Development and Evaluation of a Multilevel, Socio-Culturally Contextualized Digital Health Decision Intervention to Reduce Medical Mistrust and Improve Status-Neutral HIV Service Use among HLMSM

Duke University, Durham NC

Investigators

Abstract

Project Summary/Abstract: HIV disproportionately affects Hispanic/Latino gay, bisexual, and other men who have sex with men (HLMSM), threatening progress toward the Ending the HIV Endemic (EHE) initiative’s 2030 goals. Medical mistrust (MM) among HLMSM, which is associated with reduced engagement with HIV prevention and treatment services, has been identified as an important root cause and driver in sustaining and exacerbating HIV inequities among HLMSM. Thus, research to understand and address factors that shape MM and HIV service trustworthiness (MMT) in key geographies of elevated HIV incidence among HLMSM represents a public health priority to enable progress toward meeting national EHE goals. Throughout the proposed project, the HLMSM-led investigative team will partner with a steering committee consisting of HLMSM, community leaders with strong community ties to the Hispanic/Latino (H/L) community and HLMSM, healthcare providers who serve HLMSM, academic partners with subject expertise relevant to the proposed study activities and methods, media and communication partners with strong connections to the HLMSM community, and other key stakeholders. The project consists of two integrated study phases focusing on five geographic areas — Los Angeles County, CA; Bronx County, NY; Bexar County, TX; Miami-Dade County, FL; and San Juan Municipio, PR — that align with EHE priority jurisdictions and account for a significant burden of HIV incidence among HLMSM across the US. During Phase I, we will conduct formative research to inform the development of a multilevel digital health intervention and to identify existing local interventions that address MM among HLMSM, including (1) in-depth interviews with N=60 diverse HLMSM exploring the root causes and pathways shaping MMT and HIV service use as well as concept validity, verification, and reliability to inform quantitative measurement protocols; (2) focus groups (2-3 per geography) with N=6-8 HLMSM exploring acceptability and feasibility of and preferences for a digital MMT intervention as well as perspectives on participant recruitment and retention methods; (3) interviews with N=50 key informants (HIV service providers, H/L community leaders, local elected officials) about their experiences with MM among HLMSM, local and organizational laws/policies that contribute to MMT, and recommendations for decreasing MM among HLMSM; and (4) a cross-sectional online survey with N=1,625 HLMSM exploring correlates of MMT and HIV service use. In Phase II, we will conduct a three-arm (1:1:1) parallel explanatory randomized control trial to evaluate the efficacy of our digital health intervention in addressing MMT and improving use of status-neutral HIV services among HLMSM. N=336 HLMSM will be recruited from each of the five project geographies (N=1,680 total) and randomly assigned to receive either the multilevel digital intervention alone (interactive web platform and downloadable intervention workbook and toolkit), or multilevel digital intervention plus peer navigation (telehealth component with participants and an HLMSM peer navigator), or the standard of care (referral to existing local HIV prevention/treatment services).