JMIR Publications

ABSTRACT

Background:

Gay, bisexual, and other men who have sex with men (GBMSM) living with HIV have low antiretroviral treatment (ART) adherence in South Africa due to limited skills in managing disclosure and prevention behaviors with sexual and romantic partners. As a result, there is high HIV transmission within HIV-discordant partnerships: but an existing intervention may address these outcomes, if adapted effectively. Healthy Relationships (HR) is a behavioral intervention originally delivered in groups and in-person over five sessions to develop coping skills to manage HIV-related stress and sexually risky situations, enhance decision-making skills for HIV disclosure to partners, and establish and maintain safer sex practices with partners. HR effectively improves prevention behaviors, but has yet to be tailored to a context outside the U.S.

Objective:

To adapt HR into a new culturally adapted intervention entitled, Speaking Out & Allying Relationships (SOAR) for GBMSM, and then assess its feasibility in Eastern Cape, South Africa.

Methods:

The study will be conducted over two aims. Aim one, adaptation, will use a human-centered design approach. Initial intervention tailoring will integrate U=U and PrEP education, develop intervention content for a video conference (VC) format, and design role-plays and movies for skill-building based on preliminary data. Afterward, interviews and a survey will be administered to GBMSM to assess intervention preferences, and a focus group will be conducted with healthcare providers and IT experts to assess intervention design. Finally, a usability test will determine functionality and content understanding. Participants will be GBMSM living with HIV (N=15) and in a relationship, and healthcare providers and IT (N=7) experts working in HIV care and programming with this population. Aim two 2 will examine the feasibility of the adapted intervention, using a pilot randomized control design. There will be sixty individuals (N=60) per arm with feasibility surveys and interviews conducted with the intervention arm, and behavioral and biomedical assessments for relationship and treatment adherence outcomes will be collected for both arms. All participants will be GBMSM, living with HIV, and in a relationship with a HIV-negative or unknown status partner.

Results:

Intervention adaptation began in August 2021 with initial tailoring and refining GBMSM intervention preferences completed by December 2021, and usability and feasibility due to be completed by March 2022 and February 2024 respectively.

Conclusions:

GBMSM need efficacious interventions that tackle partnership dynamics and HIV prevention and treatment outcomes for ART adherence and viral suppression in South Africa. Harnessing everyday technology use for social networking, like VC, and U=U and PrEP to update an existing intervention for South African GBMSM has the potential to strengthen relationship communication about HIV treatment and prevention and in turn improve outcomes.