This research study aims to test the effectiveness, reach, and maintenance over time of the iTHRIVE 365 intervention for Black same gender loving men (SGLM) living with HIV. iTHRIVE 365 is a SGLM community-developed multicomponent mHealth intervention that aims to: 1) Support daily health promotion via HIV and psychological health education and health maintenance reminders; 2) Foster positive social connections among SGLM via online moderated forums, interpersonal chats, and community calendars; 3) Connect clients to SGLM-affirming healthcare, including HIV treatment and mental healthcare; 4) Provide resources for housing, transportation, and other economic empowerment.
This research study aims to test the effectiveness, reach, and maintenance over time of the iTHRIVE 365 intervention for Black same-gender loving men (SGLM) living with HIV. I thrive 365 is an SGLM community-developed multicomponent intervention that aims to: 1) Support daily health promotion via HIV and psychological health education and health maintenance reminders; 2) Foster positive social connections among SGLM via online moderated forums, interpersonal chats, and community calendars; 3) Connect clients to SGLM-affirming healthcare, including HIV treatment and mental healthcare; 4) Provide resources for housing, transportation, and other economic empowerment. The investigators will pursue the following aims: 1. Test the effectiveness of THRIVE365 in improving daily and longer-term (1-6 months) HIV-related behavioral health (primary outcome: ART adherence) and psychological health (e.g., secondary outcomes: lower depressive and anxiety symptoms) in a 6-month waitlist randomized controlled trial with 350 Black SGLM living with HIV in the four Atlanta-area Ending the HIV Epidemic (EHE) jurisdictions. 2. Examine the moderating effect of THRIVE365 on associations between intersectional stigma (e.g., intersectional racist, heterosexist, and HIV stigma) and our primary and secondary HIV outcomes. 3. Evaluate THRIVE365 maintenance and reach the user level (e.g., within-user changes in engagement and daily effects) and setting level (e.g., intervention adaptations, Black SGLM community uptake). Participants will be recruited in collaboration with THRIVE SS, the most prominent Black SGLM-led social service organization for Black SGLM in the Atlanta, GA metro area. After completing an online screener to assess basic eligibility requirements, participants will be scheduled for an online Health Insurance Portability and Accountability Act (HIPPA)---compliant Zoom consent and baseline survey process. All online assessments will be completed using HIPAA-compliant Qualtrics surveys. Participants will review study information and complete informed consent procedures with study staff, including agreeing to provide access to their iTHRIVE 365 paradata and HIV viral suppression results. Once consented, participants will complete a computerized retrospective interview to assess HIV anti-retroviral treatment (ART) adherence and substance use, as well as measures of intersectional stigma, depressive symptoms, anxiety symptoms, emotion regulation, social support coping, ART information and motivation, and multilevel barriers to ART adherence. Participants will also be guided through a practice daily diary. Finally, intervention group participants will be registered for the mHealth (e.g., online forums) and institutional (e.g., linkage to care) aspects of iTHRIVE 365. Control group participants will remain on the registration waitlist until after the 6-month study is over. All participants will receive virtual gift card compensation directly following the baseline. All participants will complete brief daily measures of intersectional stigma, ART adherence, substance use, depressive and anxiety symptoms, emotion regulation, and social support coping for 14 days after baseline to assess daily iTHRIVE 365 effectiveness. Upon completing the 2-week cycle, participants will complete a 2-week follow-up online survey, including identical measures to those received at baseline. All participants will receive compensation for their participation in the 2-week assessment and compensation based on the number of daily surveys the participants completed. There will be online follow-up surveys at 1-, 2-, 4-, and 6-months post baseline. These assessments will include measures identical to the baseline and 2-week assessments. As with the baseline, participants will receive virtual gift card compensation directly after participants complete their surveys. Following the 6-month assessment, all participants will participate in a second 2-week daily diary study. At the end of the 2-week process, participants will engage in a debriefing session and be able to provide feedback on the iTHRIVE 365 intervention and the research process. As with the initial daily diary period, participants will receive virtual gift card compensation based on the number of surveys completed. To accomplish study aims, the investigators will estimate all analytic models in Mplus and SPSS. The investigators will test the effectiveness of iTHRIVE 365 on daily primary and secondary HIV and psychological outcomes by examining a series of two-level dynamic structural equation models (DSEMs) that test differences in within-participant changes in our outcomes across intervention groups. The investigators will test the effectiveness of iTHRIVE 365 on longer-term primary and secondary outcomes through between- and within-group analyses estimated as latent growth curve models that test changes in the outcomes across intervention groups during the 6-month study period. The investigators will examine the main effects of intersectional stigma on primary and secondary outcomes using DSEM in autoregressive models (VAR (1)). The investigators will build off these VAR (1) models to examine the moderating effects of iTHRIVE 365 on the intersectional stigma HIV outcomes associations using multiple group moderation analyses. The investigators will run all descriptive analyses in SPSS for reach and maintenance. Effects maintenance analyses will build off the DSEM and VAR (1) models to observe time as a predictor of changes within and across participants in the iTHRIVE 365 effects.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
350
iTHRIVE 365 is a multicomponent intervention that combines mHealth features and institutional to support community priorities identified in formative CBPR. In line with best-practices for trials of intervention principles (TIPs) with mHealth interventions, iTHRIVE 365 deploys intervention elements that serve to accomplish intervention strategies. iTHRIVE 365 intervention strategies are to promote: 1)Health knowledge and motivation; 2)Social support coping; 3)Access to culturally-affirming healthcare; and 4)Housing and other economic resources. iTHRIVE 365 pursues these strategies via these intervention elements: 1)Weekly HIV and psychological health information and motivation content and daily health notifications; 2)Online moderated forums, interpersonal chats, and community calendars; 3)Linkage to biopsychosocial healthcare via THRIVE SS's network of Black SGLM-affirming providers; and 4)Housing and economic resources through THRIVE SS's direct support and referral network.
