Social Capital and Engagement in Care Among Young Black Men Who Have Sex With Men Living With HIV
Phase: NA
Conditions: HIV Infections
Sponsor: Emory University

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University 
 
1
 
 
 
 
 
 
 
 
Social Capital and Engagement in Care Among Young Black Men who have Sex with Men 
Living with HIV 
NCT03664817 
Date: 08/29/2019 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University 
 
2
 
 
 
 
 
Social Capital and Engagement in Care Among Young Black Men who have Sex with Men 
Living with HIV 
Funding Mechanism: PS16-001 Minority AIDS Research Initiative 
Grant Number 1U01PS005112 
 
Funding Agency: 
U.S. Centers for Disease Control and Prevention 
National Center for HIV, STD and TB Prevention 
Division of HIV/AIDS Prevetion Surveillance and Epidemiology 
 
Conducted at: 
Rollins School of Public Health 
Emory University 
1518 Clifton Rd NE 
Hubert Department of Global Health 
 
PRINCIPAL INVESTIGATOR 
Sophia Hussen, M.D., M.P.H. 
Assistant Professor of Public Health and Medicine 
 
MENTORS/ CO-INVESTIGATORS: 
Andres Camacho-Gonzalez, MD, MSc 
Assistant Professor of Pediatrics 
 
Carlos del Rio, MD 
Professor of Public Health and Medicine 
 
KEY COLLABORATOR: 
Gary W. Harper PhD, MPH 
Professor of Public Health (University of Michigan) 
 
PROJECT COORDINATOR 
Marxavian Jones, MPA 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University 
 
3
 
 
TABLE OF CONTENTS 
Listof Abbreviations and Acronyms……………………………………………..……………..4 
Project       Overview…………………………………………………………………..……………..5 
Research Team and Collaborators……………………………………………………………...6 
Introduction………………………………………………………………………………..……..7 
Literature       Review……………………………………..…………………….……..…….7 
Justification for Study………………………………..………………………………….9 
Intended/Potential Use of Findings……………………………………………………10 
Study       Design/Location………………...………..……………………....……………...10 
Study       Objectives………………………...…………………………….......……………10 
Procedures/methods…………………………………………………………………………….11 
Design…………………………………………………...………………………………11 
Procedures: Phase I……………………………………..……………………………..12 
Procedures: Phase II and III...…………………………..…………………………….15 
Audience and Stakeholder participation……………...………………………..…….18 
Description of risks to individual/group……………...………………………………18 
Description of benefits………………………………...……………………………….18 
Emergency Care………………………………………..…………………………..….18 
Study       Timeline…………………………………………...…………………………….19 
Study       Population………………………………………………………………………………..19 
Description and source of study population/catchment area…..…...………………19 
Inclusion and Exclusion Criteria………………………………….………………….19 
Justification for inclusion/exclusion criteria……………………..…………………..20 
Estimated number of participants………………………………..…………………..20 
Sampling, including sample size and statistical power…………..………………….20 
Enrollment…………………………………………………………..…………………20   Consent 
Process……………………………………………………..………………. ................. 21 
Tokens of Appreciation……………………………………………..………………. ... 23 
Variables/Intervention………………………………………………………………………….22 
Variables……………………………………………………………..………………..22 
Intervention Content………………………………………………..………………..24 
Outcomes……………………………………………………………..……………….24 
Training for study personnel………………………………………..……………….25 
Procedures for implementing informed consent…………………..…………….   25 
Plan for monitoring informed consent……………………………..……………….25 
Data Handling and Analysis…………………………………………………………………...25 
Data Analysis………………………………………………………..………………..25 
Data Collection……………………………………………………..………………...26 
Data Entry, Editing and Management……………………………..……………….27 
Provisions for protecting privacy/confidentiality……………...…..………………27 
Information management and analysis software……………...…..……………….28 
Quality control/assurance………………………………………......………………..28 
Bias in data collection, measurement and analysis………………..……………….28 
Intermediate reviews and analyses………………………………..………………..28 
Limitations………………………………………………………….………………..29 
Identifying, managing and reporting adverse events……………..……………….29 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University 
 
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Dissemination of Results…………………………………………….………………30 
References……………………………………………………………………………………….30 
Appendix………………………………………………………………………………………...34 B6 
Addendum……………………………………………………………………….34 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University 
 
5
 
 
LIST OF ABBREVIATIONS AND ACRONYMS 
 
ACASI: Audio computer assisted survey instrument 
AIDS: Acquired Immune Deficiency Syndrome 
ARV: Antiretroviral medications 
ART: Antiretroviral Therapy 
CBO: Community-Based Organization 
CDC: Centers for Disease Control and Prevention 
CFAR: Center for AIDS Research 
EMR: Electronic Medical Record 
HCW: Health Care Worker 
HIPAA: Health Insurance Portability and Accountability Act 
HIV: Human Immunodeficiency Virus 
IDI: In-depth Interview 
IDP: The Grady Infectious Disease Program 
IOM: Institute of Medicine 
LGBT: Lesbian, Gay, Bisexual and Transgendered 
MACARTI: Metropolitan Atlanta Community Adolescent Rapid Testing Initiative 
MARI: Minority AIDS Research Initiative 
MARTA: Metropolitan Atlanta Rail Transit Authority 
MSCS: Modified Social Capital Scale 
MSM: Men who have sex with Men 
REDCAP: Research Electronic Data Capture 
RCT: Randomized Controlled Trial 
YBMSM: Young Black Gay, Bisexual and Other Men who have Sex with Men 
YCAB: Youth Community Advisory Board 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University 
 
6
 
 
PROJECT OVERVIEW 
 
TITLE: Social Capital and Engagement in Care among Young Black Men who have Sex with 
Men Living with HIV 
 
PROTOCOL SUMMARY: Young black gay, bisexual and other men who have sex with men 
(YBMSM) have high rates of HIV acquisition and low rates of healthcare utilization. Innovative 
interventions are urgently needed to improve engagement in care in this population. We propose 
a study focused on understanding and augmenting social capital among YBMSM with the 
ultimate goal of positively impacting engagement in HIV care. There are three phases to this 
study. Phase I: A mixed methods exploration of social capital including qualitative interviews 
and analysis of previously collected survey data, leading to development of a social capital 
intervention. Phase II: A randomized controlled trial of groups of YBMSM implementing the 
social capital intervention versus groups of YBMSM receiving a general health promotion 
intervention (Health for Life; H4L).  Phase III: Follow up measurements of social capital and 
engagement in care with the HIV-positive YBMSM at 1 month, 4 month, and 10 month 
timepoints. We plan to enroll 180 total participants (120 in the randomized controlled trial and 
60 in preliminary interviews) over the four year study period. 
 
FUNDING MECHANISM/FEDERALWIDE ASSURANCE NUMBERS: 
This study is funded under the CDC Minority AIDS Research Initiative (MARI) cooperative 
agreement: 1U01 PS005112-01. 
Emory University Federalwide Assurance No.: 00005792 
 
 
CONFLICTS OF INTEREST: None 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University 
 
7
 
 
 
RESEARCH TEAM AND COLLABORATORS 
 
Name 
Degree (s)
Role on Project/Tasks
Institution
 
 
 
Sophia Hussen 
MD, MPH 
Principal Investigator 
-lead all aspects of study 
activities, data security, 
analyses and 
dissemination
Emory University 
Andres Camacho-Gonzalez 
MD, MSc 
Mentor/Co-Investigator 
-local senior mentor; 
provides scientific 
guidance and support
Emory University 
Carlos del Rio 
MD 
Mentor/Co-Investigator 
-local senior mentor
Emory University 
Gary Harper 
PhD, MPH 
Key Collaborator 
-community-based 
participatory research 
expertise
University of 
Michigan 
Marxavian Jones 
MPA 
Research 
Interviewer/Interventionist 
-study coordinator, 
recruiter, group facilitator, 
-manage day-to-day 
aspects of research 
activities
Emory University 
Jasper Hood 
BA 
Recruiter, Research 
Interviewer
Emory University 
Shamia Moore 
MPH 
Research Interviewer 
-process evaluation
Emory University 
Madeline Sutton 
MD, MPH 
Scientific Mentor 
-CDC support and 
mentorship
Centers for Disease 
Control and 
Prevention
Ashley Murray 
MPH 
Project Officer 
-CDC support and 
guidance
Centers for Disease 
Control and 
Prevention
 
Ms. Ashley Murray is the CDC project officer and will be providing technical support only. She 
will not directly engage with study participants, nor have access to identifiable data. Therefore, 
CDC is considered not engaged in this study. 
 
Dr. Madeline Sutton is the CDC scientific mentor and will be providing technical support only. 
She will not directly engage with study participants, nor have access to identifiable data. 
Therefore, CDC is considered not engaged in this study. 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
v 6.21.18 
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PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
8 | P a g e
 
 
1.1 INTRODUCTION 
 
1.2 Literature Review 
 
1.2.2 Epidemiology of HIV among young Black men who have sex with men: Young Black gay, 
bisexual and other men who have sex with men (YBMSM) are being diagnosed with HIV at 
increasing rates, more than any other demographic or risk group category in the United States.1 
Between 2006 and 2009, HIV incidence among YBMSM increased by 48%, which was the largest 
increase seen in any population subgroup.1 Effective interventions to improve HIV treatment and 
prevention among YBMSM are urgently needed.2 The “Test and Treat” approach, which promotes 
rapid initiation of antiretroviral medications (ARVs) soon after diagnosis, is now accepted as the 
standard of clinical care; and “Treatment as Prevention” is similarly gaining traction in the field of 
HIV prevention, as population-based studies clearly demonstrate a decrease in HIV transmission 
with widespread uptake and utilization of ARV use.3,4 However, these proven strategies can only 
be effective in the context of optimized engagement in medical care. Given that YBMSM make up 
an increasing proportion of HIV-positive patients entering care, it is critically important to 
characterize and understand influences on engagement within this specific population. 
 
