{"id":{"repo_id":"uic","oai_identifier":"oai:figshare.com:article/31451473"},"canonical_url":"https://search.dev.ndltd.org/etd/uic/oai:figshare.com:article/31451473","repository":{"repo_id":"uic","name":"University of Illinois - Chicago","base_url":"https://api.figshare.com/v2/oai"},"display":{"title":"Barriers to HIV Care and Randomized Controlled Trial Retention among Black Men Who Have Sex with Men","abstract":"The HIV epidemic remains a significant global health challenge, including in the United States, where disparities in HIV care continuum outcomes persist between priority populations for Ending the HIV Epidemic (EHE) initiative. Among these priority populations, young Black men who have sex with men (YBMSM) have increased HIV acquisition and are more likely to experience challenges in being retained in HIV care. Despite advances in HIV prevention and treatment over the past five decades, YBMSM face intersecting social, economic, and structural barriers, including stigma, limited access to culturally competent care, and inadequate support services. These factors contribute to delayed HIV diagnosis, missed HIV care appointments, and poor adherence to antiretroviral therapy (ART). Young Black men are also often underrepresented in behavioral research and have higher rates of attrition, leading to gaps in tailored interventions that this population may benefit from to improve HIV care continuum outcomes. Addressing these disparities requires dismantling systemic inequalities to improve access to HIV prevention and treatment services, including tailored behavioral interventions. Mobile health (mHealth) interventions have emerged as promising tools to address disparities in HIV care continuum outcomes, including care retention, particularly among populations that experience multiple barriers to care, such as YBMSM. mHealth interventions provide innovative solutions to overcome logistical, social, and economic barriers that hinder traditional in-person behavioral interventions and healthcare engagement. For YBMSM, mHealth tools can offer discreet, convenient, and culturally competent support, which may facilitate improved HIV care continuum outcomes, such as ART adherence and HIV care retention. Previous research has shown that mHealth interventions can improve HIV self-management by offering personalized reminders, educational resources, and virtual peer support. Additionally, mHealth platforms are private, easily accessible, and may be relational, which can improve engagement with hard-to-reach populations. By expanding accessibility, mHealth interventions have the potential to improve health outcomes for YBMSM and reduce disparities that continue to contribute to the ongoing HIV epidemic. In the United States, we developed an mHealth app to improve HIV care continuum outcomes, including HIV care retention, among YBMSM. We conducted a randomized controlled trial (RCT) to explore the 6-Month intervention effect of the My Personal Health Guide mHealth app on HIV care continuum outcomes among YBMSM. We found that the app demonstrated an elevated but insignificant effect on self-reported HIV care retention after 6-months of follow-up. We believe My Personal Health Guide warrants further development to improve HIV care retention. In this sample, we observed a substantial proportion of research participants that were loss-to-follow-up (LTFU), so investigated factors associated with LTFU in an RCT among YBMSM. Loss-to-follow-up was associated with lower social support and YBMSM randomized to the attention control arm of the study, suggesting future behavioral interventions should consider whether the attention control is as engaging as the intervention. Additionally, determining the prevalence of lower self-perceived social support during RCT approach development might be considered to obtain accurate sample size estimates. Lastly, as the RCT began enrollment concurrent with the COVID-19 pandemic lockdowns, we conducted a qualitative analysis of barriers and facilitators of the HIV care experience among a convenience sample of YBMSM from the RCT. The most commonly reported barriers to HIV care retention were healthcare access factors, including administrative or technological issues, clinic hours, clinic location, and experiencing stigma in the clinic. Notably, positive interactions with provider and staff was commonly cited as a facilitator of HIV care retention, so future behavioral interventions might consider incorporating patient satisfaction with provider and staff interactions to improve care retention. Effective and tailored interventions that retain YBMSM and improve their retention in HIV care is particularly important due to the higher burden of HIV diagnoses within this group and the disparities they face in healthcare access, social determinants of health, and HIV-related stigma. While there have been improvements over time in national metrics for HIV care continuum outcomes, disparities still exist between priority populations, with YBMSM suffering a disproportionate burden of diagnoses, non-optimal adherence, and poor retention in care. Ultimately, these findings point to a multifaceted approach to improve retention in HIV care and RCTs among YBMSM. These data provide support for continued development of mHealth delivered HIV behavioral interventions, with enhanced efforts to recruit and retain a larger sample of YBMSM with engaging control arms, and leveraging positive interactions with providers to improve care retention in this vulnerable population.","abstract_html":"The HIV epidemic remains a significant global health challenge, including in the United States, where disparities in HIV care continuum outcomes persist between priority