JMIR Publications

ABSTRACT

Background:

Black women continue to bear a disproportionate burden of HIV, accounting for nearly 60% of new diagnoses among U.S. women. Women living with HIV (WLHA), and in particular Black WLHA, often experience HIV with mutually reinforcing epidemics, known as syndemics, inclusive of interpersonal violence and substance use. Syndemic experiences are associated with decreased HIV care engagement and treatment adherence and worsening HIV outcomes. Compounding this, few HIV services and supportive resources are tailored to Black WLHA, including elements that are gender- and culturally-responsive and trauma-informed. Technology-based and psychoeducational programming, as well as peer navigation, offer promising pathways to Black WLHA-specific HIV support services, and improved HIV care outcomes. With this is mind, the web-based, trauma-informed intervention LinkPositively was developed in collaboration with Black WLHA to promote uptake of HIV care and ancillary support services.

Objective:

The primary aim is to determine the feasibility and acceptability of the gender-responsive, culturally-tailored, and trauma-informed LinkPositively intervention among Black WLHA affected by interpersonal violence. The secondary aim is to examine the preliminary impact of the LinkPositively intervention on retention in HIV care, ART adherence, and viral suppression, while evaluating the role of mechanism of change variables (i.e., social support, activation of social support networks, self-efficacy, and utilization of ancillary support services) in the associations.

Methods:

The LinkPositively trial is a pilot randomized controlled trial conducted in California, USA, among 80 adult Black WLHA who have experienced lifetime interpersonal violence. Core components of LinkPositively include: a) virtual peer navigation that includes phone and text check-ins and 4 weekly one-on-one video sessions to build skills to cope with barriers and navigate care; b) social networking platform to receive peer support; c) educational database with healthy living and self-care tips; d) GPS- enabled resource locator for HIV care and ancillary support agencies; and e) HIV medication self-monitoring and reminder system. Participants are randomly assigned to the intervention (n=40) or control (Ryan White standard of care, n=40) arm, with follow-up at 3- and 6- months. At each assessment, participants complete an interviewer-administered survey and submit hair samples for assessment of HIV medication adherence. All research staff and investigators adhere to ethical principles and guidelines in the conduct of research activities. Data will be analyzed utilizing generalized estimating equations.

Results:

Recruitment of participants is ongoing. We anticipate dissemination of preliminary results in 2024.

Conclusions:

This trial will benefit the advancement of HIV prevention science by harnessing technology to promote engagement in HIV care, while improving social support through peers and social networking – all under the auspices of being trauma-informed for Black WLHA with experiences of interpersonal violence. If shown to be feasible and acceptable, LinkPositively has the potential to improve HIV care outcomes among Black WLHA, a socially marginalized, key population. Clinical Trial: NCT04199052