A trauma-informed intervention for sexual minority men recently diagnosed with HIV

The National Institute of Mental Health (NIMH) awarded a Project Grant under the Mental Health Research Grants program (CFDA 93.242) to Temple University to develop and pilot test a trauma-informed intervention called RISE (Resilience-based Intervention for Stress Reduction and HIV-related Efficacy). The $721,833 award aims to address the high rates of trauma, depression, and antiretroviral treatment non-adherence among Black sexual minority men living with HIV, particularly those recently diagnosed.

The key products and services to be delivered under this 3-year grant include: 1) Formative research to assess the mental health needs and preferences of the target population, 2) Development of the RISE intervention manual and digital health infrastructure, including tailored text messages and health promotion materials, and 3) A randomized, controlled pilot trial to assess the feasibility, acceptability, and preliminary efficacy of the RISE intervention in improving HIV care engagement and reducing trauma symptoms. The project involves a sub-award to the University of Georgia Research Foundation to support study design, data collection, and dissemination activities.

Abstract

Compared to the general population in the united states, people living with HIV (plwh) show high rates of trauma- and stress-related disorders and severe acute stress reactivity to events that are, diagnostically, not considered traumatic. Trauma is highly correlated with depression, a robust predictor of antiretroviral treatment (art) non-adherence. Additionally, reporting a high number of recent stressful events is associated with art non-adherence. Despite black sexual minority men (bsmm), particularly those under age 40, being disproportionately affect by HIV and trauma and less likely to be linked to HIV care after diagnosis, bsmm remain grossly underserved with respect to their mental health. Further, although interventions exist that address trauma for pwlh, few HIV-related interventions emphasize the traumatic stress cycle and acute stress reactivity immediately following an HIV diagnosis. To address the need for early mental health intervention immediately after HIV diagnosis, in general, as well as the under-addressed mental-health needs of HIV+ bsmm (+bsmm), in particular, we will develop and pilot-test a resilience-focused, trauma-informed intervention called, resilience- based intervention for stress reduction and HIV-related efficacy (rise). Rise will be based on approaches and techniques of cognitive-behavior therapy (CBT) and the framework of resilience theory. IT will address trauma- and stress-related symptomology and acute stress reactivity within three months of an HIV diagnosis to facilitate linkage to HIV care. The brief rise will include six online sessions, a booster session, and text messaging. Innovative commercial marketing techniques will be used to develop highly targeted messages to supplement the CBT- and resilience-based approach of rise. First, aim 1 will involve formative research to assess +bssm's needs, preferences, and perceptions regarding their mental health and their engagement in HIV care via in-depth interviews with +bsmm and service providers. Next, aim 2 will include development of the rise intervention manual and digital health infrastructure. Tailored text messages and health-promotion materials will be developed via in-depth interview-derived quantitative surveys with 50 +bsmm. The aim will also include an iterative process of intervention development, including focus groups with +bsmm and service providers, respectively, and intervention theatre tests with 6 +bsmm. Finally, aim 3 will consist of a randomized, controlled pilot trial for feasibility (e.g., recruitment and enrollment rates, fidelity), acceptability (i.e., feedback interview, satisfaction questionnaire), and preliminary efficacy (i.e., increased HIV care engagement, including attending an HIV care appointment, antiretroviral treatment [art] initiation, and art adherence [primary outcome]; reduced trauma symptoms, including intrusive experiences, avoidance, and hyperarousal [secondary outcome]) with 40 +bsmm diagnosed within the past three months. Participants will be assessed at baseline, post-intervention, and 6- and 9-month follow-UPS post-baseline. We will develop and maintain a community advisory board for consultation throughout the study.