populations for Ending the HIV Epidemic (EHE) initiative. Among these priority populations, young Black men who have sex with men (YBMSM) have increased HIV acquisition and are more likely to experience challenges in being retained in HIV care. Despite advances in HIV prevention and treatment over the past five decades, YBMSM face intersecting social, economic, and structural barriers, including stigma, limited access to culturally competent care, and inadequate support services. These factors contribute to delayed HIV diagnosis, missed HIV care appointments, and poor adherence to antiretroviral therapy (ART). Young Black men are also often underrepresented in behavioral research and have higher rates of attrition, leading to gaps in tailored interventions that this population may benefit from to improve HIV care continuum outcomes. Addressing these disparities requires dismantling systemic inequalities to improve access to HIV prevention and treatment services, including tailored behavioral interventions. Mobile health (mHealth) interventions have emerged as promising tools to address disparities in HIV care continuum outcomes, including care retention, particularly among populations that experience multiple barriers to care, such as YBMSM. mHealth interventions provide innovative solutions to overcome logistical, social, and economic barriers that hinder traditional in-person behavioral interventions and healthcare engagement. For YBMSM, mHealth tools can offer discreet, convenient, and culturally competent support, which may facilitate improved HIV care continuum outcomes, such as ART adherence and HIV care retention. Previous research has shown that mHealth interventions can improve HIV self-management by offering personalized reminders, educational resources, and virtual peer support. Additionally, mHealth platforms are private, easily accessible, and may be relational, which can improve engagement with hard-to-reach populations. By expanding accessibility, mHealth interventions have the potential to improve health outcomes for YBMSM and reduce disparities that continue to contribute to the ongoing HIV epidemic. In the United States, we developed an mHealth app to improve HIV care continuum outcomes, including HIV care retention, among YBMSM. We conducted a randomized controlled trial (RCT) to explore the 6-Month intervention effect of the My Personal Health Guide mHealth app on HIV care continuum outcomes among YBMSM. We found that the app demonstrated an elevated but insignificant effect on self-reported HIV care retention after 6-months of follow-up. We believe My Personal Health Guide warrants further development to improve HIV care retention. In this sample, we observed a substantial proportion of research participants that were loss-to-follow-up (LTFU), so investigated factors associated with LTFU in an RCT among YBMSM. Loss-to-follow-up was associated with lower social support and YBMSM randomized to the attention control arm of the study, suggesting future behavioral interventions should consider whether the attention control is as engaging as the intervention. Additionally, determining the prevalence of lower self-perceived social support during RCT approach development might be considered to obtain accurate sample size estimates. Lastly, as the RCT began enrollment concurrent with the COVID-19 pandemic lockdowns, we conducted a qualitative analysis of barriers and facilitators of the HIV care experience among a convenience sample of YBMSM from the RCT. The most commonly reported barriers to HIV care retention were healthcare access factors, including administrative or technological issues, clinic hours, clinic location, and experiencing stigma in the clinic. Notably, positive interactions with provider and staff was commonly cited as a facilitator of HIV care retention, so future behavioral interventions might consider incorporating patient satisfaction with provider and staff interactions to improve care retention. Effective and tailored interventions that retain YBMSM and improve their retention in HIV care is particularly important due to the higher burden of HIV diagnoses within this group and the disparities they face in healthcare access, social determinants of health, and HIV-related stigma. While there have been improvements over time in national metrics for HIV care continuum outcomes, disparities still exist between priority populations, with YBMSM suffering a disproportionate burden of diagnoses, non-optimal adherence, and poor retention in care. Ultimately, these findings point to a multifaceted approach to improve retention in HIV care and RCTs among YBMSM. These data provide support for continued development of mHealth delivered HIV behavioral interventions, with enhanced efforts to recruit and retain a larger sample of YBMSM with engaging control arms, and leveraging positive interactions with providers to improve care retention in this vulnerable population.","abstract_has_math":false,"creators":["Kara Nitti (23291713)"],"institution":null,"degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2025,"date_issued":"2025-12-01T00:00:00Z","date_published":"2025-12-01T00:00:00Z","updated_at":"2026-07-27T21:34:28Z","subjects":["Young Black men who have sex with men"],"languages":[],"rights":["In Copyright"],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://doi.org/10.25417/uic.31451473.v1","outbound_label":"DOI","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:creator","label":"Author","values":["Kara Nitti (23291713)"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2025-12-01T00:00:00Z"]},{"key":"dc:relation","label":"Dc