1.2.3 Continuum of Engagement in HIV Care: Engagement in HIV care has been conceptualized 
as a continuum with the following stages: (1) HIV diagnosis, (2) Linkage to care, (3) Retention in 
care, (4) Initiation on, and adherence to, ARV therapy, and (5) Virologic suppression.5 Population- 
based studies have yielded sobering statistics about the degree to which HIV-positive individuals  
in the United States are engaged in care, among whom only 19-28% are estimated to have achieved 
virologic suppression.5-7 Optimizing engagement in care at each stage of the continuum is               
a critical national priority, as engagement in care decreases individual morbidity and mortality, and 
dramatically reduces the risk of HIV transmission to others.8 
 
1.2.4 YBMSM are at risk for suboptimal engagement at multiple stages along the continuum, 
including virologic suppression, adherence, and retention: Adolescents, including YBMSM, are 
less likely to achieve and maintain virologic suppression compared to the adult population.9-12 
Unpublished data from the Grady Infectious Disease Program clinic (IDP) showed that only 46% 
of adolescents aged 13-24 achieved viral suppression within a year of commencing ARV  
therapy,13 compared to the 72% for adults in the same clinic building.14 Virologic failure (VF) in 
the growing young patient population has enormous public health implications, including increased 
risk of HIV transmission, evolution and transmission of multi-drug resistant HIV                
strains,15 and an increase in AIDS-related morbidity and mortality. Poor adherence to ARVs is the 
strongest predictor of VF in horizontally/behaviorally-infected adolescents.12,16 Understanding and 
modifying factors that influence ARV adherence in this population is therefore of paramount 
importance. ARV adherence in HIV-infected adolescents is often sub-optimal, and there is a dearth 
of evidence-based interventions to address this problem. A multitude of factors are variably 
associated with adherence in adolescents, including contextual factors, developmental factors, co- 
morbidities, regimen factors and personal characteristics.17-26 Socio-contextual factors are 
repeatedly cited as important influences on adherence, but they are rarely studied or incorporated 
into interventions, in spite of repeated calls for approaches to adherence support that place equal 
focus on network-level factors.17,27,28 Even when youth are initially adherent, research also 
indicates that YBMSM may be difficult to retain in HIV care as youth and ethnic minorities face 
more challenges to accessing and staying in medical care in general.29 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
9 | P a g e
 
 
 
1.2.5 Social capital. We define social capital as “the sum of an individual’s resource-containing, 
reciprocal, and trustworthy social network connections.”16  The social network is the core 
element of social capital.30 Social capital is a multidimensional construct that includes structural, 
cognitive and functional features of social networks. Features such as the size and diversity of a 
person’s network, as well as the socioeconomic and other resources owned by contacts in that 
network, all have a bearing on the quality and quantity of social capital that can be derived 
therein.31,32 
 
Researchers have outlined several mechanisms through which social capital can affect health and 
behavior: through informational support, instrumental support, emotional support and collective 
efficacy (Figure 1).16 That is, through one’s social network connections (be it friends, family, 
workmates, casual acquaintances, etc.), an individual can obtain informational, instrumental and 
emotional support. Adequate network connections are needed to develop collective efficacy, which 
refers to community action for self-empowerment. A prior multi-site study in three sub-Saharan 
African nations highlighted social capital as a key mechanism underlying engagement in HIV 
care.33 The researchers found that due to the structure of many of those societies, HIV-positive 
individuals were able to draw on network connections for emotional support, transportation to the 
clinic, and reminders to take medication—all of which positively impacted HIV clinical outcomes. 
In Dr. Hussen’s own prior qualitative work in Ethiopia, similar patterns were found. Additionally, 
Hussen found that community participation enhanced HIV-positive individuals’ personal sense of 
well-being and motivation to adhere to care.34 
 
Importantly, scholars in the field have also highlighted different types of social capital.35 Social 
capital can be further divided into bonding capital, which refers to trusting and cooperative 
relations between similar members of a network, and bridging capital, which consists of relations 
between people who differ in some sociodemographic sense (i.e. age, class, ethnicity, sexual 
identity). The majority of existing studies, however, have yet to differentiate between the effects 
of bonding and bridging capital on health. 
Figure 1. Mechanisms of Social Capital Effects on Health 
 
 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
10 | P a g e
 
 
 
 
 
 
In the domestic setting, social capital has been found to be protective against a range of adverse health 
outcomes in adolescents and young adults, including obesity, smoking, and teen pregnancy. There is 
evidence that the protective effects of social capital on health may be particularly pronounced in the life 
trajectories of urban minority youth.36,37 Social capital has not been studied among HIV-positive YBMSM 
to date. Factors such as poverty, lack of education, and racism shape individuals’ networks and could 
restrict the accumulation of social capital for marginalized youth such as HIV-positive YBMSM.36 At the 
same time, YBMSM often have strong informal support networks and robust community connections that 
may increase social capital and resiliency in the face of obstacles.38,39 YBMSM living with HIV 
therefore face many potential threats to their social capital,29,40 but may benefit more from 
interventions to augment it. 
 
1.2.6 Social Capital Interventions. Interventions designed to build social capital as a way of 
improving HIV-related outcomes (including both prevention and treatment) have utilized four 
main strategies, all of which inform the novel social capital intervention that we propose to 
develop here. These existing interventions can be described as community empowerment 
interventions, group-based microfinance interventions, support group interventions, and peer 
interventions focused on building social capital among group members.41 Empowerment 
interventions have included programs focused on sex workers in India and Latin America, and 
have shown association with reduced sexual risk behaviors.42,43 Group-based microfinance 
involves the awarding of a small grant to a group of individuals to facilitate public health message 
development for improved HIV care, which theoretically can lead to economic empowerment as 
well as bonds between group members.44 The efficacy of group based microfinance interventions 
has primarily been shown when this strategy is combined with other interventions such as health 
education programming, and to date, these programs have primarily been implemented and tested 
in sub-Saharan Africa.45 Support group interventions have been used worldwide and some of 
these aim to build social capital among group members as a way of improving psychological and 
clinical outcomes. Finally, peer interventions utilize members of high risk groups as leaders and 
educators.46,47 
 
While the above strategies have been developed and tested in other settings, there is a dearth of 
social capital-based interventions with a focus on YBMSM in the United States. We are therefore 
proposing to empower HIV-positive YBMSM to develop an intervention that will combine all 
of the above elements into a cohesive social capital intervention with and for HIV-positive 
YBMSM. As detailed later in the protocol, we will provide guidance through a YCAB for 
YBMSM to develop and test a group-based intervention for HIV-positive YBMSM centered on a 
group community action project. That is, each group of HIV-positive YBMSM will be given a 
micro-grant to develop programming that empowers participants and their communities, and also 
builds social capital within the group during the process (Figure 2). 
 
1.3 Justification for Study: While our preliminary research indicates that social capital is likely to be 
important for engagement in HIV care among YBMSM, this area is understudied at the time. 
Additionally, there is a critical need for novel strategies to improve engagement in this population, 
which will have implications for both clinical and public health outcomes. We are planning an in- 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
11 | P a g e
 
 
depth exploration of social capital in this population that will inform a novel intervention designed to 
augment social capital among YBMSM. 
 
 
Figure 2. Social Capital Interventions Informing Proposed Community Action Projects 
 
 
 
1.4 Intended/potential use of study findings: We hope to apply our findings towards the creation and 
refinement of an intervention for YBMSM living with HIV that can be disseminated and implemented 
in other settings in the future. 
1.5 Study Design/Location: The study design includes a cross-sectional mixed-methods study for the 
formative research, followed by a randomized controlled trial to pilot and test the intervention, as 
depicted in Figure 3. All study activities will take place in Atlanta, Georgia. 
 
1.5.1 Aims and Hypothesis 
 
Aim 1: To characterize the social networks of YBMSM living with HIV with respect to the 
multiple dimensions of social capital using a mixed-methods research design. 
 
Aim 2: To develop a social capital-based intervention to enhance engagement in care among HIV- 
positive YBMSM utilizing a participatory, youth-centered approach. 
 
Aim 3: Implement a randomized controlled trial with groups of HIV-positive YBMSM to develop 
and pilot our social capital interventions. 
Aim 3a: To assess participant satisfaction and feasibility of the intervention. 
Aim 3b: To test impact on social capital and HIV care engagement outcomes. 
 
 
2.0 
PROCEDURES/METHODS: Design  
Figure 3. Study Design* 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
12 | P a g e
 
 
 
*We envision each arm in Phase II will have six groups of approximately 10 participants, 
completing the same intervention or H4L curriculum. 
 
 
 
As depicted in Figure 3 above, there are three phases of our research, each corresponding to one of 
the study aims: Phase I: a mixed methods exploration of social capital and development of a 
social capital intervention; Phase II: a randomized controlled trial of the social capital 
intervention; and Phase III: 1-, 4-, and 10-month follow up for the RCT. For Phase I, we will 
recruit 30 HIV-positive YBMSM and explore the nature of their social capital and social networks 
using in-depth individual qualitative interviews (IDIs). We will also analyze previously collected 
survey data (from a pilot study of 80 YBMSM, conducted last year) to quantitatively understand 
relationships between social capital constructs and engagement in care. We will also engage 30 
key informants (healthcare providers and community-based organization (CBO) staff) in IDIs to 
gain their input about how best to augment social capital among YBMSM. We will use the 
information collected in the formative research, and together with a Youth Community Advisory 
Board (YCAB), we will develop an intervention to augment social capital among YBMSM. In 
Phase II, we will conduct an RCT with 120 YBMSM, split between 6 intervention groups and 6 
control groups. Groups in each arm will implement the same intervention (social capital 
intervention arm) or receive the same health education information (H4L). Justification for the 
number of groups is provided below. Finally, in Phase III, we will obtain follow-up data at 3 and 9 
months after study completion. 
 
