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Principal Investigator: Derek Tramel Dangerfield II
Organization: GEORGE WASHINGTON UNIVERSITY
Fiscal Year: 2024
Award: $811,432
Funding agency: National Institute of Mental Health
Project Summary/Abstract
The U.S. will not meet the targets of the Ending the HIV Epidemic Plan (EHE) without an intentional
focus on improving outcomes among Black sexual minority men living with HIV (BSMM LWH). Only 55% of
BSMM LWH maintain 100% daily treatment adherence and only 62% are virally suppressed. Research proves
that multilevel factors such as racism, stigma, depression, victimization, and economic instability are important
unaddressed determinants of HIV care outcomes. Updates to health care delivery models due to COVID-19
(i.e. telehealth) provided novel ways to improve HIV care engagement, retention, and adherence. However,
BSMM still experience worse outcomes than others even when accounting for differences in access to
resources. The literature collectively suggests that multilevel factors could create distinct socioecological
patterns that impact HIV care outcomes for BSMM LWH, especially across age groups. BSMM LWH have not
adequately engaged or retained in care activities because previous approaches do not account for their current
or combined socioecological experiences. Previous studies are outdated, cross-sectional, utilize culturally
inappropriate measures, and have small samples of Black participants. Sustainable approaches to engage this
population remain elusive, especially for young BSMM LWH. There is no digital, limited interaction cohort study
centered on BSMM LWH despite focus given to other priority populations such as transwomen, drug users,
and adolescents. The goal of this Limited Interaction Targeted Epidemiology proposal is to conduct a
prospective cohort study to identify the HIV care riskscape for BSMM LWH and examine how multilevel factors
impact changes in retention in HIV care, treatment adherence, and viral suppression. Phase 1 will identify
effective recruitment strategies (Aim 1) and validate commonly accepted scales among BSMM LWH to aid in
survey design (Aim 2). Then we will explore the feasibility and acceptability of enrolling a large digital cohort of
Mid-Atlantic BSMM LWH (Aim 3). Phase 2 will collect and analyze prospective cohort data collected at
baseline, 3-months, 6-months to quantify the cross sectional and longitudinal relationships between multilevel
factors and HIV care outcomes among 1,500 BSMM LWH (Aim 4). This study will be the largest prospective
cohort focused on BSMM LWH ever conducted and targets high-priority EHE locales. This study aligns with
NIH priorities to map longitudinal trajectories of the HIV care continuum, identify predictors of changes in viral
suppression, and support large studies led by Black investigators. This work also builds upon the existing
collaboration, resources, and support of the Mid Atlantic CFAR Consortium and is the next step needed in our
work to design equitable approaches to improve HIV care outcomes for BSMM LWH.
Terms: <AIDS Virus><Accounting><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome Virus><Adherence><Adolescent><Adolescent Youth><Baltimore><Black><Black race><COVID-19><CV-19><Caring><Chi-Square Tests><Cities><Cohort Studies><Collaborations><Concurrent Studies><Continuity of Care><Continuity of Patient Care><Continuum of Care><Coronavirus Infectious Disease 2019><Data><Drug usage><Drug user><Economics><Enrollment><Epidemiology><Equity><Generations><Goals><HIV><High Prevalence><Human Immunodeficiency Viruses><Incidence><Investigators><Knowledge><LAV-HTLV-III><Life Cycle><Life Cycle Stages><Literature><Locales><Longitudinal Studies><Lymphadenopathy-Associated Virus><Maps><Measures><Medical><Mental Depression><Methods><Modeling><NIH><National Institutes of Health><Outcome><PWUD><Participant><Pattern><Phase><Philadelphia><Population><Prospective Studies><Prospective cohort><Prospective, cohort study><Psychometrics><Research><Research Personnel><Research Resources><Researchers><Resources><Risk><Sampling><Service delivery model><Service model><Sexuality><Survey Instrument><Surveys><Target Populations><United States National Institutes of Health><Update><Victimization><Viral><Virus-HIV><Washington><Work><acceptability and feasibility><access differences><age associated difference><age associated effects><age based difference><age dependent difference><age dependent variation><age difference><age effect><age group><age related difference><age related effects><age related variation><age specific difference><aging effect><analyzing longitudinal><care delivery model><care outcomes><cohort><coronavirus disease 2019><coronavirus disease-19><coronavirus infectious disease-19><depression><design><designing><differ by age><difference across age><difference in age><differences in access><digital><drug use><economic><effectiveness testing><enroll><epidemic planning><epidemic preparedness><epidemiologic><epidemiological><experience><health care delivery model><health care organization><health care outcomes><health care service organization><healthcare delivery model><healthcare organization><healthcare outcomes><healthcare service organization><impact of age><improved><improved outcome><influence of age><juvenile><juvenile human><life course><long-term study><longitudinal analysis><longitudinal outcome studies><longterm study><marginalized group><marginalized individual><marginalized people><marginalized population><men><novel><people who use drugs><people who use illicit drugs><persons who use drugs><prospective><racism><recruit><sexual minority men><social stigma><stigma><telehealth><theories><trans-women><transgender women><transwoman><transwomen><treatment adherence><treatment compliance><trend><variation by age>