Testing A Mobile App HIV Intervention For African American MSM
Research Question: Is a social work/legal case management (SW/LCM) application (app) intervention plus in-person SW/LCM navigator (hereafter SW/LCM App Plus) effective in improving HIV-related health outcomes (i.e., ART adherence, viral suppression) among HIV-positive African American young (ages 18-29) men who have sex with men (YMSM) versus the SW/LCM app alone?
Specific Aims: Our research aims to (1) Develop and pilot test the SW/LCM App Plus intervention for HIV-positive African American YMSM in Los Angeles County (LAC); and (2) Evaluate the efficacy of the SW/LCM App Plus intervention in improving treatment outcomes (i.e., ART adherence, viral suppression) compared to the SW/LCM app alone.
Background and Significance: In LAC, HIV incidence continues to increase among African American YMSM. HIV-positive African American YMSM experience worse HIV treatment outcomes than their white and Latino counterparts. These disparities have been attributed, in part, to economic disadvantage, lower educational attainment, higher rates of unemployment and incarceration, and lack of meaningful access to healthcare. While mobile app interventions to improve HIV treatment outcomes exist, few have been culturally tailored for African American YMSM and few address the social determinants of health impacting this population.
Approach and Methods: Our research will target HIV-positive African American YMSM who are newly diagnosed (i.e., within the past year) or not currently retained in HIV medical care (i.e., < 2 medical care visits at least 90 days apart within the past year). To improve cultural tailoring of the intervention we will focus specifically on sexual minority (i.e., gay, bisexual) identified African American YMSM. In Phase 1 we will use qualitative methodologies to develop the SW/LCM App Plus intervention through iterative focus group testing with the target population (n=48). In Phase 2 we will use technology- and clinic-based recruitment to identify HIV-positive African American YMSM who are recently diagnosed or not currently retained in HIV medical care (n=260). Participants will be randomly assigned to one of two treatment conditions, both of which will be implemented over the course of one year: (1) SW/LCM App Plus or (2) SW/LCM app alone. Participants in the SW/LCM App Plus condition (n=130) will receive information plus automated text messaging and access to an in-person SW/LCM navigator. Participants in the SW/LCM app alone condition (n=130) will only receive information plus push notifications and automated text messages focused on social work/legal needs. Participants’ engagement with the mobile app will be measured through ecological momentary assessment and ACASI surveys administered at 3 time points (baseline, 6 months, 12 months). Outcome measures, which include ART adherence and viral suppression, will be assessed using self-reported data verified through independent medical chart review.
Expected Results/Impact: We hypothesize that HIV-positive African American YMSM participants in the SW/LCM App Plus condition will experience better treatment outcomes (ART adherence, viral suppression) compared to participants in the SW/LCM app alone condition. This research stands to significantly impact HIV treatment by demonstrating that mobile technology may be useful in improving HIV treatment outcomes and by assessing the added efficacy of providing in-person SW/LCM navigator support targeting social determinants of health.