2.1 Procedure: Phase I (Aim 1-Background work on social capital in YBMSM) 
 
Part 1a: In-depth Interviews with YBMSM (n=30) 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
13 | P a g e
 
 
Procedures-Interviews with YBMSM: All interviews will take place in a private and quiet room 
within the IDP clinic, the Rollins School of Public Health, or an alternate location that is mutually 
convenient. Interviews will be conducted by a graduate research assistant who is trained in 
qualitative methods and interviewing techniques. All interviews will be digitally recorded for 
subsequent professional transcription. Written informed consent will be obtained before beginning 
the interview. Interviews will be expected to last approximately 60-90 minutes each. 
Interview guide: We have developed a semi-structured interview guide based on the theoretical 
conceptualizations of social capital and resilience presented above (Appendix C). That is, we will 
ask questions to elicit participants’ experiences with the various dimensions of social capital 
including bonding capital, bridging capital, and collective efficacy. We will elicit participants’ 
perspectives on the types of support that they do or do not receive, and the sources of support in 
their lives—examples may include biological family, LGBT organizations, and church 
communities. We will also ask for examples of community involvement. Finally, we will ask for 
participants’ recommendations regarding potential strategies for improving social capital in their 
lives. 
Sample Size: We plan to interview 30 YBMSM in this portion of the study. Based on our prior 
experiences with qualitative research, we expect this to be a sufficient sample size to achieve 
thematic saturation. 
Qualitative Data Analysis: All interviews will be digitally recorded and transcribed verbatim by a 
professional business transcription service. Qualitative data will be de-identified during this 
transcription process. Transcripts will then be uploaded into the MaxQDa qualitative data 
management software (VERBI Software, Berlin, Germany) for further processing and analysis. 
We will conduct thematic analysis using a combination of inductive and deductive coding. In 
deductive coding, we will apply pre-determined codes from our theoretical model (e.g. collective 
efficacy) to segments of text that correspond to each theme. In inductive coding, we will elicit 
themes that emerge from the text but were not previously considered (for example, church 
community could come up as a recurring theme among several participants and be added to our 
code lists). Once the list of themes has been created, we will create a codebook listing the codes 
and strict definitions to delineate which passages should be labeled with a certain code. Two 
members of the study team will each code 5 transcripts in parallel to determine inter-coder 
reliability. If any significant disagreements arise in coding, the entire research team will discuss 
each discrepancy and come to a consensus in order to finalize the codebook. Two graduate 
research assistants (GRAs) will then split and code the remainder of the transcripts. This coding 
will facilitate further analysis of the transcripts by comparing cases and summarizing comments 
under each code across participants. 
Tokens of Appreciation: We will provide participants with two gift cards (value $75) as a token of 
appreciation for their time and will also provide Metropolitan Atlanta Rapid Transit Authority 
passes (MARTA cards; $5 fare for a single round-trip) if needed for transportation assistance. $25 
will be given on the first day and $50 will be given on the second day. 
Timeline and feasibility: Given our prior success in recruiting HIV-positive YBMSM for 
qualitative interview studies, we expect to be able to complete these interviews within the first 6 
months following project determination and we expect to complete qualitative analysis within 
months 6-12. 
 
Part 1b: Additional In-depth interviews with YBMSM (n=30) 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
14 | P a g e
 
 
In order to understand additional life experiences, desires, and intentions of YBMSM living with 
HIV, specifically surrounding forming families and parenting, in-depth interviews separate from 
the ones described in part 1a will be conducted as a sub-study. 
Procedures – Additional In-depth interviews with YBMSM: Participants for these interviews will  
be recruited from the database of those who have completed the screener form for the larger study 
and indicated that they would like to be contacted for other studies, or from those participants that 
have already participated in the intervention or control arms. Interviews will take place in a private 
and quiet area in the IDP clinic, at the Rollins School of Public Health, or in an alternative location 
that is convenient for both the participant and interviewer. These interviews will also be conducted 
by a graduate research assistant who is trained in qualitative methods and interviewing techniques. 
All interviews will be digitally recorded and subsequently transcribed by a graduate research 
assistant trained in transcription. Verbal informed consent will be obtained prior to the interview. 
Interviews may last approximately 45-60 minutes each. 
Interview guide: We have developed a semi-structured interview guide based on informal 
discussions Dr. Hussen has had with prior patients, as well as discussions had with healthcare 
providers specializing in fertility options and childbearing options for individuals living with HIV. 
Various themes that are a part of the larger study, including identity and community, are also 
incorporated into this interview guide in order to understand the intersections of HIV status, black 
and gay identities, communities, engagement in care, and the desire to form families and become a 
parent. 
Sample size: Similar to the in-depth interviews described in part 1a, we plan to conduct 30 
interviews for this portion of the study, with the expectation that this result in sufficient data to 
reach thematic saturation. 
Qualitative data analysis: The data analysis process for these interviews will be similar to the 
process that will be conducted for the interviews described in part 1a. All interviews will be 
digitally recorded and transcribed verbatim by a graduate student assistant trained in transcription. 
During transcription, the interviews will be de-identified and subsequently uploaded into MaxQDa 
qualitative data management software. Inductive reasoning will be used to develop a list of themes 
that are representative of the themes that arise in the interviews as the transcripts are reviewed. 
After the creation of a list of themes, we will create a codebook containing codes that reflect the 
themes and are defined clearly, so that these codes can be used to label passages of interview 
transcripts. Similar to the process of coding the in-depth interviews described in part 1a, two 
members of the study team will each code 5 transcripts in parallel to determine inter-coder 
reliability. In the event of disagreements, the research team will discuss the discrepancies to arrive 
at a consensus for the finalized codebook. One graduate research assistant will then code the 
remaining transcripts. Transcripts will be further analyzed through comparison. 
Tokens of appreciation: Participants will be provided with a $25 gift card as a token of 
appreciation for their time. Metropolitan Atlanta Rapid Transit Authority passes (MARTA cards; 
$5 fare for a single round-trip) will also be provided if needed for transportation assistance.  
Timeline and feasibility: Interviews are expected to be completed within the first 4 months from 
the start of the sub-study (approximately September 2019), given our prior success in recruiting 
HIV-positive YBMSM. Analysis is expected to be completed approximately 4 months following 
data collection. 
 
Part 1c: Quantitative analysis of previously collected social capital and engagement data (n=80) 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
15 | P a g e
 
 
In order to understand which components of social capital are most important for YBMSM and 
engagement in care, we will draw on quantitative data that is currently being collected with 
YBMSM in our clinic. Dr. Hussen successfully competed for a developmental grant from the 
Emory Center for AIDS Research (CFAR), in which she is beginning to explore social capital 
among YBMSM at the IDP clinic. The study has a cross-sectional design and participants’ 
involvement involves a single study visit in which they complete an ACASI including our 
modified social capital scale (MSCS). We also obtained the participants’ permission and 
abstracted data for each patient with respect to appointment adherence, and viral suppression. We 
can therefore measure associations between engagement outcomes and various dimensions of our 
social capital measure. 
Measure: There is no existing published scale for social capital which has been validated in a 
United States youth population or in YBMSM more specifically. However, as mentioned above, 
we have recently modified, pilot tested, and validated Chen’s Social Capital Scale to create the 
MSCS) that we will use in this study. Although Chen’s original scale addressed conceptual 
domains of interest (bonding social capital, bridging social capital, and collective efficacy), it was 
developed for use among adults in China and therefore contained items that we not culturally 
relevant to YBMSM. Our MSCS had excellent reliability in an online sample of YBMSM (α=0.88; 
data not yet published). The scale contains subscales for bonding and bridging capital, and             
it also contains items that specify sources (including family, friends, and LGBT organizations) and 
types of support (e.g. emotional support, instrumental support and informational support). We can 
therefore determine which components of individuals’ networks are most related to care 
engagement outcomes using our cross-sectional data. 
Sample Size: 80 HIV-positive YBMSM in care at the Grady IDP clinic 
Data Analysis: An odds ratio plus the 95% confidence interval will be calculated to measure the 
degree of association between retention in care measures and total social capital (all analyses will 
also be computed for bonding/bridging subscales alone, as well as for item clusters focusing on 
different dimensions of social capital). Odds ratios will also be calculated to measure the degree of 
association between other risk factors (education, employment, age, depression, substance use, 
HIV stigma and CD4 cell count) and patient retention. Additionally, total social capital will be 
compared between engaged and non-engaged patients using a two-sided two-sample t-test. Other 
potential risk factors will be compared between retained and non-retained patients using a chi- 
square test or Fisher’s exact test for categorical covariates and a two-sided two sample t-test for 
continuous covariates. 
Multivariable analyses: Covariates significant to at least P ≤ 0.20 in the univariable analyses will 
be used in multivariable logistic regression analyses. Although empirical techniques will be used 
to identify important covariates, theoretical expectations from our social capital conceptual 
framework will also augment these decisions. Interactions between covariates will be evaluated, 
either because suspicions are raised by clinical judgment before the analyses are performed or by 
statistical examination. Forward stepwise selection will be used if necessary to choose prognostic 
variables for a multivariable logistic regression model. The odds ratio and its 95%confidence 
interval will be calculated for each risk factor in the presence of others in the final model. 
Timeline and feasibility: Given that this data will already be collected, when the MARI award 
period begins, and utilizing the statistical support that we have included in our budget, we expect 
to be able to complete this statistical analysis within the first 6 months of the project period. 
 
