JMIR Publications

ABSTRACT

Background:

In the United States (US), sexual and gender minority (SGM) people of color (POC) are disproportionately impacted by HIV. Persisting new diagnoses in SGM POC make it unlikely that the US will meet the Ending the HIV Epidemic’s (EHE) goal to reduce new HIV diagnoses by 90% by 2030. Innovative strategies are needed to address this challenge, particularly in the US South, where Black/African American and Latine SGM are disproportionately impacted by HIV. Social network approaches have led to increased HIV testing uptake. Social network interventions that are responsive to SGM POC individuals’ needs could also increase engagement across the HIV prevention and care continuum.

Objective:

This hybrid Type 1 effectiveness-implementation study will evaluate an enhanced Social Network Strategy (eSNS) intervention designed to increase engagement in HIV services (HIV testing, pre-exposure prophylaxis [PrEP] use, and HIV care) among SGM POC. From 2025-2027, eSNS will be delivered in the Charlotte, North Carolina (NC) region, which includes Mecklenburg County, a priority EHE jurisdiction.

Methods:

Phase 1 of the study was a formative period of mixed methods data collection to operationalize enhancements to the Centers for Disease Control and Prevention’s Social Network Strategy (SNS), which will address key facilitators and modifiable barriers to engaging SGM POC in HIV services. In Phase 2, the intervention will be integrated into standard NC Partner Services for people diagnosed with HIV and their sexual and/or social contacts. We will identify network recruiters (Ambassadors) among SGM POC who are either reached by study team members (DIS Coaches) performing Partner Services or referred at community sites. DIS Coaches will guide Ambassadors to identify and refer people in their network (Peers) for HIV services and will support each Ambassador over 2-6 weeks to facilitate Ambassadors’ peer outreach and Peers’ referrals to HIV services. Finally, the study’s Phase 3 will evaluate the eSNS’s effectiveness in increasing HIV services uptake compared to standard-of-care Partner Services in the Raleigh, NC region.

Results:

This project was funded by the National Institutes of Health and initially approved by the University of North Carolina at Chapel Hill’s Institutional Review Board in 2022. Phase 1 concluded in August 2024. Implementation of eSNS (Phase 2) will launch in January 2025. Evaluation measures (Phase 3) will be assessed at 6-month intervals during and after eSNS implementation. Based on Phase 1 findings, the study was modified to include Latine SGM as Ambassadors and expand identification of Ambassadors through community sites.

Conclusions:

Substantial reductions in new HIV diagnoses depend on public health approaches that effectively reach people with a higher likelihood of acquiring HIV. Our protocol proposes integrating existing strategies with an innovative intervention (eSNS) to reduce social barriers to increasing SGM POC’s engagement in the full HIV prevention and care continuum.