Relation","values":["https://figshare.com/articles/thesis/Barriers_to_HIV_Care_and_Randomized_Controlled_Trial_Retention_among_Black_Men_Who_Have_Sex_with_Men/31451473"]},{"key":"dc:type","label":"Dc Type","values":["Text","Thesis"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Young Black men who have sex with men"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:rights","label":"Dc Rights","values":["In Copyright"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["10.25417/uic.31451473.v1"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["The HIV epidemic remains a significant global health challenge, including in the United States, where disparities in HIV care continuum outcomes persist between priority populations for Ending the HIV Epidemic (EHE) initiative. Among these priority populations, young Black men who have sex with men (YBMSM) have increased HIV acquisition and are more likely to experience challenges in being retained in HIV care. Despite advances in HIV prevention and treatment over the past five decades, YBMSM face intersecting social, economic, and structural barriers, including stigma, limited access to culturally competent care, and inadequate support services. These factors contribute to delayed HIV diagnosis, missed HIV care appointments, and poor adherence to antiretroviral therapy (ART). Young Black men are also often underrepresented in behavioral research and have higher rates of attrition, leading to gaps in tailored interventions that this population may benefit from to improve HIV care continuum outcomes. Addressing these disparities requires dismantling systemic inequalities to improve access to HIV prevention and treatment services, including tailored behavioral interventions. Mobile health (mHealth) interventions have emerged as promising tools to address disparities in HIV care continuum outcomes, including care retention, particularly among populations that experience multiple barriers to care, such as YBMSM. mHealth interventions provide innovative solutions to overcome logistical, social, and economic barriers that hinder traditional in-person behavioral interventions and healthcare engagement. For YBMSM, mHealth tools can offer discreet, convenient, and culturally competent support, which may facilitate improved HIV care continuum outcomes, such as ART adherence and HIV care retention. Previous research has shown that mHealth interventions can improve HIV self-management by offering personalized reminders, educational resources, and virtual peer support. Additionally, mHealth platforms are private, easily accessible, and may be relational, which can improve engagement with hard-to-reach populations. By expanding accessibility, mHealth interventions have the potential to improve health outcomes for YBMSM and reduce disparities that continue to contribute to the ongoing HIV epidemic. In the United States, we developed an mHealth app to improve HIV care continuum outcomes, including HIV care retention, among YBMSM. We conducted a randomized controlled trial (RCT) to explore the 6-Month intervention effect of the My Personal Health Guide mHealth app on HIV care continuum outcomes among YBMSM. We found that the app demonstrated an elevated but insignificant effect on self-reported HIV care retention after 6-months of follow-up. We believe My Personal Health Guide warrants further development to improve HIV care retention. In this sample, we observed a substantial proportion of research participants that were loss-to-follow-up (LTFU), so investigated factors associated with LTFU in an RCT among YBMSM. Loss-to-follow-up was associated with lower social support and YBMSM randomized to the attention control arm of the study, suggesting future behavioral interventions should consider whether the attention control is as engaging as the intervention. Additionally, determining the prevalence of lower self-perceived social support during RCT approach development might be considered to obtain accurate sample size estimates. Lastly, as the RCT began enrollment concurrent with the COVID-19 pandemic lockdowns, we conducted a qualitative analysis of barriers and facilitators of the HIV care experience among a convenience sample of YBMSM from the RCT. The most commonly reported barriers to HIV care retention were healthcare access factors, including administrative or technological issues, clinic hours, clinic location, and experiencing stigma in the clinic. Notably, positive interactions with provider and staff was commonly cited as a facilitator of HIV care retention, so future behavioral interventions might consider incorporating patient satisfaction with provider and staff interactions to improve care retention. Effective and tailored interventions that retain YBMSM and improve their retention in HIV care is particularly important due to the higher burden of HIV diagnoses within this group and the disparities they face in healthcare access, social determinants of health, and HIV-related stigma. While there have been improvements over time in national metrics for HIV care continuum outcomes, disparities still exist between priority populations, with YBMSM suffering a disproportionate burden of diagnoses, non-optimal adherence, and poor retention in care. Ultimately, these findings point to a multifaceted approach to improve retention in HIV care and RCTs among YBMSM. These data provide support for continued development of mHealth delivered HIV behavioral interventions, with enhanced efforts to recruit and retain a larger sample of YBMSM with engaging control arms, and leveraging positive interactions with providers to improve care retention in this vulnerable population."]