Part 1d: Key Informant Interviews 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
16 | P a g e
 
 
To answer this question, we will conduct IDIs with up to 30 key informants who have experience 
and interest in working with YBMSM living with HIV. Key informants may include healthcare 
workers (HCWs) and representatives of community-based organizations (CBOs) who work with 
YBMSM. 
Procedures-Interviews with Key Informants: Procedures will be similar to the YBMSM interviews 
described above, except that interviews may take place at a key informant’s place of work (e.g. a 
CBO) or a mutually agreed upon location in the community. As the interview is likely less 
sensitive in nature for a key informants talking about their work as opposed to YBMSM reporting 
on their own lives, interviews with key informants can be more flexible in terms of public 
locations. 
Interview guide: We have developed a semi-structured interview guide to focus instead on the key 
informants’ work experiences with YBMSM and their observations of social capital in this 
population (Appendix D). We will still address the various theoretical dimensions of social capital 
including bonding capital, bridging capital, and collective efficacy as well as detailing types of 
support that key informants feel are present or missing among their clients (informational support, 
instrumental support, emotional support). We will ask for key informants’ recommendations 
regarding potential strategies for improving social capital in the lives of YBMSM. 
Sample Size: We plan to interview up to n=30 key informants. Based on our prior experiences 
with qualitative work, we expect this to be a sufficient sample size to achieve thematic saturation.  
Qualitative Data Analysis: As described in 1a: In-depth interviews with YBMSM.. 
Timeline and feasibility: This analysis will overlap with the qualitative analysis of YBMSM 
interviews described above. Given our established network of community contacts and familiarity 
with clinical providers, we expect to be able to complete these interviews within the first 6 months 
of the award period, and to complete qualitative analysis within months 6-12. 
 
2.2 Procedure: Phase II (Aim 2- Intervention Development) 
Creation of the Youth Community Advisory Board (YCAB) (N=9): Interventions that include 
stakeholders (in this case, YBMSM) in their development have the potential for increasing 
feasibility, acceptability and sustainability. Our YCAB will be made up of HIV-positive (by self- 
report) YBMSM who are willing to serve in an advisory capacity over the course of the project. 
We will form the YCAB, with nine individuals, within the first year of the Minority HIV/AIDS 
Research Initiative (MARI) award period to inform all subsequent phases of the research. We will 
aim to recruit a YCAB that is diverse in terms of socioeconomic status, educational attainment, 
and extracurricular interests. Of note, given their intricate involvement in intervention 
development, members of the YCAB will be excluded from participation in the randomized control 
trial (Phase II). 
 
Time Commitment: Once membership is solidified, the YCAB will meet approximately every two 
weeks throughout the award period. We expect meetings to last between 2-3 hours on average, and 
they will be scheduled at mutually convenient times for the participants. YCAB members will be 
hired as temporary employees at Emory University and will be compensated for their time at a rate 
of $12.50/hr. 
Development of Social Capital Intervention: The development of our social capital-based 
intervention guidelines will require integrating scientific literature, preliminary data (both 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
17 | P a g e
 
 
qualitative and quantitative), and the perspectives of YBMSM, members of the YCAB, and other 
community and clinic-based stakeholders. 
The development of the social capital intervention will continue throughout the first 18 months of 
the award period. Intervention development will be a continuous and iterative process during this 
timeframe and will involve Dr. Hussen, her mentors and collaborators, the study team and the 
YCAB. We will present qualitative and quantitative data from Phase I formative research to the 
YCAB as it is collected and analyzed as a way of “member checking” our results. We will also 
solicit ideas for the social capital intervention, discussing ideas in an iterative process until we 
have completed development of the intervention. Finally, we will have the YCAB test out a mock 
intervention with our team, and give us feedback on what works or does not work well in our 
curriculum. We will present the intervention to the YCAB as many times as needed in an iterative 
fashion until the study team and YCAB are satisfied with the final product. Our YCAB will give  
us input on every aspect of the intervention, including timing, location, content, and process 
Before we are ready to share the intervention as part of our RCT, we will standardize the 
intervention in a standard operating manual which will also be reviewed by the YCAB. 
 
The social capital intervention will be a group-level, multi-session program that entails a 
structured curriculum and process culminating in a community photovoice project. The specifics  
of the community photovoice project are yet to be determined, and will be decided on with the 
YCAB as a part of the formative work. The curriculum will also include components focused on 
training in advocacy, HIV knowledge, and project planning. 
 
 
2.3 Procedure: Phase II and III (Aim 3- Randomized Controlled Trial) (n=120) 
Randomized Controlled Trial Overview: We propose a prospective RCT in which groups of 
YBMSM will implement a novel intervention with the goal of enhancing social capital and 
engagement in care among YBMSM living with HIV. Sixty of our participants will be randomized 
to the treatment arm (divided into at least 6 groups) and participate in the social capital 
intervention, while the other 60 will be randomized to a group-based health promotion intervention 
(divided into at least 6 groups) that does not explicitly aim to build social capital (Health             
for life, or “H4L”). (See Figure 3) Each of the 6 groups in the treatment arm will              
implement the same intervention. Six groups are necessary in order to ensure that each group has 
no more than 10 individuals, ensuring that groups are neither too small nor too big. Each of the 6 
groups in the group-based health promotion intervention arm will also complete the same 
curriculum. We will measure social capital using our Modified Social Capital Scale (MSCS; 
Appendix F, Section 2) at baseline, immediately after completing the intervention (approximately  
1 month) and at 4 and 10 months after beginning the intervention. We will also abstract clinical 
data from electronic medical records at these time points in order to quantify any effect on our  
care engagement outcomes. 
 
Overview--Intervention Arm: The social capital intervention will be implemented according to the 
detailed guidelines and manual developed in Phase I above. We will plan for our intervention (and 
our control condition) to be delivered in either a one day or consecutive two day group meeting at 
Emory University Rollins School of Public Health or another agreed upon location, at mutually 
convenient times for the participants. Staff members will be flexible in case evening or weekend 
meeting times are more convenient for the study participants. The exact number of sessions and 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
18 | P a g e
 
 
format of the intervention may be modified based on YCAB input; it may be that the intervention 
can be delivered in fewer sessions, or in a retreat format, to enhance acceptability and retention. 
 
Community Photovoice Project: Our social capital intervention will focus on developing skills 
and group-work that culminate in participant-derived photovoice projects. This is based on our 
own and others’ prior qualitative work that demonstrates HIV-positive YBMSM’s interest in HIV 
education, peer mentoring, and community involvement.48,49 We envision having six sets of 
intervention and control groups with 10 YBMSM in each group (Figure 3). Each group of 
YBMSM will be encouraged to complete a 30 day photovoice challenge. The 30 day challenge is 
based on a prior community action project done as a part of our CFAR-funded research, which  
was a Photovoice project conducted by Dr. Hussen and an MPH student.50 Photovoice is a 
participatory action research methodology in which groups of individuals from a population of 
interest are given cameras to document events, people and places of significance in their lives.51 In 
that project, n=7 YBMSM were recruited from AID Atlanta (one of our CBO partners) and given 
digital cameras with which to document and describe events, people and places of significance in 
their lives. Their pictures and the ensuing discussions gave us insight into community and identity 
within the population. Costs included digital cameras, compensation for transportation to meetings, 
and printing of photos for display in a booklet and a community exhibit. 
 
As we saw preliminarily with our Photovoice experience, we expect that the process of working 
together with other YBMSM and engaging the community will enhance the social capital of 
individuals in the intervention arm by creating bonds that will lead to the aforementioned health- 
promoting mechanisms: informational support, emotional support, instrumental support and 
collective efficacy (Figure 2). 
 
Again, the exact nature of the 30 day challenge and the intervention will be determined in 
conjunction with the YCAB over the course of Phase I intervention development. (The control 
groups will not participate in the 30 day challenge). The process of working on the 30 day 
challenge as part of the proposed social capital intervention has the potential to increase bonding 
social capital through the group’s interactions with one another, as well as bridging social capital 
through meaningful connections with community partners and study staff. Finally, the act of 
creating and executing a community-oriented project will also increase participants’ sense of  
collective efficacy (as measured by items in the MSCS), another important component of social 
capital. 
 
 
Overview--Control arm: The control arm will participate in a health education intervention that 
will be delivered in a group, but without a specific goal of creating group cohesion or social 
capital. The intervention will be a modified version of “Health for Life” or H4L, which was used 
as a control arm intervention in a recently completed protocol of the Adolescent Trials Network 
which was co-chaired by Dr. Harper (University of Michigan). This intervention was specifically 
developed for young MSM of color and focuses on general health topics including diet, exercise, 
and safe sex. Details about the Health for Life program are included as Appendix G. We will 
modify the H4L intervention as needed based on the input of our YCAB. Similar to the 
intervention arm, the control participants will participate in either a one day or a consecutive two 
day group meeting at a convenient time and location. The exact number of sessions and format of 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
19 | P a g e
 
 
the intervention may be modified based in YCAB input; as with the intervention arm--it may be 
that the intervention can be delivered in fewer sessions, or in a retreat format, to enhance 
acceptability and retention. The same format and number of sessions will be used for both the 
intervention and control arms. 
 
