Prioritizing Flexibility, Human Connection, and Representation: Findings from the Qualitative Process Evaluation of the Special Projects of National Significance Black Men Who Have Sex with Men Initiative.

Previous research has identified significant unmet need for behavioral health care services for Black men who have sex with men (Black MSM); this challenge has been linked to poorer overall health and well-being. Health Resources and Services Administration (HRSA) funded a Special Projects of National Significance (SPNS) Initiative, Implementation of Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black Men who have Sex with Men, with a goal to integrate behavioral health and clinical care services using four different evidence-informed models of care, ultimately improving HIV health outcomes. NORC at the University of Chicago conducted a multisite evaluation to assess the success of this Initiative, including a qualitative process evaluation that examined adaptations, services, integration activities, recruitment methods, and fidelity. The process evaluation described methods and processes used by demonstration sites to achieve their goals. This included challenges or barriers to implementation and the associated adaptations, notably due to the COVID-19 Public Health Emergency. Our study found key themes that indicated successful implementation were flexible service delivery, human connection, and client representation. We recommend future replicators apply these lessons learned in diverse health care and community settings that serve Black MSM. Additional information about the interventions can be found on TargetHIV.

Evaluating Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes: Quantitative Findings from the Ryan White HIV/AIDS Program Special Projects of National Significance Black Men Who Have Sex with Men Initiative.

The Black Men who have Sex with Men (MSM) Initiative was implemented at eight sites to engage and retain Black MSM in HIV medical care and supportive services (SS) by addressing their behavioral health (BH) care needs. Using a pre-post design and generalized logistic mixed-effects models adjusting for patient-level random effects, site, baseline age, and baseline mental health status, we evaluated whether participants experienced increased postintervention attainment of (1) Awareness of HIV medical care, BH care, and SS; (2) Screening, referral, linkage, receipt, and engagement in HIV care, BH care, and SS; and (3) Retention, antiretroviral therapy prescription, and suppressed viral load. Among 758 evaluated participants, the proportion of participants who were aware of, screened for, screened positive for, and referred to BH and SS, retention in care (72% to 79%), and viral load suppression (68% to 75%) increased between baseline and postintervention. Among participants who screened positive and received BH services were statistically more likely to be linked to [OR, 1.34 (95% CI: 1.08-1.66)] and retained in [OR, 1.36 (95% CI: 1.00-1.83)] care. Among those who screened positive and received SS were statistically more likely to be retained in care [OR, 1.54 (95% CI: 1.07-2.22)]. Measures of linkage to care declined significantly during the study period, perhaps because of COVID-19 that delayed in-person care. This study suggests that interventions designed to increase utilization of BH services and SS can be effective at improving retention in care and viral load suppression among Black MSM, at least among those currently using HIV services.

School environments and obesity: The mediating role of personal stress.

BACKGROUND: Youth spend a large amount of time in the school environment. Given the multiple influences of teachers, peers, and food and physical activity options, youth are likely to experience stressors that can influence their weight. This study examines the association between school climate and weight status. METHOD: Students (n = 28,582; 58 schools) completed an online, anonymous school climate survey as part of the Maryland Safe and Supportive Schools Project. Multilevel structural equation modeling was used to explore the association between school climate, personal stress, and obesity. Analyses were stratified by gender. RESULTS: At the individual level, poor school climate (bullying, physical safety, and lack of whole-school connectedness) was associated with an increased likelihood of being overweight among females (ß =.115, p = .019) but not males (ß = .138; p =.244), after controlling for age, race, and physical activity. There was no association between school climate at the school level and being overweight among males or females. A second model included stress as a potential mediator; stress attenuated the relationship between poor school-related climate and being overweight (ß = .039; p = .048) among females. CONCLUSION: Findings suggest that stress related to school climate can play a role in the health and weight status of youth.