},{"key":"dc:title","label":"Title","values":["Barriers to HIV Care and Randomized Controlled Trial Retention among Black Men Who Have Sex with Men"]}]}],"canonical_facts":{"dc:creator":["Kara Nitti (23291713)"],"dc:date":["2025-12-01T00:00:00Z"],"dc:description":["The HIV epidemic remains a significant global health challenge, including in the United States, where disparities in HIV care continuum outcomes persist between priority populations for Ending the HIV Epidemic (EHE) initiative. Among these priority populations, young Black men who have sex with men (YBMSM) have increased HIV acquisition and are more likely to experience challenges in being retained in HIV care. Despite advances in HIV prevention and treatment over the past five decades, YBMSM face intersecting social, economic, and structural barriers, including stigma, limited access to culturally competent care, and inadequate support services. These factors contribute to delayed HIV diagnosis, missed HIV care appointments, and poor adherence to antiretroviral therapy (ART). Young Black men are also often underrepresented in behavioral research and have higher rates of attrition, leading to gaps in tailored interventions that this population may benefit from to improve HIV care continuum outcomes. Addressing these disparities requires dismantling systemic inequalities to improve access to HIV prevention and treatment services, including tailored behavioral interventions. Mobile health (mHealth) interventions have emerged as promising tools to address disparities in HIV care continuum outcomes, including care retention, particularly among populations that experience multiple barriers to care, such as YBMSM. mHealth interventions provide innovative solutions to overcome logistical, social, and economic barriers that hinder traditional in-person behavioral interventions and healthcare engagement. For YBMSM, mHealth tools can offer discreet, convenient, and culturally competent support, which may facilitate improved HIV care continuum outcomes, such as ART adherence and HIV care retention. Previous research has shown that mHealth interventions can improve HIV self-management by offering personalized reminders, educational resources, and virtual peer support. Additionally, mHealth platforms are private, easily accessible, and may be relational, which can improve engagement with hard-to-reach populations. By expanding accessibility, mHealth interventions have the potential to improve health outcomes for YBMSM and reduce disparities that continue to contribute to the ongoing HIV epidemic. In the United States, we developed an mHealth app to improve HIV care continuum outcomes, including HIV care retention, among YBMSM. We conducted a randomized controlled trial (RCT) to explore the 6-Month intervention effect of the My Personal Health Guide mHealth app on HIV care continuum outcomes among YBMSM. We found that the app demonstrated an elevated but insignificant effect on self-reported HIV care retention after 6-months of follow-up. We believe My Personal Health Guide warrants further development to improve HIV care retention. In this sample, we observed a substantial proportion of research participants that were loss-to-follow-up (LTFU), so investigated factors associated with LTFU in an RCT among YBMSM. Loss-to-follow-up was associated with lower social support and YBMSM randomized to the attention control arm of the study, suggesting future behavioral interventions should consider whether the attention control is as engaging as the intervention. Additionally, determining the prevalence of lower self-perceived social support during RCT approach development might be considered to obtain accurate sample size estimates. Lastly, as the RCT began enrollment concurrent with the COVID-19 pandemic lockdowns, we conducted a qualitative analysis of barriers and facilitators of the HIV care experience among a convenience sample of YBMSM from the RCT. The most commonly reported barriers to HIV care retention were healthcare access factors, including administrative or technological issues, clinic hours, clinic location, and experiencing stigma in the clinic. Notably, positive interactions with provider and staff was commonly cited as a facilitator of HIV care retention, so future behavioral interventions might consider incorporating patient satisfaction with provider and staff interactions to improve care retention. Effective and tailored interventions that retain YBMSM and improve their retention in HIV care is particularly important due to the higher burden of HIV diagnoses within this group and the disparities they face in healthcare access, social determinants of health, and HIV-related stigma. While there have been improvements over time in national metrics for HIV care continuum outcomes, disparities still exist between priority populations, with YBMSM suffering a disproportionate burden of diagnoses, non-optimal adherence, and poor retention in care. Ultimately, these findings point to a multifaceted approach to improve retention in HIV care and RCTs among YBMSM. These data provide support for continued development of mHealth delivered HIV behavioral interventions, with enhanced efforts to recruit and retain a larger sample of YBMSM with engaging control arms, and leveraging positive interactions with providers to improve care retention in this vulnerable population."],"dc:identifier":["10.25417/uic.31451473.v1"],"dc:relation":["https://figshare.com/articles/thesis/Barriers_to_HIV_Care_and_Randomized_Controlled_Trial_Retention_among_Black_Men_Who_Have_Sex_with_Men/31451473"],"dc:rights":["In Copyright"],"dc:subject":["Young Black men who have sex with men"],"dc:title":["Barriers to HIV Care and Randomized Controlled Trial Retention among Black Men Who Have Sex with Men"],"dc:type":["Text","Thesis"]},"updated_at":"2026-07-27T21:34:28Z"}