MSM IN HOUSE BALL COMMUNITIES

1尽管出现了高效的预防工具，如艾滋病毒暴露前预防(PrEP)，但黑人男性 2男男性行为者(MSM)仍然是美国艾滋病毒新诊断率最高的人群。风险 在病毒抑制的艾滋病毒阳性个体中，艾滋病毒继续传播的3%降至零；然而， 4黑人男男性接触者最不可能从事护理或被压制。许多黑人男男性接触者面临多重耻辱 5(例如，种族主义、同性恋恐惧症)和亲生家庭的排斥，但有些人在众议院找到了避难所 6舞会社区(HBC)-黑人LGBT亲属承诺(家庭)的国家网络，提供(非正式) 7关爱、肯定和成员生存技能的培养。关于技能建设和艾滋病毒预防， 8多人多声音(3 MV)是一项为期六个疗程的小组级别的行为干预，是唯一一个最好的- 9证据“对黑人MSM的干预。以家庭为基础的干预措施显示了预防艾滋病毒的效果；然而， 103 MV不是以家庭为基础的干预。在3 MV中，将HIV阴性的黑人MSM招募到人工组 11与他们可能几乎没有社会关系的个人的环境。3 MV都没有利用 12联系和承诺，也没有解决家庭球类家庭中艾滋病毒状况的可变性问题。 13因为HBC中的黑人MSM有更密切的社会关系，3MV需要适应才能更有反应 14给这种社会结构和活力。我们这项临床试验计划拨款的目标是为集群做准备 15项随机对照试验(CRCT)，以测试改良3 MV与标准护理在减少 16新的HIV感染和HBC家庭中黑人MSM病毒抑制率的增加。基于我们的 17形成工作，MSM社会网络预测艾滋病毒预防行为和HBC家庭文化规范 我们的中心假设是，修改后的3 mV 19包括家庭资产建设在内的干预措施将对艾滋病毒的预防和治疗产生放大作用 20个结果。我们将对这一假设进行研究，具体目的如下：目标1：开展形成性研究 21确定对3 MV干预手册和实施方案的关键修改。八步改编-- 22 ITT模型将指导我们将3 MV修改为我们的家庭我们的声音(OFOV)，其中包括 23 HBC家庭的生活体验。目标2：进行CRCT试点，以确定可行性和可接受性 24个修改的3 MV试验方案(OFOV)与等待名单的护理对照标准。我们将确定可行性/ 25可接受的OFOV和CRCT设计(n=6个家庭；100个个人)与纽约市的HBC家庭。这 26研究将提供必要的数据，以设计和进行全面的CRCT对艾滋病毒的OFOV有效性试验 27黑人男男性接触者的预防和护理结果。HBC是LGBT内部一个庞大但服务不足的社区 28个社区。通过为HBC量身定做基于证据的干预措施，我们的研究旨在改善艾滋病毒 29检测和护理参与将补充国家到2030年结束这一流行病的努力，特别是在 30黑人男男性接触者--家庭预防艾滋病毒的最优先群体。

1 Despite the advent of highly effective prevention tools such as HIV pre-exposure prophylaxis (PrEP), Black men 2 who have sex with men (MSM) continue to have the highest incidence of new HIV diagnoses in the US. The risk 3 of onward HIV transmission is reduced to zero in HIV-positive individuals who are virally suppressed; however, 4 Black MSM are least likely to be engaged in care or to be suppressed. Many Black MSM face multiple stigmas 5 (e.g., racism, homophobia) and rejection from their biological families, but some have found refuge in the House 6 Ball Community (HBC)—a national network of Black LGBT kinship commitments (families) that provide (informal) 7 care giving, affirmation and survival skills-building for its members. Regarding skills-building and HIV prevention, 8 Many Men Many Voices (3MV) is a six-session, group-level behavioral intervention and is the only “best- 9 evidence” intervention for Black MSM. Family-based interventions have shown HIV prevention efficacy; however, 10 3MV is not a family-based intervention. In 3MV, HIV-negative Black MSM are recruited into artificial group 11 settings with individuals with whom they may have little social relationship. 3MV neither leverages the 12 connections and commitments nor addresses the variability in HIV-status that exists in house ball families. 13 Because Black MSM in the HBC have closer social relationships, 3MV requires adaptation to be more responsive 14 to this social structure and dynamic. Our goal in this clinical trial planning grant is to prepare for a cluster 15 randomized controlled trial (CRCT) to test the effectiveness of the modified 3MV vs. standard of care in reducing 16 new HIV infections and increasing rates of viral suppression among Black MSM in HBC families. Based on our 17 formative work, that MSM social networks predict HIV prevention behaviors and that HBC family cultural norms 18 are primed for communication about HIV prevention and treatment, our central hypothesis is that a modified 3MV 19 intervention incorporating family asset-building will have an amplifying effect on HIV prevention and treatment 20 outcomes. We will investigate this hypothesis with the specific aims: Aim 1: Conduct formative research to 21 identify key modifications to the 3MV intervention manual and implementation protocol. The eight-step ADAPT- 22 ITT model will guide our approach to modifying 3MV into Our Family Our Voices (OFOV), which accommodates 23 the lived experience of HBC families. Aim 2: Conduct a pilot CRCT to determine the feasibility and acceptability 24 of the modified 3MV trial protocol (OFOV) vs. waitlisted standard of care control. We will determine the feasibility/ 25 acceptability of OFOV as well as the CRCT design (n=6 families; 100 individuals) with NYC HBC families. This 26 study will provide necessary data to design and conduct a full-scale CRCT effectiveness trial of OFOV on HIV 27 prevention and care outcomes in Black MSM. The HBC is a large, yet underserved, community within the LGBT 28 community. By precision-tailoring an evidence-based intervention for the HBC, our research to improve HIV 29 testing and care engagement will complement national efforts to End the Epidemic by 2030, especially among 30 Black MSM—the highest priority group for domestic HIV prevention.