Procedures for intervention and control participants: 
Tokens of appreciation: We will provide participants with two gift cards (value $75) as a token of 
appreciation for their time and will also provide Metropolitan Atlanta Rapid Transit Authority 
passes (MARTA cards; $5 fare for a single round-trip) if needed for transportation assistance. $25 
will be given on the first day and $50 will be given on the second day 
Retention Plan: Our previous experiences have demonstrated the need to pay careful attention to 
participant retention: part of the role of the study staff is to remind participants about intervention 
sessions and study visits, scheduling, and discussing any issues they face in the trial procedures. In 
Dr. Camacho-Gonzalez’s ongoing work with the Metropolitan Atlanta Community Adolescent 
Rapid Testing Initiative (MACARTI) trial, these procedures have resulted in at least an 87% 
retention among participants who were primarily HIV-positive YBMSM (and may be higher as  
the follow-up period has not yet ended). 
Clinical Outcome Measures: Viral load values and appointment attendance will be extracted from 
the participants’ electronic medical records (EMR). The goal is to abstract measures that 
correspond to the 0 month (baseline)and 10 month (long term follow-up) time points at which 
participants will be completing surveys. However, we recognize that lab tests (CD4, VL) in the 
clinical setting may not necessarily be conducted at a time that corresponds to the survey time 
point. In light of this limitation, and to make the procedures more uniform, we plan the following: 
(1) the baseline viral load will be the most recent measurement preceding study participation. If 
this is >6 months prior to the date of enrollment, this will be considered a missing value. (2) The 
10 month viral load will be the first value drawn on or after the date that is exactly one year from 
the beginning of study participation. If this test is done >6 months after the target date, it will be 
treated as a missing value. 
Study visits: In addition to attending the intervention sessions, participants in both arms will be 
asked to come to the IDP clinic or Rollins School of Public Health to participate in three study 
visits: One at baseline before starting the intervention (0 months), immediately after completing 
the intervention (around 1 month), 4 months and a long term follow-up at 10 months after study 
completion. The main purpose of these visits will be to complete a survey to measure any change 
in social capital between the pre- and post-intervention periods. The survey (Appendix F) will also 
include measures of other theoretically relevant constructs including depressive symptomatology, 
stigma, and social support. We will also verify the participants’ most recent medical care facility 
and obtain medical record release forms to facilitate abstraction of data on engagement outcomes. 
Participants will receive tokens of appreciation for each completed study visit ($25 for the first 
visit and $50 for the second) and given MARTA cards at these visits. 
Follow-up qualitative interviews: We will conduct n=30 qualitative in-depth interviews in Year 4 
with a subset of interested participants who were enrolled in the social capital intervention arm, in 
order to understand their experiences in the program and solicit feedback for future implementation 
of the intervention. Procedures and analytic plans will be as described in the Phase                          
1 interviews above. Participants will sign a separate informed consent to participate, and will 
receive an additional $25 token of appreciation for their time if they choose to do so. The 
maximum total amount for tokens of appreciation for participants who do all sessions is $175. 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
20 | P a g e
 
 
 
2.4 Audience and stakeholder participation: Our study follows a community-based participatory 
approach designed to ensure stakeholder participation. First, we will conduct interviews             
with community stakeholders to inform our understanding of social capital in our target population. 
Second, we will create a youth community advisory board (YCAB) designed                   
specifically to engage members of the community at each step of the process. Finally, at the end of 
the project, we will plan to disseminate findings not only in academic publications but also in a 
community forum. 
 
2.5 Description of risks (physical, social, psychological, economic, other) to individual or 
group: Risks to participants from a physical standpoint are minimal, as there are no medical 
procedures being conducted in this study. There are risks from a social and/or psychological 
standpoint, primarily related to the potential for a breach of privacy which could lead to inadvertent 
disclosure of HIV status or sexuality. One source of such a breach could be study                 
records; we will take the necessary precautions to prevent this including password protection of all 
participant records and de-identification of datasets before analysis. A second source of such a 
breach is other participants, as the activities include involvement in a group project with other 
HIV-positive individuals. We will make sure to explicitly discuss privacy concerns and instruct 
participants not to disclose others’ participation and/or HIV status; however this will be impossible 
for us to enforce. We will ensure that participants are aware of this potential risk in the informed 
consent process. 
 
2.6 Description of anticipated benefits to the research participant: If our intervention is 
effective, it will provide direct benefits to the participants in terms of improved social support, 
social capital and HIV related outcomes. Those in the control arm should also receive the benefits 
of a health education intervention that will improve their knowledge about HIV and other health 
issues. 
 
2.7 Emergency care: Given the non-invasive nature of this study, it is not expected that 
involvement in either the control or treatment arm would lead to any physical or psychiatric 
emergencies. However, were an emergency to occur during the course of involvement, study staff 
would be instructed to contact the PI immediately via cell phone or pager. Dr. Hussen would then 
direct the participant to either the ER (including Grady Psychiatric Emergency Services if 
applicable) or their primary medical provider, and she would also record the adverse event for 
immediate reporting to the Emory IRB (Adverse Event form in Appendix H). 
 
 
2.8 Study time line: 
 
 
Activity 
Pre- 
Award
Year 1
Year 2 
Year 3 
Year 4
Research Activities 
 
 
 
 
 
Team consolidation, hiring new staff, planning
Development of project guidelines/SOPs 
 
 
  
 
IRB review: Emory, Grady 
 
 
  
 
IRB review/project determination review: CDC
 
 
  
 
Qualitative interview guide development 
 
 
  
 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
21 | P a g e
 
 
Aim 1: IDIs with YBMSM 
 
 
  
 
Aim 1: IDIs with CBOs, providers 
 
 
  
 
Aim 1: Qualitative analysis 
 
 
  
 
Aim 1: Statistical analysis of survey data 
 
 
  
 
Aim 2: YCAB formation 
 
 
  
 
Aim 2: Intervention development 
 
 
  
 
Aim 3: Enrollment and follow-up of control arm
 
 
  
 
Aim 3: Enrollment and follow-up of intervention arm
 
 
  
 
Aim 3: Data analysis from pilot intervention/follow up
 
 
  
 
New R01 application 
 
 
  
 
3.1 STUDY POPULATION 
3.2 Description and source of study populaton and catchment area: We will recruit HIV- 
positive YBMSM from clinical, research and community settings. Flyers will be posted for self 
referral in the Grady IDP clinic, community-based organizations, and other venues (e.g. coffee 
shops) as directed by our YCAB (Example in Appendix H: final version will be created with 
YCAB input). Additionally, participants may be referred from other studies. Participants will be 
residents of the greater Atlanta area—with no strict boundaries provided they are able to get back 
and forth from their homes to the intervention sites in Midtown Atlanta. 
3.3 Inclusion and Exclusion criteria: 
3.2.1 Inclusion Criteria (participants): 
 Age < 29 years and > 18 years 
 Self-identify as Black/African-American (inclusive of multiracial identities) 
 Male sex at birth 
 Endorse history of sex with men ever (inclusive of gay and bisexual men) 
 HIV-positive (self-reported by participant and confirmed by medical record) 
 Able and willing to provide written consent and participate in surveys, interviews, 
and/or group intervention 
 
3.2.2 Inclusion Criteria (key informants): 
 Experience working with YBMSM in clinical or CBO settings 
 Able and willing to provide verbal consent and participate in in-depth interviews 
 
3.2.3 Exclusion Criteria 
 Age < 18 years or > 30 years 
 Unwilling or unable to provide written informed consent 
 Enrollment in one phase of the study is an exclusion criteria for enrollment in other 
phases 
3.3 Justification for inclusion/exclusion criteria: We are focusing exclusively on YBMSM in 
this study due to the disproportionate impact of HIV in this population, as detailed in the 
literature review above. We are aiming to develop an intervention that is culturally and 
developmentally appropriate, and as such are limiting our enrollment to this target population. 
 
3.4 Estimated number of participants: We plan to enroll 180 total participants (120 in the 
randomized controlled trial and 60 in preliminary interviews. 
 
3.5 Sampling, including sample size and statistical power: 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
22 | P a g e
 
 
Based on our MSCS scale characteristics in our previous online survey study (mean 26.6, standard 
deviation 7.0), we can estimate that a sample size of n=106 (n=53 in each of the intervention and 
control groups) would allow us to detect approximately a 15% increase in social capital 
attributable to our intervention (using 80% statistical power). For the RCT, we will therefore aim 
to recruit n=120 patients (accounting for some attrition): based on our team’s previous work in the 
same geographic area, we believe this to be a feasible number of YBMSM to recruit during the 
specified time period from our IDP clinic and community partners. 
 
Table 1. Power calculation 
Control 
Patients 
Intervention 
Patients 
Control SC 
Mean
Intervention SC 
Mean
Detectable 
Effect Size 
Detectable Percent 
Increase in SC
31 
31 
26.6
31.9
0.75 
20%
39 
39 
26.6
31.3
0.67 
17.5%
50 
50 
26.6
30.7
0.58 
15.4%
53 
53 
26.6
30.6
0.57 
15%
77 
77 
26.6
29.9
0.47 
12.5%
114 
114 
26.6
29.3
0.38 
10%
 
 
3.6 Enrollment 
 
Phase I IDIs with YBMSM: We will recruit young men from the IDP clinic as well as from 
our CBO partners AID Atlanta, NAESM and Positive Impact. Recruitment will also include 
self-referral from email and social media announcements as well as posted flyers at 
community locations and within the clinic. Flyers and announcements will contain a link to 
an online screening survey as well as a telephone number to contact study staff. Interested 
individuals will be screened for eligibility criteria via phone or online survey (must be 
HIV-positive, biologically male, endorse sexual contact with men, and between the ages of 
18 and 29). If eligible, study staff will then contact the participant to schedule an interview. 
 
