Peer Case Management Promoting Advancement Along the HIV Care Continuum Among Black Men Who Have Sex with Men Living with HIV: Building Brothers Up.

Black men who have sex with men (BMSM) in the United States are at elevated risk for HIV relative to their heterosexual and/or non-BMSM counterparts, yet on average demonstrate suboptimal HIV care linkage and rates of HIV primary care retention. From October 2019 to December 2020, 69 adult (i.e., aged 18-65) BMSM enrolled in Building Brothers Up (2BU), a 6-session peer case management intervention delivered across 3 months and designed to improve retention in HIV primary care through to full viral suppression. Peer case management sessions included detailed assessment of participants' needs and barriers to treatment, which led to the development of a participant-centered treatment plan. All participants self-identified as Black, about three-quarters self-identified as gay (72.5%), and 46.4% reported an annual income of $5000 or less. A total of 69 participants enrolled in 2BU; however, multiply imputed chained equation logistic regressions were carried out on the final analytical data set (n = 40; 99 imputations) due to a large amount of COVID-19-related missing data. Although analyses of retention and achievement of viral suppression did not reach full significance, the probability of a Type-II hypothesis testing error was high, and viral load results (adjusted odds ratio = 1.56; 95% confidence interval = 0.94-2.60; p = 0.08) suggested that increased attendance to peer case management sessions may be associated with improved odds of achieving full viral suppression among BMSM. The significant impact of national race-related civil unrest and the COVID-19 pandemic on the target population during implementation of 2BU is underscored.

Frontline Perspectives from the Implementation of Evidenced-Informed Interventions to Improve Behavioral Health and HIV Outcomes Among Black Men Who Have Sex with Men in the United States.

The perspectives and contributions of frontline staff are critical to the success of integrated HIV and behavioral health services in the United States (US). In this analytic essay, we share five key priority areas from frontline staff at four diverse sites funded by the Health Resources and Services Administration to support the implementation of interventions to improve HIV and behavioral health outcomes among Black men who have sex with men (BMSM) living with HIV. The five main priorities focused on: (1) COVID-19 pandemic adaptations; (2) recruitment/enrollment; (3) retention; (4) frontline self-care; and (5) replication considerations. Projects had to be nimble and innovative in their delivery of services; leverage existing infrastructure; and they had to try multiple approaches to reach BMSM and modify/drop them as needed. Future implementers should expect to support frontline staff self-care given the added stress of working under COVID-19 pandemic conditions and in communities with limited and uncoordinated behavioral health services.

HIV Prevention During the COVID-19 Pandemic: Sexual Activity and PrEP Use Among Black Same-Gender-Loving Men and Black Cisgender Women.

Black populations in the U.S. South are disproportionally affected by HIV and COVID-19 due to longstanding inequalities. We conducted 20 in-depth interviews-12 with Black same-gender-loving men and 8 with Black cisgender women-to explore the impact of the initial phase of the COVID-19 pandemic on sexual activities and PrEP use. Almost all participants reduced the frequency of sex and number of partners. Women described little interest in sex, whereas men began to connect with some sexual partners after stay-at-home orders were lifted. Both populations were concerned about contracting COVID-19 through sexual partners, and men described selecting partners based on perceived COVID-19 risk. Participants valued PrEP and could access it, although several men who were not having sex stopped taking it. Risk of acquiring HIV during this time was likely limited. Future qualitative research is needed to understand how sexual behaviors and PrEP use changed as the pandemic continued.