Antiretroviral (ART) Medication Use
For daily surveys, participants will report ART adherence on a single binary item ("In the past 24 hours did the participant take ART medication?")
Time frame: 24 hours
ART adherence-Long Lag Assessments
The investigators will use the NAME scale that assesses barriers to ART adherence.
Time frame: 2 weeks
Daily Diary Substance Use
The investigators will measure daily substance use with single-item binary measures of various substances (e.g.,alcohol, marijuana).
Time frame: 24 hours
Substance Use-Long Lag Assessments
For long lags (i.e., 2 week assessment to 6 month assessment), participants will complete an online, automated retrospective assessment of substance use in the past 2 weeks.
Time frame: 2 weeks
Depressive Symptoms
The Patient Health Questionnaire-4 assesses anxiety and depressive symptoms. Participants rate the extent to which the participants had been experiencing each item the past day (e.g., "In the past 24 hours, I've been feeling nervous, anxious, or on edge") on a scale from 0 (not at all) to 3 (entirely). The investigators used an average across all items for each time point.
Time frame: 24 hours
Depressive Symptoms-Long Lag
The Brief Symptom Inventory assesses anxiety and depressive symptoms. Participants rate the extent to which the participants had been experiencing each item the past two weeks (e.g., "Feeling hopeless about the future") on a scale from 0 (not at all) to 4 (Extremely). The investigators will use an average across all items for each time point.
Time frame: 2 weeks
Anxiety Symptoms
The Patient Health Questionnaire-4 assesses anxiety and depressive symptoms. Participants rate the extent to which the participants had been experiencing each item the past day (e.g., "In the past 24 hours, I've been feeling nervous, anxious, or on edge") on a scale from 0 (not at all) to 3 (completely). We used an average across all items for each time point.
Time frame: 24 hours
Anxiety Symptoms-Long Lag
The Brief Symptom Inventory assesses anxiety and depressive symptoms. Participants rate the extent to which the participants had been experiencing each item the past 2 weeks (e.g., "Feeling tense or keyed up") on a scale from 0 (not at all) to 4 (Extremely). The investigators will use an average across all items for each time point.
Time frame: 2 weeks
Emotion Regulation Emotion Regulation
A validated four-item version of the Difficulties with Emotion Regulation Scale assesses emotion regulation. Participants rated the extent to which the participants had been experiencing each item (e.g., "In the past 24 hours, I've been experiencing my emotions as overwhelming") in the past day on a scale from 0 (not at all) to 3 (entirely). The investigators used an average across all items for each time point.
Time frame: 24 hours
Emotion Regulation-Long Lag Assessments
The investigators will use the Difficulties with Emotion Regulation Scale- Short Form (DERS-SF) for long lags
Time frame: 2 weeks
COPE
A modified version of the Brief-COPE assesses coping approaches to stress over the last 24 hour. It includes the 6 items from the interconnectedness and problem-oriented subscales, and 3 original items assessing specific interconnectedness with Black LGBTQ people and problem-oriented action against injustice.
Time frame: 24 hours
COPE-Long Lag Assessments
The investigators will use the Brief-COPE measure to assess past 2-week coping, which assesses the following coping approaches in 28 items: Self-distraction, active coping, denial, substance use, use of emotional social support, use of instrumental social support, Behavioral disengagement, venting, positive reframing, planning, humor, acceptance, religion, and self-blame.
Time frame: 2 weeks
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