Phase I IDIs with Key Informants: We will directly contact clinic providers and CBO 
employees who we already know to be involved in work with YBMSM and offer 
participation in our study. We will also ask YBMSM in the initial qualitative interviews to 
nominate individuals from the community who they think could provide useful information. 
Finally, we will send email announcements to all of the IDP clinic and staff as                
well as listservs of the CBO partners, so that any additional interested individuals can self- 
refer into the study. 
 
Phase II YCAB formation: Recruitment: Although YCAB members are not research 
participants, they will also be recruited as a part of the study. We will recruit YCAB 
members from a wide range of sources with the goal of retaining a diverse group of 
committed youth to advise us on our intervention development. Sources will include 
CBOs, our clinic site, and email advertisements to community listservs. As mentioned 
earlier, we will also specifically ask for recommendations from our key informants in the 
CBOs and healthcare settings. Eligible youth will be YBMSM ages 18-29 who are living 
with HIV, and we will attempt to have representation throughout this age range. We will 
choose 9 members for the YCAB based on diversity of age, experience, education, and 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
23 | P a g e
 
 
general interests. At the latest, we hope to complete this process by month 6 of the award 
period. 
 
Phase III Randomized Controlled Trial: Recruitment: We will recruit YBMSM from the 
IDP clinic as well as from our CBO partners AID Atlanta, NAESM and Positive Impact. 
Community recruitment will occur via self-referral from email and social media 
announcements as well as posted flyers at community locations and within the clinic. 
When interested individuals contact the study team, they will be screened for eligibility 
criteria via phone or online survey. Of note, participants do not need to be patients at the 
IDP clinic; as long as they consent to release of medical records and chart abstraction by 
our study team, we will be able to obtain HIV related outcome data. If eligible, study staff 
will then contact the participant to schedule an interview. We will also directly contact and 
offer screening to patients in our clinic who meet the age criteria (aged 18-29), as long as 
the medical providers agree to the patients being directly approached at that time. The 
eligibility screening can be done in person, via phone or via an online survey. At other 
times, we will also pass out flyers and other promotional materials at events that may be 
likely to be frequented by YBMSM (e.g., Gay Pride festival), and we will consult with our 
YCAB for advice about such venues and events. We will also do on-site recruitment at the 
clinic and community venues/events, in which we will approach potential participants and 
ask if they are interested in completing an online screening survey for eligibility in our 
study. If yes, they will have the option to complete the survey on a tablet at that time. We 
will also use the snowball sampling method to recruit participants. After completing the 
intervention, we will distribute 5 flyers to each participant to distribute to people within 
their social networks as referrals to our program. These flyers will be marked with a 
number that is unique to each participant. If a potential participant contacts us through the 
referral method, they will provide the number marked on the flyer. These potential 
participants will then complete an online screening survey for eligibility in our study. 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
24 | P a g e
 
 
3.7 Consent Process: In order to screen potential participants for eligibility for the RCT, 
we will obtain online consent – this will be accompanied by a verbal consent discussion of 
the consent document if a staff member is present (e.g., at a community event or in the 
clinic), and will be online only if a participant is self-referring to the eligibility survey from 
a flyer or friend. For the RCT participants, we will obtain written consent. The consent form 
is attached and includes specific permission to access participants’ medical records           
for the purposes of abstracting the clinical outcomes (Appendix B). We are requesting a 
waiver of written consent for the IDI participants (YBMSM as well as key informants) as 
their signing of the consent form would be the only written record of participation and 
therefore could increase potential for breach of confidentiality. There is precedent for such 
waivers in our prior research; furthermore, federal regulations state that the IRB may waive 
the requirement for written consent if this will be the only record linking the subject and the 
research, and the principal risk would be potential harm resulting from a breach of 
confidentiality (45 CFR 46.117(c)). We will obtain verbal consent using the scripts  
attached to this application (Appendix A). YCAB members will not consent as they are not 
technically research participants, but rather advisors to the research process. 
 
3.8 Tokens of Appreciation: 
In Phase I, participants (whether YBMSM or key informants) will receive $50 cash or gift 
card for participating in in-depth interviews. Participants in the RCT will receive $25 
cash/gift card for the first intervention session and $50 for the second intervention session. 
Also, they will receive $25 for taking the social capital surveys at 4 months and 10 months 
after study completion ($150 total). The subset who participate in post hoc qualitative 
interviews will receive an additional $25 for that visit and therefore receive a total of $175 
over the course of 10 months participating in the study. Participants who refer up to 5 
potential participants to the study will receive $10 for each participant that enrolls in the 
study (Up to $30). Additionally, MARTA cards (valued at $5/round-trip) will be offered to 
all participants in all phases to enable them to get to the study sites and participate. 
 
4.1 
VARIABLES/INTERVENTION 
 
4.2 
Variables 
 
Table 2: Variables and Measures 
 
Method of 
Measurement
Number of 
items
Timeline 
Social Capital (Primary 
Outcome) 
Modified Social Capital 
Scale 
 
(based on Chen, et al.)16 
10 
Phase I: Analysis of 
previously collected 
data 
Phase 
III: 
RCT 
participants at 0, 1, 4 
and 10 months 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
25 | P a g e
 
 
 
Qualitative Interviews 
n/a 
Phase I: In-depth 
interviews with 
YBMSM living with 
HIV 
Phase III: Pre- and post- 
intervention interviews 
Engagement in HIV 
Care (Secondary 
Outcomes) 
 
 
 
Viral load suppression 
Electronic medical record 
abstraction 
n/a 
Phase III: RCT 
participants at baseline, 
post-intervention and 
10 months (if available; 
see page 17 for more 
detail) 
Retention in Care 
Electronic medical record 
abstraction 
n/a 
Phase III: RCT 
participants at 0 and 10 
months 
Antiretroviral adherence 
Single item self-report 52 
1 
Phase III: RCT 
participants at 0 and 10 
months 
Correlates (measuring 
other factors shown to 
relate to engagement in 
care among YBMSM in 
prior work) 
 
 
 
CD4 count (recent and 
nadir) 
Electronic medical record 
abstraction 
n/a 
Phase III: RCT 
participants at baseline 
and post-intervention 
10 months (if available; 
see page 17 for more 
detail) 
Demographics 
Survey questions 
23 
Phase III: RCT 
participants at 0, 1, 4 
and 10 months 
Depression 
CES-D53 
20 
Phase III: RCT 
participants at 0, 1, 4 
and 10 months 
HIV Stigma 
HIV Stigma Scale54 
10 
Phase III: RCT 
participants at 0, 1, 4 
and 10 months 
Ethnic Identity 
Multi-Ethnic Identity 
Measure55 
12 
Phase III: RCT 
participants at 0, 1, 4 
and 10 months 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
26 | P a g e
 
 
Gay Identity 
Internalized 
Homonegativity 
Inventory56 
23 
Phase III: RCT 
participants at 0, 1, 4 
and 10 months 
Drug Abuse 
CAGE-AID57 
4 
Phase III: RCT 
participants at 0, 1, 4 
and 10 months 
Social Support 
Zimet’s 
Multidimensional Social 
Support Scale58
12 
Phase III: RCT 
participants at 0, 4 and 
10 months 
Group Dynamics 
Selected items from 
Schulz, Israel and Lantz59 
20 
Phase III: RCT 
participants at 0, 1, 4 
and 10 months 
Social Networks 
Lubben Social Network 
Scale 
6 
Phase III: RCT 
participants at 0, 4 and 
10 months 
Engagement with Health 
Care Provider 
HCP Scale 
13 
Phase III: RCT 
participants at 0, 4 and 
10 months 
Identification and 
Involvement With the 
Gay Community 
Identification and 
Involvement With the 
Gay Community Scale
8 
Phase III: RCT 
participants at 0, 1, 4 
and 10 months 
General Wellbeing 
The General Well-Being 
Schedule (GWB) 
18 
Phase III: RCT 
participants at 0, 1, 4 
and 10 months 
Psychological Distress 
Brief Symptom Inventory 
53 
Phase III: RCT 
participants at 0, 4 and 
10 months 
 
Outcome Measures: The primary outcome measure will be social capital. The core measure of 
social capital that we will use is our Modified Social Capital Scale (MSCS) described above,  
which we developed and validated exclusively with YBMSM. Our aim is to discover whether 
social capital improves as a result of being in the social capital intervention, and also to see if there 
is any similar effect in the control arm. Secondary outcomes will be measures of HIV care 
engagement, namely: (1) Retention in care, (2) Adherence to medications, and (3) HIV viral load 
suppression. As per Institute of Medicine (IOM) recommendations, retention in care will be 
measured by determining, within the 10 months of the study period, (a) participation in continuous 
care, that is, at least two or more routine HIV visits at least three months apart, (b) receiving two or 
more CD4 tests, and (c) receiving two or more viral load tests.60 Adherence to antiretroviral 
medications will be measured using a composite of single item self-report question and pharmacy 
refill records. HIV viral suppression will be considered achieved if the medical records report a 
viral load below the level of detection for the site-specific assay. Viral load values and appointment 
attendance will be extracted from the participants’ EMR. 
 
4.3 
Intervention Content: As the details of the intervention will be influenced greatly by the 
formative research and the input of the YCAB, it cannot be described in full detail at this time. 
The main intervention delivery will consist of either a one day or a consecutive two day group 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
27 | P a g e
 
 
meeting among the YBMSM with time divided between health education and community 
photovoice project planning. Each group will contain ten YBMSM; we plan for six groups each in 
the control and intervention arms. As detailed above, the intervention will consist of a group-based 
curriculum in program planning and HIV education, culminating in the planning and 
implementation of a community photovoice project. 
 
