Our team comprised of academic and health systems leaders at Northwestern and HBH proposes to lead a mixed-methods project to rapidly develop and pilot a health systems intervention leveraging intersectional stigma PROs to improve HIV patient experience and viral suppression among racially/ethnically diverse SMM engaged in HIV care at HBH through the following

Specific Aims. 

Aim 1: Measure associations between intersectional stigma, patient experience, and viral suppression among 300 racially/ethnically diverse SMM; use MAIHDA to test if these associations vary by intersecting identities.

Sub-Aim1a: Conduct qualitative interviews with HBH PWH to identify if Aim 1 measures accurately capture experiences of intersectional HIV stigma in healthcare for diverse gay and bisexual men, respectively

.Aim 2: Iteratively develop and pilot a health systems intervention to train HIV clinicians how to interpret and use Aim 1 PRO findings to provide affirming HIV care to diverse MSMW, MSMO, gay, and bisexual men. 

Sub-Aim2a: Conduct qualitative interviews with HIV clinicians and EMR staff to identify how to interpret Aim 1 findings and to determine how providers can apply these findings to provide affirming care.

Sub-Aim2b: Select the final PRO(s), create and host intervention training, and pilot the intervention.This proposal will result in the creation of a novel intersectional stigma PRO intervention designed to improve HIV outcomes by training providers to interpret PRO data and provide affirming care to racially/ethnically diverse MSMW, MSMO, gay and bisexual men. It will also prepare our team to apply for a R01 to scale up and integrate the intervention into HBH’s clinical care operations system-wide – a proposition for which we have HBH leadership support. These studies will provide proof of concept of the effectiveness of the intervention to improve patient experience and viral suppression for multiply marginalized SMM and to reduce HIV disparities between gay vs. bisexual and MSMW vs. MSMO - goals that align with OAR’s highest HIV research priorities.