A Bilingual HIV Status-Neutral Intervention to Promote Heath Equity among GBQMSM and Transgender and Nonbinary Persons in Appalachia: Outcomes from the Appalachian Access Project Intervention Trial

We tested the Appalachian Access Project, a bilingual, HIV status-neutral, social network, peer navigation, and mHealth intervention aimed at increasing use of HIV, STI, hepatitis C virus, and mpox prevention and care services among gay, bisexual, queer, and other men who have sex with men (GBQMSM) and transgender and nonbinary persons in Appalachia. The intervention also aimed to support use of medically supervised gender-affirming hormone therapy among participants desiring such care. Trial participants were recruited and randomized by social network to the intervention (n = 7 networks including 56 individuals) or delayed-intervention waitlist control group (n = 7 networks including 57 individuals). At follow-up, relative to control participants, intervention participants reported slight, but nonsignificant, increases in an HIV status-neutral service-use outcome, PrEP use, and HIV testing; and significant increases in HIV and STI knowledge. This intervention provides a foundation for future initiatives to reduce disparities in rural Appalachia; further research with larger sample sizes is warranted.