4.4 
Outcomes: The primary outcome of interest for the RCT will be social capital, as we are 
aiming to determine whether or not our intervention is effective in increasing social capital. We 
will also look at engagement outcomes, to determine whether or not increasing social capital has 
an impact on care engagement in our participants. 
 
4.5 
Training for all study personnel: Dr. Hussen, her mentors and collaborators all have up 
to date training in research ethics that they will maintain throughout the duration of the study. The 
graduate research assistants, coordinators and public health program associate will also receive 
specific training related to their assigned tasks, including but not limited to qualitative 
interviewing, Research Electronic Data Capture (Redcap) survey administration, and qualitative 
coding and analysis. They will also, importantly, be trained in the process of obtaining informed 
consent. Dr. Hussen and the other co-investigators have experience training and supervising staff 
and research assistants in all of these skills. Where possible, we will hire staff and research 
assistants with prior experience and/or coursework that is pertinent to this work. 
 
4.6 
Procedures for implementing and documenting informed consent: As noted above, we 
have requested a waiver of written consent for participation in the formative Phase I research 
including in-depth interviews with young Black MSM, and in-depth interviews with key 
informants in the community. Verbal consent scripts are included in Appendix A. Written consent 
will be obtained for participants in the Phase III RCT. 
 
4.7 
Plan for monitoring the informed consent/assent/permission process: All study staff 
who have direct contact with participants will be trained in the process of both verbal and written 
consent administration by Dr. Hussen. This training will include instruction on the importance and 
critical elements of informed consent, as well as role-playing to demonstrate proper and improper 
consenting techniques. New research assistants will be supervised for at least the first three 
consents that they do in order to observe and provide feedback; once the trainer has determined 
that they are able to conduct the discussion independently, they will no longer be supervised. 
 
 
5.1 
DATA ANALYSIS AND MANAGEMENT 
5.2 
Data Analysis: We will be collecting both qualitative and quantitative data during the 
course of this survey. 
5.2.1 Quantitative analyses: Will be conducted using SAS or SPSS statistical software. An 
odds ratio plus the 95% confidence interval will be calculated to measure the degree of 
association between retention in care measures and total social capital (all analyses will 
also be computed for bonding/bridging subscales alone, as well as for item clusters 
focusing on different dimensions of social capital). Odds ratios will also be calculated to 
measure the degree of association between other risk factors (education, employment, age, 
depression, substance use, HIV stigma and CD4 cell count) and patient retention. 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
28 | P a g e
 
 
Additionally, total social capital will be compared between engaged and non-engaged 
patients using a two-sided two-sample t-test. Other potential risk factors will be compared 
between retained and non-retained patients using a chi-square test or Fisher’s exact test for 
categorical covariates and a two-sided two sample t-test for continuous covariates. 
Multivariable analyses: Covariates significant to at least P ≤ 0.20 in the univariable 
analyses will be used in multivariable logistic regression analyses. Although empirical 
techniques will be used to identify important covariates, theoretical expectations from our 
social capital conceptual framework will also augment these decisions. Interactions 
between covariates will be evaluated, either because suspicions are raised by clinical 
judgment before the analyses are performed or by statistical examination. Forward  
stepwise selection will be used if necessary to choose prognostic variables for a 
multivariable logistic regression model. The odds ratio and its 95%confidence interval will 
be calculated for each risk factor in the presence of others in the final model. 
 
5.2.2 Qualitative Data Analysis: All digitally recorded data will be transcribed verbatim by 
a professional business transcription service. Qualitative data will be de-identified during 
this transcription process. Transcripts will then be uploaded into the MaxQDa qualitative 
data management software (VERBI Software, Berlin, Germany) for further processing and 
analysis. We will conduct thematic analysis using a combination of inductive and deductive 
coding. In deductive coding, we will apply pre-determined codes from our            
theoretical model (e.g. collective efficacy) to segments of text that correspond to each 
theme. In inductive coding, we will elicit themes that emerge from the text but were not 
previously considered (for example, church community could come up as a recurring  
theme among several participants and be added to our code lists). Once the list of themes 
has been created, we will create a codebook listing the codes and strict definitions to 
delineate which passages should be labeled with a certain code. The two graduate research 
assistants (GRAs) will each code 5 transcripts in parallel to determine inter-coder 
reliability. If any significant disagreements arise in coding, the entire research team will 
discuss each discrepancy and come to a consensus in order to finalize the codebook. The 
GRAs will then split and code the remainder of the transcripts. This coding will facilitate 
further analysis of the transcripts by comparing cases and summarizing comments under 
each code across participants. 
 
Data collection: 
Phase 1- In-depth interviews with YBMSM and key informants: All interviews will take 
place in a private and quiet room within the IDP clinic or in the case of key informants, at 
the location of their choosing. Dr. Hussen has extensive experience conducting such 
interviews in the clinic for prior research studies and has found this location to be 
acceptable and comfortable for participants. Interviews will be conducted by a graduate 
research assistant who will be trained in qualitative methods and interviewing techniques. 
All interviews will be digitally recorded for subsequent professional transcription. Written 
informed consent will be obtained before beginning the interview. Interviews will be 
expected to last approximately 60-90 minutes each. All digitally recorded data will be 
transcribed verbatim by a professional business transcription service. Qualitative data will 
be de-identified during this transcription process. Transcripts will then be uploaded into the 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
29 | P a g e
 
 
MaxQDa qualitative data management software (VERBI Software, Berlin, Germany) for 
further processing and analysis. 
 
Phase 1- social capital surveys: this data was collected as part of our pilot work prior to 
the award period. It has already been de-identified and is ready for analysis. 
 
Phase 2 and 3-EMR extraction: Viral load values and appointment attendance data will be 
extracted from the participants’ electronic medical records (EMR) to determine retention 
and viral suppression outcomes. Clinical data will be entered directly into the Redcap 
database via a secure online form by graduate research assistants. This will be done at the 
baseline and 10 month time points. 
 
Phase 2 and 3-surveys: In addition to attending the intervention sessions, participants in 
both arms will be asked to come to the IDP clinic to participate in three study visits: One at 
baseline before starting the intervention (0 months), immediately after completing the 
intervention (around 1 month), 4 months, and a long term follow-up at 10 months after 
enrollment. The main purpose of these visits will be to complete a survey using the 
Research Electronic Data Capture (Redcap) online survey platform on an electronic tablet. 
The Redcap survey will contain our MSCS and will be used to measure change in social 
capital between the pre- and post-intervention periods. We will also verify the participants’ 
most recent medical care facility (since the last visit) and obtain the participants’ signatures 
on medical record release forms to facilitate abstraction of data on engagement outcomes. 
 
 
5.3 
Data Entry, Editing and Management: 
All survey and clinical data will be entered into a password protected, HIPAA compliant 
RedCap database. The database will be accessible only to the study team. Any subsequent 
datasets that are exported for analysis will be stripped of identifying information and will 
only be linked by a participant ID number. 
 
In terms of identifying discrepancies, some of this will be done prospectively by building 
quality checks into the Redcap data collection system—for example, if certain data do not 
line up between the baseline and follow up surveys (e.g. participant’s date of birth), 
participants will be prompted to re-enter their answers to that question. Once per month, 
data will be reviewed in more detail for potential errors. We will ask our biostatistician to 
conduct descriptive analyses in order to help us identify outliers and return to the original 
data source as needed to confirm outlying values. 
 
Qualitative interviews will be transcribed verbatim. Identifying information (names) will 
be taken out at the time of transcription. Files will be kept in a secured shared drive 
(Emory Box or equivalent) for access by study staff only. 
 
 
5.4 
Provisions for protecting privacy: 
Breach of privacy is a concern in this study as identifying information/personal health 
information will be collected as part of the data collection process. Additionally, efforts to 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
30 | P a g e
 
 
maximize retention will also include maintaining a database of participants’ phone numbers 
and email addresses. In order to minimize the risk of a privacy breach with any of        
these files, participants will be assigned a subject ID number which will be used to identify 
them in the database. Only one file will link the subject ID number to the participants’ 
medical record number, and all files will be password protected, kept on a secure server, 
and only accessible to the study team. Study files will be kept in password protected files 
within HIPAA compliant shared drive folders only (e.g. Emory Box). Any paper 
documents (such as signed informed consent forms) will be kept within a locked file 
cabinet in the PI’s locked office accessible only to key research staff. 
 
5.5. 
Information management and analysis software: 
Data will be collected and stored electronically using the RedCap (Research Electronic 
Data Capture) program. RedCap is a secure web application for building and managing 
online surveys and databases. It is compliant with the requirements of HIPAA and 
therefore ideal for the collection and storage of personal health information such as that 
which we will be collecting here. 
 
Software for data analysis will include statistical software (SAS, SPSS) as well as 
qualitative data management software (MaxQDa). We will de-identify all qualitative and 
quantitative datasets before beginning analyses and will only maintain the de-identified 
datasets once data collection is completed. 
 
5.6 
Quality control/assurance: 
All data will be collected by trained staff members. Dr. Hussen will assume primary 
responsibility for training and supervision of research staff administering the recruitment, 
informed consents, and Redcap online questionnaires. Staff will meet for weekly 
supervision with Dr. Hussen and her mentors to discuss research protocol and logistical 
issues, as a way to allow for discussions of adverse events and promote maintenance of 
study integrity. Data will also be checked periodically for consistency and quality, as 
described in the Data entry, editing and management section above. 
 
