Samuel Chidi Ohiwerei Opara

Young Black sexual minority men (YB-SMM) who are living with HIV not only face numerous challenges to their health but also demonstrate a range of resilience processes that can be augmented to improve HIV care engagement. We adapted a previously developed in-person group intervention, Brothers Building Brothers By Breaking Barriers, into a remotely delivered telehealth program (Tele-B6), with a goal to enhance existing resilience by building social capital and affirming intersectional identities among YB-SMM living with HIV. We enrolled 60 participants in Atlanta, Georgia, into a pilot randomized controlled trial with a waitlist control design, to examine feasibility, acceptability, and safety of Tele-B6. Our evaluation included brief postsession evaluation surveys, fidelity checklists completed by facilitators, and longitudinal in-depth surveys conducted at baseline and 2-month intervals up through 6 months post-enrollment. Overall, we found that Tele-B6 was feasible to implement, highly acceptable to participants, and safe. Exploratory analyses also suggested potential improvement in general well-being and social capital, though interpretation of these results is limited given the small sample size. Tele-B6 is a promising intervention with potential for scalability and impact for supporting YB-SMM in HIV care. ClinicalTrials.gov registration: NCT05829759.

Background: Young Black sexual minority men are disproportionately affected by HIV, especially in the Southern United States. To address this, we developed Brothers Building Brothers by Breaking Barriers (B6) intervention with a goal of enhancing social capital and engagement in care among young Black sexual minority men living with HIV. However, we encountered challenges to feasibility in recruiting and engaging for an in-person intervention. Objective: The objectives of this study are to iteratively adapt the original B6 intervention for telehealth delivery (Phase 1), and pilot test the intervention through a waitlist-control trial to evaluate its feasibility, acceptability, and safety (Phase 2). Methods: In Phase 1, we used the assessment, decision, adaptation, production, topical experts, integration, training, and testing (ADAPT-ITT) framework to structure the iterative adaptation process of B6, working with a diverse study team and a Youth Advisory Board (YAB). After completing the preliminary adaptation process, we conducted initial Telehealth Brothers Building Brothers by Breaking Barriers (Tele-B6) pilot testing with a community partner organization. The result was a 5-week group-level intervention, delivered entirely remotely, consisting of a series of adapted activities to address bonding and bridging social capital, affirm intersectional identities, and engage in resilience-building processes. Following feedback integration from pilot-testing, we conducted Phase 2 with 60 young Black sexual minority men living with HIV recruited over the course of one year and who were randomized at the group level to either the immediate intervention or delayed (waitlist control) intervention group. Various data sources will be used to measure feasibility, acceptability, and safety, including surveys, postsession evaluation data, in-depth qualitative interviews, and review of medical records for HIV clinical outcomes. Results: Phase 1, the adaptation process of B6, began in fall 2022 and was completed in spring 2023. Phase 2, the implementation of the waitlist control trial, began in spring 2023 and concluded in summer 2024. Final follow-up assessments were completed in fall 2024 and the results of the mixed methods evaluation are expected in winter 2025. Conclusions: The adaptation process and telehealth delivery of B6 will add to the knowledge of strengths-based interventions designed to improve care engagement among young Black sexual minority men living with HIV. Trial Registration: ClinicalTrials.gov NCT05829759,https://clinicaltrials.gov/study/NCT05829759 International Registered Report Identifier (IRRID): DERR1-10.2196/69961

