A Community-Developed, Web-Based Mobile App Intervention Addressing Social Work and Legal Needs of Black Sexual Minority Men Living With HIV: Protocol for a Randomized Comparison Trial

Abstract

Background Black sexual minority men (BSMM) are disproportionately affected by HIV. Los Angeles County (LAC) carries a substantial burden of the HIV epidemic in California. Negative effects of both psychosocial and structural barriers highlight the timely need to increase HIV treatment among BSMM. Successful HIV interventions based on social media and mobile phone technology have been demonstrated. This protocol describes LINX LA, a study that tests LINX, a web-based mobile app that provides tailored social services, legal resources, and peer support for BSMM living with HIV (BSMM+) in LAC using a randomized comparison trial. Objective During phase 1, the LINX LA study aims to engage in an iterative design process to develop the LINX App using qualitative data to inform and tailor the mobile app technology and its functionality. In phase 2 of LINX LA, we will test the efficacy of the LINX App compared with the LINX App Plus to improve HIV treatment outcomes (ie, antiretroviral therapy adherence, viral suppression) among BSMM+ in LAC by addressing social work and legal needs and developing a forum for peer support. Methods In this study funded by the California HIV/AIDS Research Program, we will recruit and enroll BSMM+ participants (aged ≥18 years) in LAC (N=400) to participate in a 12-month study that includes access to the LINX App, which provides a forum for peer support and tailored content aimed at improving the use of social and legal resources. All participants will also receive survey-based interviews at 3 time points (at baseline and 6- and 12-month intervals) and weekly text message surveys that assess medication and treatment adherence. Treatment adherence and viral suppression will be extracted from medical record data. Half of the participants will also be randomly assigned to receive 3 individualized coaching sessions (at 1-, 3-, and 6-month intervals) and the ability to directly message their coach via the LINX App. Over the course of the study, LINX App participants will receive a minimum of US $130 in cash and LINX App Plus participants will receive a minimum of US $190. We hypothesize that participants enrolled in LINX App Plus will demonstrate greater improvement in HIV outcomes compared with LINX App participants. Results The LINX study will test the efficacy of a web-based mobile app intervention for BSMM+ in LAC (N=400). The LINX App seeks to increase participants’ knowledge of HIV; to facilitate access to necessary social and legal services, including information and referrals; and to increase social support across participants by providing a mediated forum for engagement. Conclusions The implementation of LINX LA aims to develop and test a culturally tailored approach to improve the HIV treatment outcomes of BSMM+. International Registered Report Identifier (IRRID) PRR1-10.2196/19770

Ending the HIV epidemic for all, not just some: structural racism as a fundamental but overlooked social-structural determinant of the US HIV epidemic

“…The latter point is especially important given the emphasis in recent articles on community-engagement as one of the most promising and essential routes to EHE for people of color in the US [66,73 && ]. Notable examples of effective community-based collaborations include the integration of services provided by community-based pharmacists with those of medical providers to improve retention in care, rates of viral suppression, and adherence to antiretroviral medications among persons with HIV (PWHIV) [68][69][70]; community-engaged development of mobile HIV prevention apps for Black women [e.g., [71]] and Black sexual minority men; clinic-based strategies to improve care outcomes among PLWH experiencing homelessness and unstable housing [72], and concept mapping of multilevel resilience resources among adult Black PLWH in the Southern US [73 && ]. Recognizing the invaluable role of communitybased stakeholders in implementing EHE [66,74] and the need for 'multifactorial approach[es] accounting for the social, cultural, economic, and environmental factors that drive transmission of HIV' [74],…”

Internalized homophobia and social well-being among Black sexual minority men living with HIV: The mediating role of LGBT community connectedness and racial, gender, and sexual identity integration.

“…Data for these analyses were derived from a community-developed, web-based mobile application designed to address the social work and legal needs of Black sexual minority men living with HIV in Los Angeles County, described in detail elsewhere (Ochoa et al, 2021). Briefly, Black sexual minority men living with HIV aged 18 years old and above who self-identified as Black/African American and living with HIV and who did not identify as heterosexual were recruited into a randomized comparison trial of an mHealth intervention.…”

Structural Syndemics and Antiretroviral Medication Adherence Among Black Sexual Minority Men Living With HIV

“…Data for this study come from self-reported responses to a cross-sectional baseline interview from LINX LA, a prospective, randomized comparison trial of a web-based mobile application, which is described in detail elsewhere. 38 Participants (N = 124) were recruited using a variety of in-person and virtual strategies, including flyers at HIV and Lesbian, Gay, Bisexual, and Transgender-friendly clinics and postings on social media platforms. To be eligible for the study, participants had to meet the following criteria: (1) be at least 18 years or older; (2) identify as male individual; (3) identify as Black or African American; (4) identify as gay, bisexual, or another sexual minority; (5) own a smartphone; (6) be living with HIV; (7) reside in Los Angeles County; and (8) be able to provide informed consent.…”