5.7 
Bias in data collection, measurement and analysis 
There is potential for bias in data collection, measurement and analysis in this study, which 
we will make every effort to curtail. Bias in data collection is the most likely to be a 
problem in our study. Selection bias in terms of our initial qualitative interviews (Phase I) 
and RCT participants could occur, as those YBMSM more interested in our project may 
already be likely to have higher levels of social capital and be more engaged in care. Given 
this concern, we propose to expand beyond recruiting at CBOs and in the clinic, and also 
recruit in more general community settings and online. In terms of measurement, our 
primary outcome will be measured using the MSCS, which has only had limited use in the 
YBMSM population. Although our preliminary analyses have shown good reliability in 
other YBMSM samples, it will be important to continue to examine the performance of  
this measure in this population. Finally, in terms of analysis, the qualitative analysis is 
prone to bias given the inherent subjectivity in qualitative research. In order to counteract 
this, we will utilize a team approach to qualitative coding and interpretation, and we will 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
31 | P a g e
 
 
undertake member checking with our YCAB to ensure that our interpretation of our 
qualitative data is consistent with their general experiences. 
 
5.8 
Intermediate reviews and analyses 
As this is not a clinical trial with potential for physical harm, it is unlikely that any interim 
analyses of efficacy (significant differences in social capital improvement between the two 
arms) would cause us to halt the trial prematurely (either for no benefit or significant 
benefit from the social capital intervention). However, there are other reasons to conduct 
interim reviews and analyses as the trial progresses; namely: to review comparability of the 
intervention and control arms, to review retention and participant accrual rates, and to 
review quality of the data. We will plan to review our enrollment data on a weekly basis; 
our project coordinator will generate reports of numbers enrolled and rate of completing 
follow-up visits and present them at our weekly team meeting. Our biostatistician will also 
generate summaries of our enrollment, retention, and baseline survey responses every 3 
months. Additional analyses may be undertaken for the purpose of presentation in national 
and international scientific meetings. 
 
5.9 
Limitations of study: 
There are several limitations to this study. Recruitment and retention have the potential to 
be challenging among YBMSM living with HIV. In terms of initial recruitment, subjects 
who are newly diagnosed or re-engaging in care may decline participation due to  
challenges coping with new information, denial and/or grief in response to their new 
diagnosis. Experienced personnel and dedicated coordinators will be used to maximize 
recruitment. We are also planning to recruit from a wide range of venues including the 
Grady IDP clinic and our partnering community-based organizations. If enrollment is still 
inadequate, which is unlikely, we also have relationships with other clinical sites in Atlanta 
that care for HIV-positive YBMSM aged 18-29 (the Emory Midtown Hospital HIV clinic, 
Atlanta Veterans Administration Hospital, Fulton County Health Department) and could 
look into expanding recruitment to those sites. 
 
 
5.10 
Identifying, managing, and reporting adverse events: 
Study staff will be instructed to notify the PI immediately via phone or pager if there is any 
adverse event, whether or not they perceive it to be related to study participation. The 
project coordinator will then take the responsibility of reporting to the Emory IRB within 
24-48 hours. Additionally, the project staff member who witnessed the event will complete 
an Adverse and Negative Events Form (Appendix H) that includes the date, a description  
of the event, duration, severity, actions taken to remedy the negative event (including 
professional referrals).Adverse events will also be reported to the CDC. 
 
5.10.1 Specific procedures for handling reports of psychological distress: 
There is a risk of uncovering information about psychological distress during the 
qualitative interviews, as questions about social support networks (or lack thereof) 
and coping with HIV can be sensitive topics for some. Prior to beginning the study, 
research staff will receive sensitivity training from mental health providers at the 
IDP clinic, in order to be knowledgeable of psychological occurrences that require 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
32 | P a g e
 
 
intervention by a mental health professional. Any assessment of a potential 
psychological emergency during the course of the trial will result in the patient 
being transported to the Crisis Intervention Service unit at Grady Hospital, a 24- 
hour psychiatric emergency service with the ability to evaluate and stabilize 
patients. If less emergent emotional distress is noted, staff will be equipped with 
pamphlets listing mental health resources in the community and will assist with 
referrals as needed. 
 
6.0 
DISSEMINATION, NOTIFICATION AND REPORTING OF RESULTS 
 
Dissemination of the results in the scientific and local community is a critically important part of 
this process. We plan a three pronged approach that includes: (1) Community meetings at the 
midway point and at the end of the project. At these meetings (which we also plan to stream as a 
webinar), we will invite community members to hear about the status of our project, to ask 
questions and to provide feedback on next steps. We will invite all of the key informants from 
Phase 1 to these meetings and enlist the help of the YCAB in advertising to the audience who 
would find it most relevant. (2) Scientific publications: We will publish interim and final results of 
each phase in peer-reviewed publications. Where possible, we will try to publish in open-access 
journals to facilitate dissemination to those outside of academic institutions. (3) Presentations at 
Scientific meetings: We will also present interim and final results at national and international 
meetings such as the American Public Health Association and International AIDS Society 
meetings. 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
33 | P a g e
 
 
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IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
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PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
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48 
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PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
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Appendix A: B6 Addendum 
 
A result of phase 1 was the development of Brothers Building Brothers By Breaking Barriers (B6), a two- 
day, 10-module group-level intervention. B6 does not focus exclusively on HIV, but rather takes a more 
holistic approach to supporting youth and developing resilience. The B6 intervention modules aim to 
develop resilience at the individual level (exploration of black gay identity, development of critical self- 
reflection and coping skills), social network level (exploring strategies for navigating family  
relationships) and community level (developing strategies for navigating clinical spaces and plans for 
community participation). Most intervention activities are interactive, in order to facilitate new social 
network connections (social capital) within intervention groups. In summary, our intensive CBPR 
approach resulted in a novel, culturally-specific intervention designed to enhance resilience by  
augmenting social capital among YB-GBMSM living with HIV. 
 
Based on the aforementioned qualitative content analyses, a condensed list of key programmatic 
recommendations was created for incorporation into the intervention (Table 1). Participants had favorable 
reactions to the idea of a social capital-based resilience intervention for YB-GBMSM living with HIV. 
The most commonly cited recommendation was to ensure that the intervention addressed the holistic 
health and well-being of the participants, and did not focus too narrowly on HIV-specific content. 
Participants also gave feedback about the manner in which the intervention should be delivered, citing the 
importance of balancing entertainment with the educational objectives. 
 
Table 1. Key Recommendations from Qualitative Interviews 
 
 
Content 
 Find a way to treat the whole person 
 Teach about finances, school, health, wellness 
 Empower participants with skills to get support they need 
 Raise awareness and pride about black gay culture and 
history 
 Address stigma, internalized homophobia 
 Find ways to create connectedness between YB-GBMSM 
 Refer participants to other resources as needed, particularly 
mental health 
 
Approach 
 Engage participants, make activities interactive and 
entertaining 
 Group discussions 
 Be nonjudgmental, sex positive, don’t try to change people 
 Consider judicious use of social media 
 Meet participants where they are in terms of interest in HIV 
care engagement 

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
37 | P a g e
 
 
Using a process informed by Intervention Mapping, which is a planning approach that combines theory 
and evidence as the foundation for taking an ecological approach to assessing and intervening in health 
problems and engendering community participation (Eldredge, L. K. B., Markham, C. M., Ruiter, R. A., 
Kok, G., & Parcel, G. S. (2016). Planning health promotion programs: an intervention mapping approach. 
John Wiley & Sons.), we combined the qualitative findings, theoretical constructs and YCAB input to 
develop an intervention outline focused on the following overarching goals: (1) exploration of one’s self 
and identities; (2) building bonding capital; (3) building bridging capital; and (4) sustaining connections. 
We used an Intervention Mapping- informed process to align the theoretical constructs of social capital 
and the feedback from the qualitative findings with specific intervention components and activities. Table 
2 displays the intervention content and the learning goals and objectives for each of the 10 modules of the 
intervention. 
 
Table 2. Intervention Course Agenda 
 
Day 1 
Session 1 
Welcome to B6 
Module 1: Set the Stage 
Welcome/Introductions 
Brotherhood Agreement 
Brother Bingo
Module 2: Who’s on your team? 
Social Capital Presentation (together we have 
more) 
Bound By Barriers 
Session 2 
Building Myself 
Module 3: Who am I? 
Worth a Thousand Words 
On the Flip Side 
Affirmation Activity
Module 4: Communicating my Needs 
Love Languages 
Assertive 
Communication (Passive/Aggressive)* 
Module 5: Critical Reflection/Problem 
Solving 
Critical Reflection: What? So What? Now 
What?* 
What would you do? 
Session 3 
Building Bridges 
Module 6: Breaking Barriers: Relationships 
Who you gonna Call? 
Acting Out 
B6 Trivia Review 
Closing
 
Day 2 
Session 3 Continued 
Building Bridges 
Module 7: Breaking Barriers: Professional 
Settings 
Welcome Back! 
Work/School Life (Critical Reflection/Problem 
Solving) 
Rep Your Clinic 
Session 4 
Building Bonds

PI: Sophia Hussen MD, MPH 
IRB 00088255 
Assistant Professor, Emory University
shussen@emory.edu 
38 | P a g e
 
 
Module 8: Black Gay Community 
What is Black Gay Community? 
Role Models/Heroes 
Jeopardy
Session 5 
Staying Connected 
Module 9: Connecting the Dots 
Goal Setting * 
Using my Social Capital (Support Web) 
Building the Other Brother 
Module 10: My Social Capital 
30 Day Challenge 
So I know it’s real 
Conclusion