Since the 1980s when the HIV epidemic began, HIV and substance use have been intricately linked. A promising area for improving access to care and treatment for people living and aging with HIV and substance use is through integrated care (i.e., "the systematic coordination of general and behavioral healthcare"). There is a recognized need to increase collaboration and integration of mental health, substance use, and primary care providers, including infectious disease specialties. We conducted in-depth interviews with 15 administrators (e.g., clinic managers and care coordinators) and 21 providers (e.g., Physicians, Advanced Practice Providers (APPs), nurses) across Georgia between January 2021 and November 2022. Interviews explored administrator and provider perceptions of clinic integration and their desire to increase integration. Data were analyzed using inductive and deductive thematic analysis guided by the Consolidated Framework for Implementation Research. Overall, study participants in a variety of public, private, and community healthcare settings across the state recognized the benefits of integrated behavioral and physical healthcare and noted some facilitators. However, they reported significant individual-, organizational-, and community-level barriers to implementing it in practice. Our findings highlight opportunities for improvement at the provider, organization, and policy/system levels.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Young Black sexual minority men are disproportionately affected by HIV, especially in the Southern United States. To address this, we developed Brothers Building Brothers by Breaking Barriers (B6) intervention with a goal of enhancing social capital and engagement in care among young Black sexual minority men living with HIV. However, we encountered challenges to feasibility in recruiting and engaging for an in-person intervention. Objective: The objectives of this study are to iteratively adapt the original B6 intervention for telehealth delivery (Phase 1), and pilot test the intervention through a waitlist-control trial to evaluate its feasibility, acceptability, and safety (Phase 2). Methods: In Phase 1, we used the assessment, decision, adaptation, production, topical experts, integration, training, and testing (ADAPT-ITT) framework to structure the iterative adaptation process of B6, working with a diverse study team and a Youth Advisory Board (YAB). After completing the preliminary adaptation process, we conducted initial Telehealth Brothers Building Brothers by Breaking Barriers (Tele-B6) pilot testing with a community partner organization. The result was a 5-week group-level intervention, delivered entirely remotely, consisting of a series of adapted activities to address bonding and bridging social capital, affirm intersectional identities, and engage in resilience-building processes. Following feedback integration from pilot-testing, we conducted Phase 2 with 60 young Black sexual minority men living with HIV recruited over the course of one year and who were randomized at the group level to either the immediate intervention or delayed (waitlist control) intervention group. Various data sources will be used to measure feasibility, acceptability, and safety, including surveys, postsession evaluation data, in-depth qualitative interviews, and review of medical records for HIV clinical outcomes. Results: Phase 1, the adaptation process of B6, began in fall 2022 and was completed in spring 2023. Phase 2, the implementation of the waitlist control trial, began in spring 2023 and concluded in summer 2024. Final follow-up assessments were completed in fall 2024 and the results of the mixed methods evaluation are expected in winter 2025. Conclusions: The adaptation process and telehealth delivery of B6 will add to the knowledge of strengths-based interventions designed to improve care engagement among young Black sexual minority men living with HIV. Trial Registration: ClinicalTrials.gov NCT05829759,https://clinicaltrials.gov/study/NCT05829759

Background: Sexual minority men are disproportionately affected by methamphetamine use, with recent studies suggesting an increase in use specifically among Black sexual minority men. Black sexual minority men face unique structural barriers to achieving optimal health. Given its harmful effects, and in light of existing health disparities, an increase in methamphetamine use among Black sexual minority men poses a significant public health concern. Objective: The Health Impacts and Struggles to Overcome the Racial Discrimination of Yesterday (HISTORY) study is investigating the potential impacts of exposure to the census tract–level structural racism and discrimination (SRD) on methamphetamine use among Black sexual minority men in Atlanta, Georgia, and will identify intervention targets to improve prevention and treatment of methamphetamine use in this population. Methods: This study uses a mixed methods and multilevel design over a 5-year period and incorporates participatory approaches. Individual-level quantitative data will be collected from a community-based cohort of Black sexual minority men (N=300) via periodic assessment surveys, ecological momentary assessments, and medical record abstractions. Census tract–level measures of SRD will be constructed using publicly available administrative data. Qualitative data collection will include longitudinal, repeated in-depth interviews with a subset (n=40) of study participants. Finally, using a participatory group model–building process, we will build on our qualitative and quantitative data to generate causal maps of SRD and methamphetamine use among Black sexual minority men, which in turn will be translated into actionable recommendations for structural intervention. Results: Enrollment in the HISTORY study commenced in March 2023 and is anticipated to be completed by November 2024. Conclusions: The HISTORY study will serve as a crucial background upon which future structural interventions can be built, to mitigate the effects of methamphetamine use and SRD among Black sexual minority men. International Registered Report Identifier (IRRID): DERR1-10.2196/63761

BACKGROUND Sexual minority men are disproportionately affected by methamphetamine use, with recent studies suggesting an increase in use specifically among Black sexual minority men. Black sexual minority men face unique structural barriers to achieving optimal health. Given its harmful effects, and in light of existing health disparities, an increase in methamphetamine use among Black sexual minority men poses a significant public health concern. OBJECTIVE The Health Impacts and Struggles to Overcome the Racial Discrimination of Yesterday (HISTORY) study is investigating the potential impacts of exposure to the census tract–level structural racism and discrimination (SRD) on methamphetamine use among Black sexual minority men in Atlanta, Georgia, and will identify intervention targets to improve prevention and treatment of methamphetamine use in this population. METHODS This study uses a mixed methods and multilevel design over a 5-year period and incorporates participatory approaches. Individual-level quantitative data will be collected from a community-based cohort of Black sexual minority men (N=300) via periodic assessment surveys, ecological momentary assessments, and medical record abstractions. Census tract–level measures of SRD will be constructed using publicly available administrative data. Qualitative data collection will include longitudinal, repeated in-depth interviews with a subset (n=40) of study participants. Finally, using a participatory group model–building process, we will build on our qualitative and quantitative data to generate causal maps of SRD and methamphetamine use among Black sexual minority men, which in turn will be translated into actionable recommendations for structural intervention. RESULTS Enrollment in the HISTORY study commenced in March 2023 and is anticipated to be completed by November 2024. CONCLUSIONS The HISTORY study will serve as a crucial background upon which future structural interventions can be built, to mitigate the effects of methamphetamine use and SRD among Black sexual minority men. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/63761